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30 Cards in this Set
- Front
- Back
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what are the two common cognitive disorders
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Dementia and delirium
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Delirium
what is it hallmark symptoms |
is not a disease it is a snydrome
disturbance in consciousness by changes in cognition |
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what are the key findings of delirium
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disturbance in level of consciousness that fluctuates over the course of the day
sleep-wake disturbance (may be reversed) psychomotor agitation |
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what is the illness course of delirium
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hours to days
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what exam findings do you see with delirium
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tremors
incoordination urinary incontinence myoclonus nystagmus asterixis (flapping of the wrists) increased muscle tone and reflexdysnomia |
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MSE- delirium
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rambling, incoherent, slurred speech
dysarthria-words-objects dysgraphia-writing |
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pharmacological treatment of delirium
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symptomatic
antipsychotic anxiolytics haldol, ativan and risperdal used commonly |
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dementia is
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a group of disorders that characterize the development of multiple cognitive deficits
impaired executive funciton global intellect and preservation of level of consciousness problem solving organizational skills altered memory |
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What are the most common types of dementia (7)
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Alzheimer's
vascular HIB Pick's Creutzfeld-Jacob disease Huntingtons Lewy Body |
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Alzheimer's is
most ___ type? ___onset and progressive decline with OUT ___ ____ deficits hallmark are ____ deposits and _____ tangles. |
most common type
gradual onset, no focal neurological deficits amyloid deposits, neurofibrillary tangles |
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Vascular dementia
___ most common type? caused by mostly____ and characterized by ___-___ declines most common in ___ with pre-existing ____ and ___ risk factors Hallmark are ___ ____, ____ _____ and ____ ____ ____ |
second
cardiovascular, step-type men, HTN and cardiovascular risk factors carotid bruit, fundoscopic abnormalities, enlarged cardiac chambers |
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HIV dementia
classified as a ______ dementia Parenchymal abnormalities visualized on ____scan Manifests by ___, ___ and ___ Co-occuring with (5) psychiatric disorders development of dementia in HIV is a indicator of ___ prognosis and death occurs within ____ months psychotic symptoms occur at what stage of infections |
subcortical dementia
MRI progressive cognitive decline, motor abnormalities, behavioral abnormalities OCD, PTSD, GAD, depression and mania poor, 6 months late |
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the clinical signs of LATE stage HIV related dementia include cognitive, motor, behavioral and affective impairment (7)
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global cognitive impairment
mutism seizures hallucinations delusions apathy mania |
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what do you have to be aware of when prescribing protease inhibitors to HIV people (what one med and 2 classes)
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welllbutrin, SSRI, benzo
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what does protease inhibitors do to the metabolism causing subtherapeutic levels in which two drugs
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depakote and ativan
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Pick's disease
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neuronal loss, gliosis, Pick's bodies present
personality and behavioral change in EARLY stage cognitive changes LATER IF Kluver Bucy syndrome - hypersexual, hyperorality, placidy |
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Creutzfeld Jacob disease
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fatal and rapid
occurs in adults and middle age or older initial flu-symptoms, fatigue and cognitive impairment LATER-aphasia, aprexia, emotional lability, depression, mania, psychosis, dementia death in 6 months |
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Huntingtons disease
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Subcortical dementia
characterized by mostly motor abnormalities psychomotor slowing and difficulty with complex tasks memory, language, and insight are usually intact until late stage high incidence of depression and psychosis |
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Lewy body disease
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lewy inclusion body in cortex
hallucinations, Parkinsonian features, EPS reacts BAD to antipsychotics |
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etiology of dementia
decreased___ and ____ in DAT Genes __, __ and __ with a history of DAT autosomial ___ trait |
ACh and norephinephrine
1.14, 21 DOMINANT |
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duration of illness
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8-10 years
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what instruments are used for assessing level of impairment
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Mini-mental state exam MMSE
short portable mental status questionnaire blessed dementia rating scale |
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what are the physical exam findings in dementia
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unilateral vision loss "curtain over eye
unilateral focal motor weakness asymmetrical reflexes |
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how is the speech in dementia
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deterioration of language skills
aphasia circumlocutory phrases indefinite object recognition |
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why is N-methyl D-Aspartate Glutamate Receptor Antagonists used
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to prevent over-excitation of glutamate receptors and stabilize the neurodegenerative process
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Memantine (Namenda)
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may slow the degenerative process
promotes synaptic plasticity may be used with cholinesterase inhibitors |
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what are cholinesterase inhibitors used for
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mild to moderate Alzheimers
modest clinical improvement treat only symptoms, slow loss of function and may improve agitated behavior do not prevent pathological progression of disease not effective in end stage disease |
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what are the three cholinesterase inhibitors
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Donepezil (Aricept 5-10mg)
now first line best with mild symptoms may elevate LFTs Rivastigmine tartrate (Exelon 1.5-6 mg bid) best for moderate symptoms Tacine (Cognex 40-160mg) may elevate LFTs and cause liver toxicity so monitor MANY drug interactions |
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What do you do or how do you treat psychosis and agitation in dementia
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try non-pharmacological therapies first
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when do you use antipsychotic agents regularly
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agitation and psychotic symptoms
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