Dementia, Delirium, Amnesia - Barbely

Front 1

Delirium is an indepedent marker for ______ 1 yr after hospitalization

Back 1

Mortality

Front 2

3 C's of delirium criteria

Back 2

- Consciousness disturbance
- Cognition change
- Course is abrupt

Front 3

Reduced consciousness in delrium resers to dec _____ of awareness of environment

Back 3

clarity

Front 4

Only ___% routinely screen for delirium

Back 4

40%

Front 5

Tx for delirium (3)

Back 5

- Haldol (#1)
- Ativan
- Atypicals

Front 6

Delrium pathophysiolgy = dec ____ and inc ____

Back 6

Dec Ach and inc dopamine

Front 7

Study: dopamine use in ICU tripled risk for ____ use

Back 7

Haldol

Front 8

Study: showed disordered _____ in surgery pats who developed delirium (sleep wake cycle imp)

Back 8

Disordered melatonin

Front 9

Elderly and those with dementia at inc risk for ______

Back 9

Delirium

Front 10

4 etiologies of delirium

Back 10

- structural
- infectious
- metabolic
- iatrogenic

Front 11

Structural etiologies of delirium (3)

Back 11

- Stroke
- Intracranial lesion
- Subdural Hematoma

Front 12

Most common cause of infectious delirium in elderly

Back 12

Urosepsis

Front 13

Causes of infectious delrium (3)

Back 13

- Urosepsis
- Pneumonia
- CNS infections (esp AIDS defining)

Front 14

Causes of metabolic delirium (8)

Back 14

- inc/dec Na
- inc/dec CO2
- inc/dec Ca
- inc/dec glucose
- dec O2
- Hypoperfusion
- ETOH withdraw

Front 15

Iatrogenic cause of delirium

Back 15

Medications

Front 16

Assessment of delirium for ventilated patients

Back 16

CAM-ICU

Front 17

Alz mutation
______ gene on chrom 21

Back 17

APP

(all with downs get alz if live past 40)

Front 18

Alz mutation
_______ gene on chrom 14

Back 18

Presenilin 1

Front 19

Alz mutation
________ gene on chromosome 1

Back 19

Presenilin 2

Front 20

Alz mutation
_____ of APOE on chrom 19

Back 20

E4 polymorphism

Front 21

Risk factors in ICU for delirium (5)

Back 21

- HTN
- Smoking hx
- Bilirubin level
- Morphine and Ativan use
- Rooms w/o windows

Front 22

Delirium in ventilated pts = ______ inc risk of death

Back 22

3x

Front 23

4 principles of treating delirium

Back 23

- Tx underlying condition
- Avoid causal factors
- Prevent further decline
- Control aggressive behaviors

Front 24

Primary tx for delirium
- No studies support but still used
- Low dose preferred

Back 24

Haldol

Front 25

Only used to tx delirium from alcohol withdraw

--> amnestic so add to memory issue

Back 25

BZ's

Front 26

Use of ________ to tx delrium benefits:
- Less EPS
- Less QT prolongation

Back 26

Atypical antipsychotics

Front 27

Atypical antipsychotics shown to be as effective as Haldol in treating delirium (2)

Back 27

Zyprexa
Risperidol

Front 28

Delirium affect on consciousness

Back 28

Decreased or Hyper alert

Front 29

Dementia affect on consciousness

Back 29

Alert

Front 30

Delirium affect on Orientation

Back 30

Disorganized

Front 31

Dementia affect on orientation

Back 31

disoriented

Front 32

Delrium course

Back 32

Fluctuating

Front 33

Dementia course

Back 33

Steady slow decline

Front 34

Delirium attn

Back 34

Impaired

Front 35

Dementia attn

Back 35

Normal

Front 36

Delirium psychomotor

Back 36

Agitated or lethargic

Front 37

Dementia psychomotor

Back 37

Normal

Front 38

Delirium halluncinations

Back 38

Perceptual disturbances

Front 39

Dementia hallucinations

Back 39

Not present

Front 40

Sleep wake cycle of delrium

Back 40

Not normal

Front 41

Sleep wake cycle of dementia

Back 41

Normal

Front 42

Speech of delirium

Back 42

Slow, incoherent

Front 43

Speech of dementia (2)

Back 43

- Aphasic, anomic
- Difficulty finding words

Front 44

#1 cause of degenerative demetia

Back 44

Alz

Front 45

Degenerative Dementia (6)

Back 45

- Alz
- Vascular dz
- Lewy Body
- PD
- Frontotemporal (Picks)
- Huntington's Dz

Front 46

Inherited Metabolic Dementias (3)

Back 46

- Wilson Dz
- Adrenoleukodystrophy
- Gaucher Dz

Front 47

Causes inherited metabolic dementia
- Aut rec
- Copper deposits in liver and basal ganglia
- Kaiser-Fleisher rings = brown around iris
- Dec ceruloplasmin = binds Cu

Back 47

Wilson Dz

Front 48

Causes inherited metabolic dementia
- X linked, M
- FA's deposited in CNS, adrenal, testes

Back 48

Adrenoleukodystrophy

Front 49

Causes inherited metabolic dementia
- Glucocerbrosidase enzyme deficiency
- Lysosomal packing disorder
- Lipid in spleen, liver, kidney, CNS, lung

Back 49

Gaucher's Dz

Front 50

Toxic Metabolite causes of dementia (potentially reversible (4)

Back 50

- Wernicke-Korsakoff
- B12 def
- Hypothyroidism
- Hypercalcemia

Front 51

Toxic metabolite that causes dementia --> from paraneoplastic or small cell lung cancer, etc

Back 51

Hypercalcemia

Front 52

Toxic metabolite cause of dementia --> Hasimotos = #1 cause

Back 52

Hypothyroidism

Front 53

Pernicious anemia =

Back 53

B12 deficiency

Front 54

Metabolite needed for glial and neuronal cells --> esp diencephalon and mammilary bodies

Back 54

B12 deficiency

Front 55

Metabolite cause of dementia
- From alcohol and thiamine def
- ataxia, 20% mortality

Back 55

Wernicke

Front 56

Metabolite cause of dementia
- Dec thiamine prolonged
- probs with periaqueductal gray, mamillary bodies, diencephalon
- hole in memory --> fabrications

Back 56

Korsakoff

Front 57

Infectious causes of dementia (2)

Back 57

- HIV
- Prion dz's

Front 58

Prion dz's that cause infectious dementia (3)

Back 58

- Creutzfeld Jakob Dz
- Gerstmann Straussler-Schneiker
- Fatal Familial Insomnia

Front 59

First sx of alzheimers =

Back 59

Loss of newly acquired info

Front 60

Sx's in up to 20% of Alz pts (2)

Back 60

- Delusions
- Hallucinations

Front 61

Alz dz is confirmed only by ______

Back 61

Autopsy

Front 62

EEG findings of Alz = ____________-

Back 62

Generalized slowing

Front 63

Neuroimaging of alz (4)

Back 63

- Dilated lateral ventricles
- Widened sulci
- Atrophy
- Hypometabolsim of Temporal and Parietal Lobes

Front 64

Earliest cell loss in Alz is in ________

Back 64

Entorhinal area

Front 65

Alz dz
- Have cell loss in basal nucleus of ______

Back 65

Meynert

Front 66

Alz dz
- Have senile plaques (________)

Back 66

Beta amyloid

Front 67

Alz dz
- _____ protein cause neurofibrillary tangles

Back 67

Tau

Front 68

Tx of Alz (2)

Back 68

- Acetylcholinesterase inhibitors
- MAO inhibitors (Selegiline)

Front 69

2nd leading cause of dementia

Back 69

Vascular dementia

Front 70

Dementia in 15-20% of pts over 60 with ________

Back 70

Ischemic CVA

Front 71

Risk of vascular dementia incs ___% per year after age 60 with ischemic CVA

Back 71

5%

Front 72

Vascular dementia can cause ____ and ____ syndromes

Back 72

Cortical and subcortical

(subcortical = localized --> alz only has cortical)

Front 73

3 distinct neuropathic changes in dementia of PD

Back 73

- Alz dz changes
- Lewy bodies (cortical and subcortical)
- Primary nigral degeneration

Front 74

- Parkinsons - like
- Rapid cognitive decline
- Visual hallucinations
- Sensitivity to neuroleptics (D2 blockers)

Back 74

Lewy Body Dementia

Front 75

Frontotemporal dementia = mutation on chromosome ____

Back 75

17 (tau gene)

Front 76

Frontotemporal demetnia = mutation on ____ gene

Back 76

Tau

Front 77

Initial presentation of frontotemporal dementia

Back 77

Personality change

Front 78

Demetia kind
- personality change
- speech prob
- inattentiveness
- extrapyramidal signs

Back 78

Frontotemporal dementia

Front 79

Dementia kind
- Atrophy of frontal and temporal poles
- Deterioration of memory and executive fx

Back 79

Frontotemporal Dementia

Front 80

A type of frontotemporal dementia

Back 80

Pick disease

Front 81

Intraneuronal inclusions in a type or frontotemporal dementia

Back 81

Pick bodies

Front 82

Trinucleotide repeates = CAG
- aut dominant

Back 82

Huntington Dz

Front 83

Dementia
- Choreic movements (invol --> proximal, distal, axial)
- Personality change

Back 83

Huntington Dz

Front 84

If known Huntington Dz, get earlier sx's from genetic phenomenon known as _______

Back 84

Anticipation

Front 85

Prion related dz
- Protein infectious agent
- no DNA or RNA present

Back 85

Creutzfeld Jakob Dz

Front 86

3 characteristics of Creutzfeld Jakob Dz

Back 86

- Myoclonus
- Periodic EEG complexes (sharp waves)
- Dementia

Front 87

Dementia type
- Apathy
- Memory loss
- Cognitive slowing
- Frontotemporal atrophy
- Giant cells
- Microglial nodules
- Perivascular infiltrates

Back 87

HIV Dementia Complex

Front 88

"Reversible" Dementias (6)

Back 88

- B12/Folate def
- Lyme dz (Neuroborreliosis)
- Neurosyphilis
- Normal Pressure Hydrocephalus
- Hypothyroidism
- Depression (pseudodementia)

Front 89

Reversible Dementia
- magenetic gait --> feet look magnetized to floor when walk
- Clogged arachnoid vestibules --> no resorption CSF

Back 89

Normal Pressure Hydrocephalus

Front 90

Memory loss with preserved intellect (memory loss alone is not dementia)

Back 90

Amnestic Disorders

Front 91

Associated with injury/dysfx of
- Hippocampus
- Limbic System

Back 91

Amnestic Disorders

Front 92

Amnestic Disorders can be (2)

Back 92

- Transient
- Permanent

Front 93

Transient Amnestic Disorders (6)

Back 93

- Alcohol related (blackout or wenicke-korsakoff)
- Concussion
- Meds
- Partial complex seizure
- Ischemia --> transient global amnesia
- ECT (electroconvulsive therapy)

Front 94

Permanent amnestic disorders (5)

Back 94

- Wernicke-Korsakoff
- Herpes encephalitis
- Contusion head trauma
- Kluver Bucy syndrome
- Pareneoplastic limbic encephalitis

Front 95

Cancer that causes paraneoplastic encephalitis --> permanent amnesia

Back 95

Small cell cancer of lung