Neuropsychiatric & Behavioral Symptoms
Neuropsychiatric issues are (common/not common) in dementia populations.
(Early/Late) onset psychiatric symptoms often increase risk of dementia
Common and are not always secondary to dementia severity
Late
What is a TBI? What impacts the length of recovery? What is the difference between open and closed head injuries?
An alteration in brain function or other evidence of brain pathology caused by an external force and characterized by: Any period of loss of consciousness (LOC), Any memory loss for the events immediately before or after the injury, Any neurological deficits and/or…, Any alteration in mental state at the time of the injury
Severity of TBI, age, mood issues, substance use, closed vs open injury
Open: Skull penetrated into dura into the subdural space
Closed:No skull penetration a linear skull fracture may be present
What is a seizure? What is the most common identifiable cause of seizures in older adults? What is the most common seizure type in patients with brain tumors?
Transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain. Having 1 seizure puts you at risk of another. However, people who have had a TBI are not at a high risk of seizures.
Stroke
Focal and focal to bilateral
Should individuals going through AED withdrawal drive?
What are the AED side effects?
NO
Higher doses, rapid titration, and the additive effect of multiple AEDs increase the likelihood of adverse side effects
Psychomotor speed, sustained attention, memory and mood are the most significantly impacted by AED use
Phenobarbital is associated with the greatest cognitive risk, including lower IQ and academic functioning in children, as well as decreased attention and depression in both children and adults
Of the newer AEDs, Topamax has been associated with changes in language, memory, processing speed, and frontal lobe functioning
Keppra has been associated with behavioral changes
Name a psychosocial risk factor following stroke.
What can be impacted by mood changes after a stroke?
Poor social support
Quality of life, recovery, functional outcomes, and mortality rates.
What are the common neuropsychiatric symptoms associated with dementia? What are the rare behavioral symptoms?
NP: Apathy (emotional blunting, increased indifference, and lack of social engagement), depression, and agitation
Bx: euphoria, sleep disturbances, appetite changes
What constitutes a mild TBI? moderate? severe?
Mild: altered or LOC <30 min w/normal CT and/or MRI; GCS 13-15; and PTA <24 hrs
Moderate: LOC <6hrs w/abnormal CT and/or MRI; GCS 9-12; PTA <7 days
Severe: LOC >6hrs w/abnormal CT and/or MRI; GCS <9; PTA > 7 days
What is an aura? automatism? kindling? status epliepticus? idiopathic epilepsy? symptomatic? Postictal?
Aura – a subjective sensory phenomena that precedes a seizure and may serve as a warning that a seizure may be imminent.
Automatism - a more or less coordinated, repetitive, motor activity usually occurring when cognition is impaired and for which the subject is usually amnestic afterward. This often resembles a voluntary movement and may consist of inappropriate continuation of ongoing preictal activity.
Kindling – the development of an epileptogenic network by exposure to recurrent seizures
Status epilepticus - a seizure that shows no clinical signs of arresting after a duration encompassing the great majority of seizures of that type in most patients or recurrent seizures without resumption of baseline central nervous system function interictally
Idiopathic epilepsy - no known etiology
Symptomatic epilepsy - known etiology
Postictal – the period of time after a seizure, during which time patients often experience confusion or drowsiness
What is the goal of surgery in epilepsy and what is a risk? What is a predictor of seizure-free outcomes?
What is associated with poorer cognitive functioning in epilepsy patients?
Reduce seizures; cognitive decline
Complete resection
Earlier age of onset
Why should you assess mood in patients with Huntington's disease?
They are at increased risk of SI.
What are the common neuropsychiatric symptoms of Alzheimer's
Apathy, aggression, and anxiety
What is the difference between TBI and PCS?
Name 1 co-occurring condition with TBI
Presence of symptoms post mTBI that occur beyond the normal course of recovery
Chronic pain
What are the different types of seizures?
Focal vs. generalized
Focal aware seizure : The patient’s awareness remains intact. The patient might not be able to talk or respond, but still has awareness of the situation. Autonomic does not involve motor onset.
Myoclonic seizures – present as quick jerks, involving symmetric movements of the head, distal limbs, or axial musculature.
Non-epileptic seizures: patients are unable to consciously produce their symptoms
What is the triad of cognitive deficits commonly as a result of cancer treatment in children?
Are primary brain tumors more common in adults or children?
What are the most common type of primary brain tumors in adults?
Attention, processing speed, and EF
Children
Meningioma and gliomas
What do emotional changes associated with left hemisphere lesions include?
Decrease in spontaneous talking
In vascular dementia, are the neuropsychiatric symptoms dependent on the brain regions affected?
Yes
What are common neuropsychological symptoms of TBI?
What is an evidence-based treatment to help patients compensate for cognitive challenges associated with TBI?
Attention, processing speed, and executive dysfunction
Cognitive rehabilitation
What are symptoms and neuropsychological symptoms of temporal lobe epilepsy? frontal? parietal? occipital?
Temporal: Aura, automatisms with upper extremity involvement, alter consciousness, executive dysfunction, and other cog issues depending on location
Frontal: behavioral changes, deficits in motor skills, inattention, decreased working memory, and executive dysfunction
Parietal: visual disturbance, sensory disturbance, motor disturbance, and psychiatric/mood disturbance. Also visual associative agnosia, attentional dysfunction (including hemineglect), visuospatial deficits, apraxia, and linguistic deficits
Occipital: auras, visual field defects and visualperceptual deficits, mild impairment in IQ, speed attention, and executive functioning
What is a meningioma? What are the cognitive symptoms?
What are the symptoms of ependymomas? glioblastomas?
What does the initial presentation of CNS lymphoma look like?
What is a medulloblastoma?
Arise from cells forming the external membranes covering the brain. Cog sxs: memory, attention, and language
Increased cranial circumference in kids, irritability, sleeplessness, vomiting, headaches
Headaches, nausea, vomiting, and drowsiness. Other sxs can arise depending on location of tumor
Headaches are the most common brain tumor symptom
Personality and behavioral changes and focal cerebral signs
fast growing tumor
Which patient is more likely to be apathetic? Progressive supranuclear palsy (PSP) or Alzheimers
PSP
What are some of the psychiatric changes that can be seen in frontotemporal dementia?
Ritualized behaviors, lack of empathy, apathy, and hyperorality
What are different types of treatment recommendations for symptoms associated with moderate TBI
Psychotherapy/psychiatry, Cog rehab, Physiatry Speech/occupation/physical therapy, ENT, Ophthalmology, Primary care, Neurology, Sleep management/education (CBT-I), Pacing techniques/fatigue management, Headache management (Relaxation techniques, Biofeedback)
What is the Wada procedure?
Injection of sodium amobarbital into the internal carotid
Allows for brief assessment of language and memory (functional integrity) of the hemisphere that has not been pharmacologically ablated
Can provide evidence of abnormal language organization
Warns of potential severe memory problems following surgery based on intactness of functioning in each hemisphere
Can provide further evidence of lateralizaton of memory function
What cognitive domain might be impacted if someone presents w/ "chemobrain?" What tests might you give?
What about someone w/an oligodendroglioma?
What are the neuropsy deficits associated with post radiation?
EF - any of those (Trails 4, TMT B, WCST, color word etc.)
Memory (WMS, CVLT, etc.)
Memory, processing speed, attention, and EF
What is an intraventricular hemorrhage? intraparenchymal?
Intraventricular: bleeding into the ventricles
Intraparenchymal: bleeding into brain parenchymal