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Exam (elaborations)

Neuro Exam 3

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is treating psych disor- ders & mental illness that affect human behavior & emotions where treatment might include some medication manage- ment. is treating psych & men- tal illnesses that affect human behavior & emotions where treatment is primarily focused on counseling & cognitive be- havioral therapy. is treating physiologic ill- nesses that affect the central & peripher- al nervous system. is surgical treatment of neurologic disorders. Which form of brain imaging provides a more in depth evaluation of soft tissue structures? What form of imaging maps the distri- bution of metabolic activity of the brain using radioisotopes? language psychiatry psychology neurology neurosurgery MRI PET What are the 6 domains assessed for standardized cognitive assessments? executive function abstract reasoning memory attention/concentration visuospatial skills (constructional tasks) What factors does the MMSE look at? orientation registration (immediate recall) attention & calculation delayed recall language visual construction Which cognitive assessment is a lit- tle more sensitive to subtle cognitive changes? is an acute onset altered mental status. delirium will present w ag- itation, while delirium will pre- sent w withdrawn affect. memory is ability to keep a limited amount of info readily available to use for processing thoughts, plans, & carrying out ideas. memory is brief period of time where you can recall info you were just exposed to. memory is the transfer of info from short term to long term storage to create enduring memories. memory is a cognitive system with a limited capacity that can hold information temporarily. It is impor- tant for reasoning and the guidance of decision-making and behavior. is decline in cognitive do- mains that are abnormal for age & ed- MOCA delirium hyperactivity, hypoactivity working **connected to executive functioning** short term memory long term memory working mild cog impairment ucation level. This creates difficulty w ADLs but pt remains independent. What labs should be checked in a pt w mild cognitive impairment? cognitive impairment is objective impairment in condition that is not severe enough to require help w usu- al activities of daily living. is acquired deterioration in memory & other cognitive skills that re- duce a person's ability to perform every- day activities. What are the main types of dementia? What is the primary treatment for demen- tia? What does this target? What is the most common cause of de- mentia? What are some risk factors for alzheimers disease? What causes alzheimers disease? CBC, CMP, thyroid panel, vit B12, folate mild dementia (major cog impairment) alzheimers vascular frontotemporal lewy body other cholinesterase inhibitors -- Donepezil, Rivastigmine, Galantamine 3 targets working memory alzheimers -- 2/3 of cases 65 y/o familyW hx accumulation of beta amyloid plaques, neurofibrillary tau tangles, & shrinkage of the brain hippocampus temporal lobe Where does most brain atrophy occur in pts w alzheimers? parietal lobe 70-year-old gentleman is brought to his primary care provider by his son. He states that it seems like he has strug- gled more and more with everyday living. Initially, he forgot simple things such as dates and addresses, but this has pro- gressed over the last few years to an inability to pay his own bills. He has even gotten lost coming home from the library which is two blocks away from his house. What type of cognitive impairment does this pt have? Which type of dementia has slow & pro- gressive decline in memory and ability to take care of oneself? How do you make a definitive dx of alzheimers? What may a CSF analysis of a pt w alzheimers show? alzheimers just presents w short term memory loss. alzheimers presents w impairment in problem solving, judg- ment, executive functioning, lack of mo- tivation, & disorganization. alzheimers presents w apathy, social withdrawal, agitation, psychosis, wandering, incontinence, & more. Which of the following treatments are used in an attempt to prevent or delay deterioration of cognition in patients with Alzheimer disease? A - Vitamin E supplementation major/dementia alzheimers you cant until you autopsy the pt :( presence of tau & beta amyloid plaques mild moderate severe (end of life) D - Cholinesterase inhibitors B - Nonsteroidal anti-inflammatory drugs (NSAIDs) C - Neuroleptic agents D - Cholinesterase inhibitors How do you treat mild-moderate alzheimers? How do you tx moderate-severe alzheimers? What is the average life expectancy for 4-8 yrs donepezil donepezil + namenda someone diagnosed w alzheimers? What is the most common cause of death in pts w alzheimers? What do you expect to find on brain MRI of a pt w moderate-severe alzheimers? 77-year-old female who for the past 4 days, has been crying easily, confused, and rambling incoherently. Her medical history is remarkable for mild demen- tia and well-controlled hypertension. She has never had anything like this in the past and she has not had any recent changes to her medications. When ques- tioned, she has no difficulty articulating a sentence but difficulty remembering what she was asked. Laboratory testing is significant for leukocytosis. What is go- ing on w this pt? Diagnostic criteria for delirium include which of the following? A - disturbed consciousness B - cognitive change C - rapid onset and fluctuating course D - evidence of a causal physical condi- **note some can live up to 20 yrs after dx** pneumonia brain atrophy/shrinkage delirium **altered from baseline w infection as likely underlying cause (prob UTI)** E - all of the above

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