1What is the term used to describe memory impairment?
Amnesia
2What is the term used to describe language impairment?
Aphasia
3What is the term used to describe motor impairment?
Apraxia
4What is the term used to describe recognition impairment?
Agnosia
5What is the term used to describe impairment of the working memory or problem solving?
Executive function impairment
6What term includes memory, language, orientation, judgment, conducting interpersonal relationships, performing actions (praxis), and problem-solving.
Cognition
7What domains are affected by a cognitive disorder?
memory
language
orientation
judgment
social/interpersonal realtionships
actions/paxis
problem-solving (executive)
8What is the outcome associated with biological insults to the brain?
behavioral symptoms
9What behavioral syndromes complicate the course of dementias?
anxiety
depression
sleep problems
psychosis
aggression
10What is the term for a condition of short-term confusion & changes in cognition?
delirium
11What is the term used to refer to a major neurocognitive disorder that is marked by severe impairment in memory, judgment, orientation, & cognition?
Demenita
12What are the defining features of alzheimer's disease?
>65 y/o
progressive intellecutal disorientation, dementia, delusions, or depression
13What often is the cause of amnestic disorders?
medical condition
toxin or medication
14What essential components of the history should be reveiwed for any type of cognitive complaint?
-development of symptoms
-subtle cognitive changes
-fluctuating symptoms
-progression details
-changes in daily routine (ADLs & iADLs)
-changes in socialization
-baseline data
-changes in fuction r/t attention & concentration, intellectual abilities, personality, motor skills, mood
15What is the primary tool of assessment after the history is obtained from the patient and other support person(s)?
MSE
16Testing of cognitive function should include what areas?
memory
visuospatial
reading/writing/math
abstraction
17Why is obtaining a MRI of more benefit than a CT when looking at the brain for evidence of non-acute findings?
better discriminates between the grey and white matter and can identify white matter lesions and helps to exclude tumors or vascular disease
18True or False: Delirium can be life-threatening?
True
19What are the sympotms of delirium?
Impaired attention/awareness
Acute onset with a change from baseline & may fluctuate throughout the day
Impairment of cognitive functions
Evidence for physiologic cause of the impairment
20What is one thing that differentiates delirium from dementia?
Potentially reversible when the identified cause is eliminated
21What neurotransmitter is highly associated with delirium?
acetylcholine
22What part of the brain is most likely impacted by delirium?
retiular formation (in the brainstem) is responsible fro regulating attention & arousal
23What pathway is most likely implicated by delirium?
dorsal tegmental and thalamus
24WHat is one of the most common causes of delirium?
Multiple medications prescribed with anticholinergic activity
25What altered attention symptoms may be present in a pt w/ delirium?
diminished ability to focus, sustain or shift attention
26What type of disorientation is most notable with delirium?
time and space
27What is the typical course of delirium?
Rapid onset (hours to days)
Brief duration (days to weeks)
Marked, unpredictable fluctuations in severity
May be worse at night (sundowning)
28what workup should be done for a pt w/ delirium?
CMP
CBC
TSH/T4/T3
Syphillis
HIV
UA
EKG
EEG
chest xray
bloodrine drug screen
bloodrine/CSF culture
B12
CT or MRI
LP & CSF exam
29What differentiates dementia from delirium?
time to devlop the condition
fluctuations in attention
30What is the term used for a pt that has dementia that also develops delirium?
beclouded dementia
31What are the prodromal signs of delirium that can occur in the days leading up to the onset of the delirius state?
restlessness
fearfulness
32How long does delirium last?
until the cause is resolved but typically about 3-7 days
33What is the primary treatment for delirium?
Treatment of the underlying cause
34What medication can provide relief if the cause is r/t anticholinergic medications?
physostigmine salicylate 1-2 mg IV or IM and is repeated every 15-30 minutes PRN
35What is one nonpharmacological approach to treating delirium?
Enviornmental and sensory control
-safety from physical harm
-sensory neutral environment
-familiar person in the room w/ the pt
-familiar pictures or decor
-prescence of a clock/calendar
-regular orientations to person, place, and time
36what is one trick that can help with delirium for a pt wearing an eye patch after cataract surgery?
placement of a pinhole in the patch and occasionally removing the patch
37What 3 symptoms of delirium require pharmacological treatment?
psychosis (haldol)
agitation (antipsychotics) *Depakote if fail
insomnia (difficult to treat; may consider benzo but at risk of worsening confusion)
38What is one major side effect of droperidol that needs to be fully assessed before administration?
Potential for QT prolongation and development of torsades de pointes
39What medication should be avoided in a delirious pt?
phenothiazines r/t significant anticholinergic activity
40What is the impairment of memory for delirium vs dementia?
delirium=short term
dementia=long term
41what is the impairment of attention for delirium vs dementia?
delirium=very poor
dementia=impaired
42What is the impairment of orientation for delirium vs dementia?
delirium=grossly disorganized
dementia=variable
43What is the impairment of sensorium for delirium vs dementia?
delirium=prominent hallucinations
dementia=rare hallucinations
44What is the impairment of thought content for delirium vs dementia?
Both may be paranoid
45What is the impairment of judgment, social skills, & behavior for delirium vs dementia?
delirium=grossly impaired
dementia=initially intact but worsens over time
46What is the level of onset in delirium vs dementia?
delirium=acute
dementia=incidious
47What is the level of fluctuation throughout the day in delirium vs dementia?
delirium=fluctuates throughout the day
dementia=generally more stable
48What is the long term prognostics for delirium vs dementia?
delirium=may improve depending on underlying cause
dementia=chronic & progressive; graual or stepwise
49What are the most likely causes of delirium?
metabolic
toxic
infection
50what medication is FDA approved to treat psychosis in Parkinson's Disease?
pimvanserin
51What are the pharmacological options for treatment of delirium?
Haldol: 0.5-1mg BID and q 4-6 hur PRN
Risperdol: 0.5-1 mg daily
Zyprexa: 5-10 mg daily
Seroquel: 25-150 mg daily
Lorazepam: 0.5-3mg daily & PRN q 4 hours
52What is a significant risk factor for delirium?
advancing age
53What factors are highlighted with a dementia diagnosis?
-decline from a previous level of fucntion
-involves multiple cognitive domains
-deficits cause significant impairment in social & occupational function
54True or False: Dementia can be reversed
True in about 15% of people w/ dementia that is caused by an underlying pathologic condition and the application of effective treatment is initiated before irreversible damage takes place
55What factor contributes to the assignment of a minor or major cognitive disorder classification?
Based on levels of functioning
56A personality change in someone older than the age of 40 should prompt what consideration for a diagnosis?
Dementia
57What are important factors for the clinician to consider when assessing for dementia?
intellectual impairment
forgetfulness
the pt's evasion, denial, or rationalization aimed at concealment of the deficits
58What is an early and prominent feature in dementia?
memory impairment
59What type of memory loss is most notable early in the course of dementia?
mild and usually marked for recent events
examples:
forgetting phone numbers, conversations, and events of the day
60What types of dementias affect the cortex?
Alzheimer's & Vascular
61What cognitive domain is typically affected when the cortex of the brain is affected by dementia?
language
62What type of delusions may prompt a person w/ dementia to become hostile to family or caregivers?
paranoid
63What area of the brain is typically involved if the person displays changes in personality?
frontal & temporal
64What type of dementia often have headaches, dizziness, faintness, weakness, focal neurological signs, and sleep disturbances?
Vascular
65What type of dementia has pseudobulbar palsy, dysarthria, and dysphagia more commonly than other dementias?
Vascular
66When assessing abstraction, what may be noted when a pt has dementia?
Difficulty generalizing from a single instance, forming concept, and grasping similarities or differences between two objects or concepts
67What is notable about reasoning and judgment with dementia?
Becomes poor and is compromised w/ < ability to solve problems and reason logically
68What often happens when a pt with dementia is put under pressure or stress?
a catastrophic reaction marked by agitation
69What area of the brain is often impacted when the patient lacks judgment and has poor impulse control?
Frontal
70Impairments linked to the frontal lobe may be displayed by what behaviors?
Coarse language
Inappropriate jokes
Neglect of personal hygiene
General disregard for the conventional rules of social conduct
71What is sundowner syndrome?
Syndrome characterized by drowsiness, confusion, ataxia, and accidental falls
May result from overmedication or dementia and occurs when external stimuli (light & orienting cues) are diminished
72What is the primary difference in onset between vascular and AD?
Vascular shows more of a stepwise deterioration
>focal neurological symptoms
73What is one vitamin to check in a pt with cognitive changes and a history of prolonged, heavy alcohol use?
B1
74Symptoms of the vetebrobasilar system may include what symptoms?
Transient functional disturbance in the brainstem or occipital love
75Symptoms of the carotid arterial system may include what symptoms?
Unilateral retinal or hemispheric abnormalities
76WHat is the treatment for TIAs?
Prevention of a stroke: anticoagulant, antiplatelet, a reconstructive vascular surgery
77What is the diagnositic term assigned to cognitive symptoms that result from depression?
pseudodementia
78What is one notable difference between pseudodementia and dementia?
Prominent depressive symptoms and more insight into their symptoms than those with dementia
79What is defining about normal aging associated with cognitive decline?
Changes are minor in severity and do not impact social or occupational behaviors
80What is the classic course of dementia?
onset in 60s
gradual deterioration over 5-10 years
81What is the average age of survival for a pt w/ AD?
8 years
82What is notable about early onset dementia or with a family history of dementia?
Disease is more likely to have a more rapid course
83What is the first step in treatment of dementia?
accurate diagnosis
84What are some steps to help slow down progression of vascular dementia?
Lifestyle improvements w/ diet & exercise, control of BP/lipids/diabetes
85Where should BP control be focused for a pt w/ vascular dementia?
Upper end of normal
86What BP pills can exaggerate cognitive symptoms?
Betablockers
87What type of psychotherapy is beneficial for those with dementia symptoms?
Supportive
Educational
88What nonpharmacological interventions can be of benefit for a patient with dementia?
identification of strengths and promotion of these activities to maintain independence
find ways to deal w/ deficits: calendars, schedules, notes may help overcome some challenges
89What medications are available to treat mild to moderate cognitive impairment in AD?
donepezil
rivastigmine
galantamine
90What pt educaton about cholinesterase inhibitors needs to be shared with pts receiving this treatment?
None the medications prevent the progression of the neuronal degeneration of the disorder
91What dementia medication protects neurons from excessive amounts of glutamate which can be neurotoxic?
memantine
92What nonpharmacological intervention should be discussed with patients with early symptoms?
>daily physical exercise
93What are two most common forms of dementia in those >65?
AD
Vascular
94What are the neuropathology hallmark changes for Alzheimers?
amyloid deposits in the brain tissue
95The gene fro APP is located on what chromosome?
21
96What gene is linked to Alzheimers?
E4
If pt has 2 E4 genes, disease is 8x more likely
97The brain has what features in a pt w/ AD when examined postmortem?
diffuse atrophy w/ flattened cortical sulci & enlarged cerebral ventricles
microscopic findings of senile plaques, neurofibrillary tangles, neuronal loss (>in hippocampus & cortex), synaptic loss (up to 50% in the cortex), and granulovascular degeneration of neurons
98What are the nurofibrillary tangles composed of?
cytoskeletal elements primarily of phosphorylated tau protein but are not AD specific
99What are the most diagnostic features noted in the brains of AD pts?
Senile plaques (amyloid plaques) and the number on autopsy seems to correlate clinically w/ disease severity
100What neurotransmitters are implicated in AD?
acetylcholine
norepinephrine
**both are hypoactive