Mind: Delirium And Dementia

Front 1

What is this?

Rapid onset of fluctuating global confusion with disturbances of attention, sleep and activity vary from extreme lethargy to hyperactivity.

Back 1

delirium

Front 2

What kind of hallucination may people with delirium experience? (visual or auditory)?

Back 2

Visual.

*Auditory hallucinations are associated with schizophrenia or other mood disorders.

Front 3

What are the four most important yet often missed symptom descriptions of delirium?

Back 3

- confusion
- sudden onset
- inattention
- fluctuating course

Front 4

What criteria would make the diagnosis of delirium? (4)

Back 4

1. acute onset, fluctuating course of mental status change
2. Inattention
3. Disorganized thinking
4. altered level of consciousness

Diagnosis requires 1 and 2 with either 3 or 4

Front 5

What are some causes of delirium? (5)

Back 5

1. Drugs
2. alcohol
3. infections
4. metabolic disorders
5. CV disorders

Front 6

What drugs would cause delirium? (8)

Back 6

1. sedatives/hypnotics
2. benzodiazepines
3. anticholinergics
4. antidepressants
5. antiparkinsonian agents
6. analgesics: opioids
7. Digitalis preparations
8. steroids

Front 7

What kind of cardiovascular diseases would cause delirium?

Back 7

MI
subacute bacterial endocarditis
dysrhythmias
hypertensive encephalopathy
Stroke/ TIA
subdural hematoma
cerebral vasculitis

Front 8

What are some common infections that would cause delirium?

Back 8

- septicemia
- pneumonia
- UTI: sometimes may not be real UTI, maybe poor hygiene or old age.
- systemic viruses

Front 9

Which of the following is the most common cause of delirium?
A. Drugs
B. Infections
C. Degenerative diseases
D. Metabolic disorders
E. Cardiovascular diseases

Back 9

A.

Front 10

A patient who has functioning well cognitively, but quickly develops problems of intellectual functioning or attention. It is ____ until proved otherwise.

Back 10

Delirium.

1. make syndrome diagnosis
2. make etiological diagnosis: history, PE, labs...
3. treat causative disease
4. treat symptoms.

Front 11

Which type of intelligence is better in the elderly population? (fluid or crystallized)

Back 11

crystallized intelligence: access to material gained from experience.

Front 12

Does this require medical attention?

Slower learning, vulnerable to distraction.

Back 12

No. Normal aging, short-term memory is more vulnerable to distraction.

Front 13

Does this require medical attention?

confusion, disorientation.

Back 13

Yes. These represent pathology that demands clinical attention.

Front 14

Does this require medical attention?

emotional and behavioral symptoms of memory impairment.

Back 14

Yes. These represent pathology that demands clinical attention.

Front 15

List some symptoms associated with memory that require medical attention.

Back 15

- confusion
- disorientation
- emotional and behavioral symptoms

Front 16

Which drugs should you used to calm extremely agitated delirious patients?

Back 16

Low dosage antipsychotics:
haloperidol
risperidone

Front 17

What is this?

Acquired impairment of cognitive capacity in areas of memory, logical thinking, abstraction, and other aspects of higher cortical functioning.

Back 17

Dementia

Front 18

Is development of dementia always insidious?

Back 18

Yes.

Front 19

What is this?

Memory loss
aphasia
apraxia
agnosia
disturbance in planning, organizing, sequencing, abstraction

Back 19

Dementia

Front 20

Is level of consciousness impaired in patients with dementia?

Back 20

No.

Front 21

Delirium may coexist with dementia. Can you make diagnosis of dementia in a delirious patient?

Back 21

No.

Front 22

What is pseudodementia?

Back 22

A syndrome in which features of dementia are mimicked by functional disturbances.

It is not dementia and it often accompanies depression, also in schizophrenia, mania. And it is treatable.

Front 23

Delirium or dementia?

symptom develop abruptly.

Back 23

delirium.

Front 24

Delirium or dementia?

symptom develop insidiously.

Back 24

dementia

Front 25

Delirium or dementia?

impaired attention.

Back 25

delirium or advanced stage dementia.

Front 26

Delirium or dementia?

fluctuating consiousness.

Back 26

delirium or advances stages of dementia.

Front 27

Delirium or dementia?

incoherent speech.

Back 27

delirium.

Front 28

Attention and wakefulness are always preserved in _____. (delirium or dementia)

Back 28

dementia

Front 29

Depression or dementia?

clear onset, rapid progression.

Back 29

depression

Front 30

Depression or dementia?

insidious onset, slow progression.

Back 30

dementia

Front 31

Depression or dementia?

exaggerate deficits.

Back 31

depression

Front 32

Depression or dementia?

minimize deficits.

Back 32

dementia

Front 33

Depression or dementia?

variable performance.

Back 33

depression

Front 34

Depression or dementia?

consistent performance

Back 34

dementia

Front 35

Depression or dementia?

little effort.

Back 35

depression

Front 36

Depression or dementia?

struggle to perform.

Back 36

dementia

Front 37

What is the most common cause of dementia?

Back 37

Primary degenerative diseases: 50%.

Front 38

Is dementia a syndrome or diagnosis?

Back 38

Syndrome. Still need to figure out the etiology!

Front 39

What do you test in a cognitive exam?

Back 39

1. Sensorium
- orientation: year, month, day, city
- memory: 3 word test
- cognitive capacity: calculation

2. Intellectual functioning

Front 40

What are some criteria for diagnosis of a probable Alzheimer's disease?

Back 40

- deficits in at least 2 areas of cognition
- progressive worsening of cognition
- no disturbance of consciousness
- between age 40-90, usually after 65
- absence of other disease that could account for these deficits.

Front 41

What are the 7 stages of Alzheimer's disease?

Back 41

1. normal
2. very mild: forgetfulness
3. mild: early confusional
4. moderate: late confusional
5. moderately severe: early dementia
6. severe: middle demetia
7. very severe: late demetia

Front 42

Stages of Alzheimer's disease

Cannot survive without assistance
Cannot recall major aspects of current life
Disoriented

Back 42

Early dementia (5)

Front 43

Stages of Alzheimer's disease

unaware of all events
severely disoriented
may become delusional, agitated
may become incontinent

Back 43

Middle dementia (6)

Front 44

Stages of Alzheimer's disease

loose verbal ability
incontinent
need assistance eating
unable to walk

Back 44

Late dementia (7)

Front 45

Stages of Alzheimer's disease

some anxiety/denial
family, coworker notice deficits

Back 45

Early confusional (3)

Front 46

What are the abnormal proteins in Alzheimer's disease?

Back 46

- beta amyloid: in neuritic plaques and neurofibrillary tangles (low)
- Tau protein: hyperphosphotylated tetramer, in neurofibrillary tangles.

Front 47

What chromosome abnormalities are involved in amyloid aggregation in Alzheimer's disease?

Back 47

- Ch21: APP gene
- Ch14: presenilin-1 gene
- Ch1: presenilin-1 gene
- Ch19: ApoE gene

Front 48

Which appears first (tangles or plaques)?

Back 48

Tangles

Front 49

What is in the amyloid core of neuritic plaques in Alzheimer's disease?

Back 49

Ig chains.

Front 50

Give 2 treatments for Alzheimer's disease.

Back 50

1. acetyl cholinesterase inhibitors
2. memantine: non-competitive NMDA receptor antagonist, block glutamate-induced activation of Ca++ channels.

Front 51

What kind of therapy do you give to probable Alzheimer's disease with mild to moderate severity?

Back 51

cognitive enhancement therapy.

Front 52

A patient has memory impairment, aphasia, agnosia, apraxia, hyperreflexia, ataxia, and paresis. What is the syndrome?

Back 52

Vascular dementia: dementia criteria and signs indicative of cerebrovascular etiology.

Front 53

These are the features of ____.

abrupt onset
stepwise deterioration
fluctuating course
spotty patchy deficits
depression or emotional incontinence
preservation of personality

Back 53

vascular dementia

Front 54

What are some risk factors for vascular dementia?

Back 54

Hypertension
smoking
diabetes
hypercholesterolemia
other vascular disease

Front 55

What is this?

Korsakoff psychosis/ Wernicke-Korsakoff syndrome
short-term memory impairment
no general loss of intellectual function

Back 55

Alcohol amnestic disorder

Front 56

What is this?

Global loss of intellectual abilities
memory impairment
disturbance in abstract thinking/judgement/personality
no disturbance in conscious level

Back 56

Dementia associated with alcoholism

Front 57

What is the most common infectious agent causing dementia in the US?

Back 57

HIV

Front 58

What is this?

Depression, anxiety early
trouble with short term memory
apathy, lethargy, irritability, emotional lability
unsteady gait, leg weakness, tremot, motor slowing

Back 58

HIV-associated minor cognitive/motor disorder (less severe form.

Front 59

The lower the CD4 counts, the ____ the rate of HIV dementia.

Back 59

Higher

Front 60

What is the triad of HIV dementia?

Back 60

motor
cognitive
behavioral symptoms

Front 61

What is a commonly used AChEsterase inhibitor to treat Alzheimer's disease?

Back 61

Donepezil (Aricept)

Front 62

What is the physical response to Donepezil for treating Alzheimer's disease?

Back 62

Initial improvement in cognition and followed by decline within 2 years.

Front 63

What are some neuronal changes during normal aging?

Back 63

- smaller neurons and more dense
- less dendrites
- neurofibrillary tangles, senile plaques, lewy bodies.
- change in distribution and quantity of neurotransmitters.

Front 64

What are the components of Lewy body?

Back 64

alpha-synuclein
ubiquitin
parkin

Front 65

Which cell inclusion has a center region with halo around it?

Back 65

Lewy bodies

Front 66

What is this?

Global impairment of intellect, reason and personality without impairment of consciousness.

Back 66

Dementia

Front 67

List the five microscopic features of Alzheimer's disease.

Back 67

- neuritic plaques
- neurofibrillary tangles
- granulovacuolar degeneration
- Hirano body (hippocampus)
- amyloid angiopathy

Front 68

Where is the gene of APP located?

Back 68

CH21

Front 69

What two enzyme would cleave APP into insoluble fragments?

Back 69

beta and gamma secretase

Front 70

Which chromosomes are involved in familial types of Alzheimer's disease?

Back 70

Down's syndrome (CH21): onset in 20s
Presenilin 1 (CH14): onset in 40s
Presenilin 2 (CH1): onset in 40s
Ch21: onset in 50s
ApoE e4 (Ch19): onset in 60s, binds beta-amyloid

Front 71

What are the components of neurofibrillary tangles?

Back 71

- hyperphosphorylated tau protein
- MAP2
- Ubiquitin
- amyloid

Front 72

What is this?

parkinsonian features
early prominent visual hallucinations

Back 72

Dementia with lewy bodies

Front 73

What are some possible pathogenesis of Alzheimer's disease?

Back 73

loss of acetyltransferase
synaptophysin immunoreactivity
amyloid burden
loss of synapses

Front 74

When depression is also present with patient who has Alzheimer's disease, which type of drug should you avoid using?

Back 74

Tricyclic antidepressants

Front 75

What type of drugs should you use to treat irritation, agitation symptomatically in patients with Alzheimers?

Back 75

- 2nd generation antipsychotics
tradazone at bedtime
anticonvulsants (carbamazepine, valporoate)
- benzodiazepine only in acute severe agitation.

Front 76

What is the 2nd most common cause of dementia?

Back 76

vascular dementia

Front 77

What is this?

rapid onset
stepwise deterioration in cognition

Back 77

vascular dementia

Front 78

What is this?

ophthalmoplegia
ataxia
nystagmus
memory impairment

Back 78

alcohol amnestic disorder (Wernick's encephalopathy)

Front 79

What might cause drug-induced parkinsonism?

Back 79

Dopamine antagonists
Merperidine contaminant MPTP (need MAO-B)

Front 80

What is this?

pallor of substantia nigra and locus ceruleus
loss of pigmented catecholaminergic neurons with gliosis

Back 80

Parkinson's disease

Front 81

What are some pathogenesis of Parkinson's disease?

Back 81

- alpha-synuclein gene mutation: lipid binding protein in lewy bodies
- parkin gene
- UCH-L1: disubiquitin enzyme
- DJ-1 (astrocytes)

Front 82

What is this?

initial asymmetric weakness
muscle atrophy
weakness and spasticity
no dementia

Back 82

ALS

Front 83

Male or female?

High ALS incidence.

Back 83

Male slightly

Front 84

Most ALS is sporadic. But which chromosome is involved in familial type ALS?

Back 84

21

Front 85

What is the cause of ALS?

Back 85

Multiple!

20%: SOD1 mutation (ch21)
glutamate toxicity
mitochondrial dysfunction
autoimmunity

Front 86

What is this?
GAA repeats (CH9)
muscle weakness, difficulty in walking
dysarthria
areflexia
impaired joint position, vibration

Back 86

Friedreich's ataxia

Front 87

What is this?

clubfoot, hammer toes, foot inversion
gradual loss of sensation in extremities which may spread to trunk
scoliosis

Back 87

Friedreich's ataxia

Front 88

In Friedreich's ataxia, what other symptoms might you see on top of motor signs?

Back 88

chest pain
HD: myocardial fibrosis, tachycardia
carbohydrate intolerance
diabetes

Front 89

What is the pathogenesis of Friedreich's ataxia?

Back 89

GAA repeats -> low frataxin -> mitochondrial Fe accumulation -> mitochondrial dysfunction -> motor neuron and cardiac tissue.

Front 90

What mechanism does DRG degeneration occur in Friedreich's ataxia?

Back 90

secondary degeneration.

Front 91

What is this?

degeneration of:
- posterior columns
- corticospinal tracts
- dorsal and ventral spinocerebellar tracts
- spinal cord nucleus
- cerebellum

Back 91

Friedreich's ataxia

Front 92

Dementia is tested for with?

Back 92

MMSE