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22 Cards in this Set
- Front
- Back
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What are the 4 significant impairments in cognitive disorders
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memory
judgement language attention |
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Delirium is characterized by
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short-term confusion and changes LOC
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what are the four subcategories based on several causes of delirium
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substance induced
general medical condition (infection) multiple etiologies (head trauma, disease) Delirium NOS (sleep deprivation) |
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What is dementia, and what two things are normal?
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marked by severe impairment in memory, judgement and orientation despite a NORMAL level of alertness and arousal.
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what are the six subcategories of dementia
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Alzheimers type (progressive intellectual deterioration)
vascular dementia other medical conditions such as AIDS or head trauma substance induced (toxin or med) multiple eitiologies NOS |
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What are amnesic disorders
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memory loss without cognitive impairment
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In the Clinical examination- what type exam do you look for in a physical exam
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neuro exam
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during the MSE
carefully evaluate |
cognition
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what are non-specific signs of brain dysfunction
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intellectual, memory and cognitive impairment
(pause in thought, lack of intellectual ability, perservation, poor judgement) Alterations in LOC Change in personality disinhibition poverty of speech visual hallucinations prominant MOOD may initially be depressed, anxious, labile but may progress to apathy affect, shallow, and flat |
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What clinical evaluation will you perform as a screening assessment of cognition
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orientation to time and place and person
calculation- subtract from 7 remember the names of a few objects from a few minutes ago language, repetition of words, writing a sentence abstraction- interpret a proverb visuospatial copying a design |
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what labs would you get
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CBC
electrolytes RBC folate THY drug screen liver enzymes |
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what other testing would you do for dementia?
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psychological testing
skull xray, EEG, CT, MRI, lumbar puncture, brain scan and angiography |
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what is the hallmark symptom of delirium (definition)
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impairment of consciousness, usually accompanied by global impairments of cognitive functions, associated with emotional lability, hallucinations or illusions, inappropriate, impulsive, irrational, violent behavior
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WHAT are the KEY features or S/S of delirium
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altered consciousness with hyperarousal or hypoarousal with agitation or apathy
disorientation memory impairment illogical speech perceptual disturbance (auditory, visual and tactile hallucinations) SEVER emotional lability REVERSED sleep wake cycle or fragmented sleep associated Neuro symptoms- incoordination, dysphagia, tremor, asterixis, ataxia and apraxia |
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What is the differential diagnosis for delirium vs. dementia
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Changes in dementia are more stable over time and do not fluctuate over the course of the day.
dementia pts are more alert delerium are more clouded |
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There is a ___ month mortality rate of __% and __% in patients who have an episode of delirium
___ year mortality rate of ___% |
3 month 23-33%
1 year 50% |
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treatment of delirium
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PRIMARY goal is to identify and treat the underlying cause, correct the metabolic abnormalities, ensure proper hydration, electrolyte balance and nutrition. Basically identify the cause
LOW doses of high potency antipsychotics may be used for agitation (2-5mg haldol) Benzos for agitation rare intractable cases, ECT |
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what is the definition of dementia
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decrease in cognition in the setting of a stable level of consciousness
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what are the effected functions in someone with dementia
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intelligence
language problem solving memory learning orientation perception attention judgement concentration social abilities |
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what are the signs and symptoms of dementia
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major deficits in
orientation memory perception intellectual functioning and reasoning marked changes in personality, affect, and behavior commonly associated with hallucinations 20-30% of patients and delusions in 30-40% of patients symptoms of depression are present in 40-50% of patients with dementia |
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what is the diagnostic criteria for dementia due to "other medical condition" such as head trauma, HIV, Huntingtons disease, Picks disease
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1) memory impairment
2) one or more of the following aphasia- language disturbance apraxia- impaired ability to carry out motor activities despite good motor function) agnosia- failure to recognize or identify objects even if good sensory function) disturbance in executive functioning (planning, organizing, sequencing, abstracting) |
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what is included in a thorough workup of dementia
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physical exam and neuro exam
VS MSE review of meds and med levels Blood and urine screen Blood work electrolytes liver and renal function SMA-12 or chem profile urinalysis CBC with diff TSH RPR FTA-ABS if CNS disease expected B12 folate levels urine corticosteriods ESR ANA Arterial blood gas HIV Urine pophobilinogens chest radiograph EKG CT MRI SPECT lumbar puncture EEG neuropsych testing |
