Medical Archive

C21.1 Introduction and Overview

Initial workup

• Cognitive testing
  • MMSE (score <24/30 suggestive of MCI/dementia)
  • Montreal Cognitive Assessment (score <26/30)
  • Mini-Cog (abnormal 3-word recall &/or clock-drawing test
• Lab testing
  • Routine: CBC, vitamin B12, TSH, CMP
  • Selective (specific risk factors): folate, syphilis, vitamin D level
  • Atypical (early onset): CSF
• Imaging
  • Routine: CT scan or MRI of the brain
  • Atypical: EEG

C21.2 Delirium

Delirium

• ?? ?? ???? ?? ??.
• ?? ??? ??? ???. ??? ??????…
• ??? ??? ????? ??
• ???, glucose, brain CT? ?? ?? r/o
• ??

Treatment

• Low-dose haloperidol.
  • ??? antipsychotics? ??.
  • Prolonged use can increase mortality in the elderly.
  • Contraindication: patients with Lewy body dementia, who may exhibit neuroleptic hypersensitivity (severe Parkinsonism and impaired consciousness)
• Benzodiazepine
  • 2nd line. May be used to treat agitation in young patients.
  • ??? ??? ???. Older patients tend to metabolize BZDs slowly
• ???
  • ??? ??, ????, ??? ??? ??
  • ??? ??? ??, ??x

Delirium tremens

• ??? ???. ? ??? 3? ?!
• Chlordiazepoxide 50-100mg 4?? ???? PO.
• ?? ?? ???? ??? ??? lorazepam
• ??, ??? ?? ???? haloperidol? ?? ??.

C21.3 Dementia (Major Neurocognitive Disorder)

C21.4 Major or Minor Neurocognitive Disorder Due to Another Medical Condition (Amnestic Disorders)

Amnestic disorder

• ???? ???? ?? ?.
• Reversible: ?????, ECT, BZD/barbiturate, ?????

C21.5 Neurocognitive and Other  Disorders Due to a General Medical Condition

C21.6 Mild Cognitive Impairment