First Aid Psych 7-1 Cognitive Disorders

Front 1

1. Cognitive disorder?

Back 1

a. A cognitive disorder is a significant change in cognition from a previous level of functioning.
b. It may affect memory, attention, language, and judgement.
c. Cognitive disorders may be associated w/abnormalities of the CNS, a general medical condition, meds, or substance use.

Front 2

2. 2 main types of cognitive disorders?

Back 2

a. Delirium and dementia.

Front 3

3. Delirium?

Back 3

a. Delirium is a waxing and waning change in a pt’s level of consciousness.
b. Has a high morbidity and mortality if untx’d.
c. Can last from days to weeks and may become chronic.
d. It can also be referred to by the terms encephalopathy, acute organic brain syndrome, acute confusional state, acute toxic psychosis, and ICU psychosis.

Front 4

4. Where is Delirium most common?

Back 4

a. In ICU setting/acute medical illness and has ↑ incidence in children and elderly.

Front 5

5. Risk factors for delirium?

Back 5

a. Advanced age
b. Pre-existing brain damage (dementia, CVA, tumour).
c. Prior hx of delirium.
d. Alcohol dependence
e. DM
f. Cancer
g. Sensory impairment or blindness
h. Malnutrition
i. Male Gender

Front 6

6. Most common causes of delirium?

Back 6

1. Infection
2. Meds
3. Substance intoxication or withdrawal
4. Electrolyte imbalances.
b. Note: Almost any medical condition can cause delirium.

Front 7

7. DSM-IV criteria for Delirium?

Back 7

1. Disturbance of consciousness (ie, reduced clarity of awareness of the environment) w/reduced ability to focus, sustain, or shift attention.
2. A change in cognition (such as memory deficit, disorientation, language disturbance) or the development of a perceptual disturbance that is not better accounted for by a pre-existing, established, or evolving dementia.
3. The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day.

Front 8

8. Tx of delirium?

Back 8

a. Rule out life-threatening causes.
b. Definitive tx requires the identification and tx of the underlying conditions. i.e. hypothyroidism, electrolyte imbalances, UTI>
c. Supportive care: Maintain hydration and nutrition.
d. Pt safety:
1. 1 on 1 nursing observation
2. Frequently orient pt.
3. Avoid napping and keep lights on or shades open during day to correct sleep cycle
e. Psychotropic meds can be used for symptomatic tx of delirium, particularly agitation.

Front 9

9. Rx for symptomatic tx of delirium?

Back 9

a. Psychotropic meds: Antipsychotics first line: Haloperidol is most studied and can be given PO/IM/IV
b. BZDs are usually avoided unless delirium is secondary to alcohol or BZD withdrawal.
c. BZDs can cause/prolong delirium.

Front 10

10. Dementia?

Back 10

a. Impairment of memory and other cognitive functions (language skills, behaviour, and personality) w/out alteration in the level of consciousness.
b. Most forms are progressive and irreversible.
c. May be etiologically related to a general medical condition, the persisting effects of substance use, or a combination.

Front 11

11. Prevalence of dementia

Back 11

a. The prevalence almost doubles every 5 yrs from age 60 (1.5% at 60 yrs, 40% at 90 yrs).
b. There is a similar pattern of dementia subtypes across the world.

Front 12

12. Most common form of dementia?

Back 12

a. Alzheimer’s (50-70%)

Front 13

13. Second most common form of dementia?

Back 13

a. Vascular dementia (15-25%)

Front 14

14. Differential diagnosis of dementia (just to prep)?

Back 14

a. Psychiatric
b. Structural
c. Metabolic
d. Infectious
e. Drugs

Front 15

15. Psychiatric causes of dementia?

Back 15

a. Depression, delirium, malingering.

Front 16

16. Structural causes of dementia?

Back 16

a. Benign forgetfulness of normal aging
b. Parkinsons
c. Normal pressure hydrocephalus
d. MS
e. Subdural hematoma

Front 17

17. Metabolic causes of dementia?

Back 17

a. Hypothyroidism
b. Hypoxia
c. Malnutrition (B12, Folate, thiamine deficiency)
d. Wilson Disease
e. Lead toxicity

Front 18

18. Infectious causes of dementia?

Back 18

a. Lyme disease
b. HIV dementia
c. Creutzfeldt-Jakob (CJD)
d. Neurosyphilis
e. Meningitis
f. Encephalitis

Front 19

19. Drug causes of dementia?

Back 19

a. ETOH (chronic and acute)
b. Anticholinergics
c. Sedatives

Front 20

20. DSM criteria for Dementia?

Back 20

a. The development of multiple cognitive deficits manifested by both:
i. Memory impairment (impaired ability to learn new information or to recall previously learned information).
b. At leats 1 of the following cognitive disturbances:
1. Aphasia (language disturbance)
2. Apraxia (Impaired ability to carry out motor activity despite intact motor function)
3. Agnosia (failure to recognize or identify objects despite intact sensory function).
4. Disturbance in executive functioning (ie, planning, organizing, sequencing, abstracting.
c. The cognitive deficits in criteria A1 and A2 each cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning.
d. The deficits do not occur exclusively during the course of delirium.

Front 21

21. Associated features of dementia?

Back 21

a. Delusions and hallucinations occur in ~30% of demented pts.
b. Affective sx, including depression and anxiety, are seen in 40-50% of pts.
c. Personality changes are also common.

Front 22

22. What should you do if a pt presents w/dementia but has a normal CT scan?

Back 22

a. Order a complete metabolic panel and MRI.

Front 23

23. Aphasia?

Back 23

a. language disturbance

Front 24

24. Apraxia?

Back 24

a. Impaired ability to carry out motor activity despite intact motor function.

Front 25

25. Agnosia

Back 25

a. Failure to recognize or identify objects despite intact sensory function.