Lecture 23 - Neurocognitive Disease (Dementia) Flashcards

1
Q

Criteria for major NCD

A

Substantial impairment in Cognition

Independence Loss

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2
Q

what are some IADLs

A

(shopping, finances, cooking, transportation, telephone use, housekeeping

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3
Q

what are some cognitive domains -

A

Learning and memory, language, attention, executiive function, social cognition,

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4
Q

Criteria for Minor NCD

A

1) Modest Cognitive Decline

2) Intact IADLs but there is increased difficulty

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5
Q

most Common cause of NCD
how does it present
Criteria for this dx

A

Alz – 2/3s
Insidious and gradual
Memory decline

    • known AD FMHx
  • -OR Memory decline + Progressive + no other attributable cauase
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6
Q

Imaging for Alz

How does it compare to imaging for Normal pressure hydrocephalus

A

Ventricular enlargement with sulcal widening
Global brain atrophy

NPH – Ventricular enlargemnut but no sulcal widening

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7
Q

Common Presenstaion for NCD

what other symptoms are usually present?

A

CC – forgetfulness, losing things, repeating in converstiaon, getting lost, loss of interest in usual activityies, decline in hygiene, paranoia, depression

  • 88% of AD patients have measurable emotional and behavioral changes (non-cognitive)
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8
Q

Assessment for suspected NCD

which of the questionaires is more sensitive

A

History ; need a Collateral Informant
Questionnaires – MMSE, MoCA (more sensitive)

labs – Standard (minimum) – CBC, Serum Electrolytes, Calcium, Glucose, Bun/CR, LFTs
B12 – treatable cause of dementia
Thyroid
Syphilis – impt for baltimore (RPR)

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9
Q

Differences in presentation and imaging of NCD due to vascular disease

A

5-10% of all demented patients
Sudden onset –
Stepwise deteriorate with subsequent vascular events
Accompanied by focal neurological signs – DTRs, babinski, gait abnormalities
Imaging with evidence of previous strokes
Evidence of stroke risk factors and systemic vascular disease

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10
Q

Advanced Neurosyphilis — what is the positive lab? what is the imaging look like?

A

white matter hyper intensities on MRI

Positive RPR

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11
Q

Normal Pressure hydrocephalus

  • classic triad of symptoms
    Imaging
    Treatment
A

Triad of Shuffling Gait, Urinary Incontinence and Cognitive Impairment

CT – Ventricular Enlargement without Sulcal Widening

Tx- Shunt

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12
Q

B12 Deficiency –
- imaging?
- labs?
treatment?

A

Demyelination of the CNS and the PNS
MRI – severe diffuse periventricular white matter demyelination
Starts in the brain stem

Don’t have to have macrocytic anemia to have NCD

	Treatable -- can give PO, IM B12
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13
Q

what are some contraindicated medications for NCD patients?

A

anti-cholinergics

			Oxybutin (ditropan) -- used for urinary incontinence
			Benzotropine
			Benadryl
			Paxil -- 
			Amitripyline (
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