Major neurocognitive disorders (MNCD): Diagnosis and workup
1) Clinical diagnosis Cognitive impairment + loss of autonomy
2) Rule out treatable conditions (1.5%) : tumors, hematoma, hydrocephalus, HIV, syphilis, Whipple, vitamin deficiency, ... laboratory tests + imaging
3) Perform the diagnostic workup What type of MNCD ? MRI, iADL scale, MMSE, neuropsychological assessment
Alzheimer
- 1st cause after 65 years
- Progressive amnesia and impaired executive functions
- Aphaso-apraxo-agnosia syndrome
- Hippocampal atrophy
Lewy body dementia
- Visual hallucinations
- Movement disorders (parkinsonian signs)
- Behavioral changes, sleep difficulties
- Fluctuating cognition (attention and altertness)
Frontotemporal dementia
- Behavioral changes (disinhibition, compulsive behavior, hyperorality,
- 25% genetic component
- Frontal atrophy
Vascular Dementia
- 2nd cause after 65 yrs
- Subacute onset with step-wise decline > progressive
- Loss of bladder control
- Unique or multiple ischemic stroke
- Amyloid angiopathy
By Dr. Amandine Dessertennes via Dr. Benjamin Terrier @TerrierBen
#MNCD #Dementia #Differential #Subtypes #Classification #Workup #Diagnosis #Geriatrics #Workup
Reversible Neurocognitive Disorders (Reversible Causes of "Dementia")
• Structural/Mass: Subdural Hematoma, NPH, Intracranial tumor
• Infection: Meningitis, Encephalitis, Abscess, Neurosyphilis, Lime disease, Whipple's disease
• Endocrine: Hypo/hyperthyroidism, Hashimoto's encephalitis, Hypo/hyperparathyroidism, Pituitary insufficiency, Hypercalcemia, Cushing's disease
• Other: Depression, Epilepsy, Drugs/toxins, Alcohol, Sleep apnea, Vasculitis, Nutritional
UCSD Internal Medicine @ucsdim
#Reversible #Neurocognitive #Disorders #dementia #differential #diagnosis #causes #neurology
HIV-Associated Neurocognitive Disorder (HAND)
Definition:
HIV-Associated Neurocognitive disorders categories:
• Asymptomatic neurocognitive impairment
• Mild neurocognitive impairment
• HIV dementia
Pathophysiology:
HIV frequently compromises the integrity of the blood-brain barrier (BBB), and infects the CNS in the early stages of infection
• HIV is neuroinvasive - HIV invades mononuclear cells in the CNS
○ Infected cells -> microglial activation -> diffuse myelin loss -> neuronal death -> astroglial proliferation
• ARVs can have low penetrance through the blood-brain barrier
Classic HIV Encephalopathy Triad:
• Memory/psychomotor impairment
• Depressive symptoms
• Movement disorders
○ This presentation is similar to PML, but MRI will show symmetric bilateral white matter lesions that are less well-defined than PML lesions, which are usually asymmetric.
Diagnosis:
MRI Findings:
• Rule out infectious etiologies and PML (JC virus)
Brain parenchymal loss:
• Increased CSF fluid
• Decrease in striatal gray matter volume
• Decrease in cerebral white matter volume
• Patchy areas of high signal intensity on T2-weighted and fluid-attenuated inversion recovery sequences with relative sparing of the subcortical white matter and posterior fossa structures.
Clinical Presentation:
The clinical syndrome of HAD comprises of a combination of:
• Cognitive
• Behavioral
• Motor dysfunction like gait disturbance and tremors
• While there is some individual variation, frequent manifestations include: inattention and reduced concentration, apathy and dulling of personality, psychomotor slowing, marked motor slowing and ataxia.
• Often presents after years of untreated HIV and with low CD4 counts.
Treatment:
• HAART treatment
• Cognitive impairment is often not fully reversible
• HAND is also associated with increased mortality among HIV patients
#HAND #HIV #Associated #neurocognitive #disorder #dementia #AIDS #Neurology
Weight Loss - Differential Diagnosis Algorithm
Decreased Intake:
• GI illness (upper and lower)
• Psychiatric (Depression, eating disorders)
• Poverty
• Abuse
• Dementia
• Anorexia as an Adverse Drug Effect
Malabsorption:
• Small Bowel Disease (e.g. Crohn's Disease, Celiac Disease)
• Pancreatic Insufficiency
• Cholestatic Liver Disease
• Protein-losing Enteropathy (e.g. Inflammatory Bowel Disease)
Increased Expenditure:
• Increased Protein/Energy Requirements (e.g. Post-Surgical, Infections, Trauma, Burns)
• Cancer
• Hyperthyroidism
• Chronic Cardiac/Respiratory distress (e.g. COPD)
• Chronic Renal Failure
• Adrenal Insufficiency
• Poorly Controlled Diabetes Mellitus
• HIV
#WeightLoss #Differential #Diagnosis #Algorithm #Causes