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5. Psychiatry > 3- Neurocognitive Disorders > Flashcards

3- Neurocognitive Disorders Flashcards

1
Q

What are the 6 broad categories of neurocognition?

A
  1. Complex attention
  2. Executive function
  3. Learning and memory
  4. Language
  5. Perceptual-motor
  6. Social cognition
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2
Q

What is defined as an acute, rapidly progressive change in cognition characterized by inattention and disturbance of consciousness in which sxs fluctuate over the course of 24 hrs?

A

Delirium (aka acute confusional state)

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3
Q

What is the DSM-5 criteria for delirium? (5)

A
  1. Disturbance in attention and awareness
  2. Develops over short period of time + fluctuates
  3. Disturbance in cognition
  4. Not better explained by NCD/ reduced level of arousal
  5. Physiological consequence
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4
Q

What must be specified for a DSM-5 dx of delirium? (3)

A

Substance intoxication vs withdrawal delirium

Acute vs persistent

Hyperactive vs hypoactive vs mixed

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5
Q

Age > 70yo, poor functional status, hearing/ visual impairment, dehydration, sleep deprivation, metabolic derangement, infection, and polypharmacy are all RFs for what condition?

A

Delirium

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6
Q

What 3 things should be avoided or used with caution in the practice of geriatric medicine? (3)

A

Benzos/ sedative-hypnotics

Physical restraints

Antipsychotics

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7
Q

What general non-pharmacologic measures are used for the tx of delirium?

A

Reassure, reorient, education

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8
Q

How does the onset differ between dementia and delirium?

A

Dementia- progressive, insidious

Delirium- acute, rapid

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9
Q

Disturbance of consciousness, fluctuation of sxs, and attention deficit are characteristic of dementia or delirium?

A

Delirium

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10
Q

How can you differentiate between major vs minor neurocognitive disorder?

A

Major

  • significant cognitive decline
  • substantial impairment in cognitive performance
  • interference w/ independence

Minor

  • modest cognitive decline
  • modest impairment in cognitive performance
  • does not interfere with independence
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11
Q

What are the similaries between major and minor neurocognitive disorder?

A

Deficits do not occur due to delirium

Not better explained by another mental disorder

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12
Q

What must be specified for DSM-5 criteria of major NCD? (3)

A

Which NCD

With/ without behavioral disturbance

Severity of interference

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13
Q

What must be specified for DSM-5 criteria of minor NCD? (2)

A

Which NCD

With/ without behavioral disturbance

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14
Q

DSM-5 criteria for ALL NCDs includes what?

A

Criteria met for major or mild NCD

Not better explained by other disease/ disorder

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15
Q

What is the DSM-5 criteria specific to Alzheimer’s Disease (AD)? (2)

A
  1. Insidious onset, gradual progression in 1+ cognitive domains
  2. Probable or possible AD
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16
Q

How do you define probable (vs possible) AD?

A

Evidence of causative agent +

  • Clear memory decline + 1 other domain
  • Steadily progressive, gradual, no extended plateaus
  • No evidence of mixed etiology
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17
Q

At what age is AD considered early onset?

A

Under 65 yo

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18
Q

What populations are a/w higher rates of AD?

A

Repeated head trauma

Down Syndrome

19
Q

What is the only way to confirm dx of AD?

A

Histopathology

20
Q

What is the DSM-5 criteria specific to frontotemporal degeneration? (3)

A
  1. Insidious onset, gradual progression
  2. Either:
    • 3+ behavioral variant
    • languange variant
  3. Sparing of learning/ memory and perceptual motor (differentiates from AD)
21
Q

Disinhibition, apathy/ inertia, loss of sympaty/ empathy, perseverative/ stereotyped behavior, hyperorality, and prominent decline in social cognitive/ executive function describe what?

(inertia: emotional states resistant to change)
(hyperorality: tendency to examine objects by mouth)

A

Behavioral variants

(part of DSM-5 criteria for frontotemporal degeneration)

22
Q

Decline in speech, word finding, naming, grammar or comprehension describe what?

A

Language variants

(part of DSM-5 criteria for frontotemporal degeneration)

23
Q

What is the DSM-5 criteria specific to Lewy body disease? (3)

A
  1. Insidious onset, gradual progression in 1+ cognitive domains
  2. Core diagnostic features (1+)
    • Fluctuating cognition
    • Visual hallucinations
    • Parkinsonism
  3. Suggestive diagnostic features (1+)
    • REM sleep disorder
    • Severe neuroeleptic sensitivity
24
Q

What is the DSM-5 criteria specific to vascular disease? (2)

A
  1. Consistent w/ vascular etiology w/
    • onset related to CV event OR
    • decline in complex attn/ frontal-exec functions
  2. Evidence of CV disease (H+P or neuroimaging)
25
Q

Vascular dementia/ NCD is aka?

A

Multi-infarct dementia

26
Q

What condition is a/w vascular RFs (HTN, hypercholesterolemia) and usually has neuro deficit from previous CVA?

A

Vascular dementia/ NCD

27
Q

What is useful for dx of vascular dementia/ NCD?

A

Imaging (CT)

28
Q

What is the DSM-5 criteria specific to traumatic brain injury? (2)

A
  1. Evidence of TBI w/ 1+ of:
    1. LOC
    2. Post-traumatic amnesia
    3. Disorientation/ confusion
    4. Neuro signs
  2. NCD presents immediately after TBI or after acute post-injury period
29
Q

What conditions are a/w poorer outcomes for a TBI? (4)

A

Repeated concussions

> 40 yo

Poor motor function

Non-reactive pupils

30
Q

What is the DSM-5 criteria specific to Prion disease?

A
  1. Insidious onset, rapid progression
  2. Motor features (myoclonus, ataxia, biomarker evidence)
31
Q

Creutzfeldt-Jakob disease, Kuru, and ‘mad cow’ are examples of what condition?

A

Prion disease

32
Q

What disease usually lasts < 6 months and is a/w psychiatric sxs and characteristic EEG patterns?

A

Prion disease

33
Q

NCD due to Parkinson’s disease exhibits what sxs and is exacerbated by what?

A

Motor sxs- tremor, rigidity, bradykinesia, postural instability

Exacerbated by depression

34
Q

Pt presents with forgetfulness, slowness, poor problem solving abilites, poor concentration, apathy and delirium. PE shows tremor and ataxia. You are concerned for NCD due to what?

A

HIV (can usually isolate in CSF)

35
Q

What NCD is a/w an autosomal dominant gene, has an onset in late 30s to 40s and exhibits choreiform movements?

A

Huntington’s dementia

36
Q

What imaging finding is a/w Huntington’s dementia?

A

Boxcar ventricles

37
Q

Does a pt with an NCD typically present with complaint of “memory loss”?

A

NO- spouse, family, friend usually notices/ reports to clinician

38
Q

How do NCDs affect neuro processing?

A

Affect ALL steps

(difficulty: retaining new info, complex tasks, reasoning, spatial ability/ orientation, language, behavior)

39
Q

What cognitive tests are used to eval dementia?

A

Neuropsych testing

MMSE (high false negatives)

40
Q

How is dementia diagnosed?

A

Clinically

Postmortem pathology only definitive confirmation

41
Q

What is included in the general management of dementia? (4)

A

Tx of cognitive sxs

Behavioral management

EDU/ caregiver support

Prevention

42
Q

What drugs are FDA approved for the tx of AD? (4)

A

Donepezil

Galantamine

Memantine

Rivastigmine

43
Q

What supplements may have a small benefit for dementia?

A

Vit E/ Selegiline

Anti-oxidants

Anti-inflammatories

44
Q

What modifiable RFs are a/w dementia?

A

Level of EDU/ cognitive training

CV fitness

Healthy diet

5. Psychiatry (19 decks)

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