Psychiatry Clerkship Shelf First Aid Cognitie Diseases

Front 1

Prevalence of dementia in >80 y.o.

Back 1

20%

Front 2

What other sx are associated with dementia?

Back 2

30% have delusions and hallucinations
40-50% have depression and anxiety
personality changes

Front 3

What is the etiology for dementia?

Back 3

60% alzheimers
10-20% vascular dementia
major depression

Front 4

Dementia + cogwheel rigidity + resting tremor

Back 4

lewy body dementia
Parkinsons' disease

Front 5

dementia + ataxia + urinary incontinence

Back 5

normal pressure hydrocephalus, see dilated cerebral ventricles

Front 6

dementia + obesity + coarse hair + constipation + cold intolerance

Back 6

hypothyroidism

Front 7

dementia + diminished position and vibration sensation + megaloblasts

Back 7

vit b12 deficiency

Front 8

dementia + tremor + abnormal LFTs

Back 8

wilson's disease, see kayser Fleischer rings

Front 9

dementia + diminished position and vibration sense + argyll-robertson pupils

Back 9

neurosyphilis (treponemal)

Front 10

sx of delirium

Back 10

clouding of consciousness
acute onset
3 days to 2 weeks
impaired orientation
immediate/recent memory impaired
visual hallucinations
sx fluctuates: worse at night
reversible
reduced awareness
EEG changes

Front 11

delirium + hemiparesis or focal neurological signs

Back 11

cerebrovascular accident or mass lesions
brain CT/MRI

Front 12

delirium + elevated blood pressure + papilledema

Back 12

hypertensive encephalopathy
brain CT/MRI

Front 13

delirium + dilated pupils + tachycardia

Back 13

drug intoxications

Front 14

delirium + fever + nuchal rigidity + photophobia

Back 14

meningitis

Front 15

delirium +tachycardia + tremor + thyromegaly

Back 15

thyrotoxicosis

Front 16

alzheimer's epi

Back 16

5%
W>M

Front 17

alzheimer's etiology

Back 17

decreased Ach, NE

Front 18

alzheimer's pathology

Back 18

enlarged ventricles, flattened sulci
senile plaques, neurofibrillary tangles

Front 19

alzheimer's sx

Back 19

gradual decline in cognitive functions (memory, language), personality changes, mood swings

Front 20

alzheimer's criteria

Back 20

memory impairment plus one of the following: aphasia, apraxia, agnosia, diminished executive function

Front 21

define the following:
apraxia
agnosia
aphasia

Back 21

1. loss of learned, purposeful movements
2. loss of ability to recognize objects
3. impairment of any language

Front 22

tx for alzheimer's

Back 22

NMDA receptor antagonists (memantine), ACh inhibitor (tacrine, donepezil, rivastigmine)

Front 23

alzheimer's life expectancy

Back 23

8 years after dx

Front 24

vascular dementia etiology

Back 24

microvascular disease ==> small infarcts

Front 25

vascular dementia sx

Back 25

similar to alzheimer's but more aburpt onset, focal changes, greater personality preservation

Front 26

vascular dementia criteria

Back 26

memory impairment and one of the following: aphasia, apraxia, agnosia, diminished executive functioning

Front 27

vascular dementia tx

Back 27

support

Front 28

pick's disease etiology

Back 28

atrophy of frontotemporal lobes and pick bodies (intraneuronal inclusions)

Front 29

pick's disease sx

Back 29

aphasia, apraxia, agnosia

Front 30

ddx pick's disease from alzheimer's

Back 30

difficult, but pick's has more personality and behavioral changes early in the disease

Front 31

huntington's disease etiology

Back 31

AD genetic disorder ==> trinucleotide repeat on chromosome
- caudate atrophy

Front 32

huntington's disease sx

Back 32

progressive dementia, bizarre choreiform movements, muscular hypertonicity, depression and psychosis

Front 33

what age dose huntington's disease present?

Back 33

35-50 years

Front 34

huntington's disease life expectancy

Back 34

15 years

Front 35

huntington's disease tx

Back 35

supportive

Front 36

Parkinson's disease is comorbid with what?

Back 36

30% develop dementia
50% develop depression

Front 37

Parkinson's disease etiology

Back 37

neuron loss in substantia nigra ==> decrease dopamine to basal ganglia

Front 38

Parkinson's dx

Back 38

bradykinesia, cogwheel rigidity, resting tremor, mask like facial expression, shuffling gait, dysarthria (abnormal speech)

Front 39

Parkinson's tx

Back 39

levodopa, carbidopa, amantadine, anticholinergics (for tremors)
dopamine agonists: bromocriptine, monoamine oxidase inhibitors (selegiline)
- surgery for thalamotomy

Front 40

CJD etiology

Back 40

spongiform changes of cerebral cortex, neuronal loss, hypertrophy of glial cells

Front 41

CJD sx

Back 41

- rapidly progressing dementia 6-12 months after onset of sx
- extrapyramidal signs: ataxia, lower motor neurons

Front 42

CJD criteria

Back 42

- pathological
or
- dementia, sharp waves on EEG plus two of the following: myoclonus, cortical blindness, ataxia, pyramidal signs, extrapyramidal signs, muscle atrophy, mutism

Front 43

Normal pressure hydrocephalus etiology

Back 43

idiopathic or secondary to CSF obstruction

Front 44

Normal pressure hydrocephalus and associated diseases

Back 44

hx of meningitiis, trauma, tumor, SIADH

Front 45

Normal pressure hydrocephalus sx

Back 45

triad: gait disturbance, urinary incontinence, dementia (mild, insidious onset)

Front 46

Which of the sx of normal pressure hydrocephalus is least likely to improve?

Back 46

dementia

Front 47

common causes of delirium?

Back 47

CNS injury, systemic illness, drug abuse, drug withdrawal, hypoxia

Front 48

amnestic disorder etiology

Back 48

hypoglycemia, systemic illness, hypoxia etc.

Front 49

amnestic disorder criteria

Back 49

impaired memory without other cognitive problems
- always secondary to underlying medical conditions

Front 50

dementia sx

Back 50

loss of memory/cognition
insidious onset
lasts months to years
orientation often impaired
recent and remote memory impaired
hallucinations less common
symptoms stable throughout day
15% reversible
awareness clear
no EEG changes

Front 51

delirium vs dementia
acute onset

Back 51

delirium

Front 52

delirium vs dementia
shorter time period

Back 52

delirium

Front 53

delirium vs dementia
impaired orientation

Back 53

both

Front 54

delirium vs dementia
impaired recent memory

Back 54

both

Front 55

delirium vs dementia
impaired immediate memory

Back 55

delirium

Front 56

delirium vs dementia
impaired remote memory

Back 56

dementia

Front 57

delirium vs dementia
sx fluctuate

Back 57

delirium

Front 58

delirium vs dementia
15% reversible

Back 58

dementia

Front 59

delirium vs dementia
reduced awareness

Back 59

delirium

Front 60

delirium vs dementia
EEG changes

Back 60

delirium

Front 61

first line tx for delirium

Back 61

antipsychotics
- benzos aren't good