3- Neurocognitive Disorders Flashcards
What are the 6 broad categories of neurocognition?
- Complex attention
- Executive function
- Learning and memory
- Language
- Perceptual-motor
- Social cognition
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?
Delirium (aka acute confusional state)
What is the DSM-5 criteria for delirium? (5)
- Disturbance in attention and awareness
- Develops over short period of time + fluctuates
- Disturbance in cognition
- Not better explained by NCD/ reduced level of arousal
- Physiological consequence
What must be specified for a DSM-5 dx of delirium? (3)
Substance intoxication vs withdrawal delirium
Acute vs persistent
Hyperactive vs hypoactive vs mixed
Age > 70yo, poor functional status, hearing/ visual impairment, dehydration, sleep deprivation, metabolic derangement, infection, and polypharmacy are all RFs for what condition?
Delirium
What 3 things should be avoided or used with caution in the practice of geriatric medicine? (3)
Benzos/ sedative-hypnotics
Physical restraints
Antipsychotics
What general non-pharmacologic measures are used for the tx of delirium?
Reassure, reorient, education
How does the onset differ between dementia and delirium?
Dementia- progressive, insidious
Delirium- acute, rapid
Disturbance of consciousness, fluctuation of sxs, and attention deficit are characteristic of dementia or delirium?
Delirium
How can you differentiate between major vs minor neurocognitive disorder?
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
What are the similaries between major and minor neurocognitive disorder?
Deficits do not occur due to delirium
Not better explained by another mental disorder
What must be specified for DSM-5 criteria of major NCD? (3)
Which NCD
With/ without behavioral disturbance
Severity of interference
What must be specified for DSM-5 criteria of minor NCD? (2)
Which NCD
With/ without behavioral disturbance
DSM-5 criteria for ALL NCDs includes what?
Criteria met for major or mild NCD
Not better explained by other disease/ disorder
What is the DSM-5 criteria specific to Alzheimer’s Disease (AD)? (2)
- Insidious onset, gradual progression in 1+ cognitive domains
- Probable or possible AD
How do you define probable (vs possible) AD?
Evidence of causative agent +
- Clear memory decline + 1 other domain
- Steadily progressive, gradual, no extended plateaus
- No evidence of mixed etiology
At what age is AD considered early onset?
Under 65 yo
What populations are a/w higher rates of AD?
Repeated head trauma
Down Syndrome
What is the only way to confirm dx of AD?
Histopathology
What is the DSM-5 criteria specific to frontotemporal degeneration? (3)
- Insidious onset, gradual progression
- Either:
- 3+ behavioral variant
- languange variant
- Sparing of learning/ memory and perceptual motor (differentiates from AD)
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)
Behavioral variants
(part of DSM-5 criteria for frontotemporal degeneration)
Decline in speech, word finding, naming, grammar or comprehension describe what?
Language variants
(part of DSM-5 criteria for frontotemporal degeneration)
What is the DSM-5 criteria specific to Lewy body disease? (3)
- Insidious onset, gradual progression in 1+ cognitive domains
- Core diagnostic features (1+)
- Fluctuating cognition
- Visual hallucinations
- Parkinsonism
- Suggestive diagnostic features (1+)
- REM sleep disorder
- Severe neuroeleptic sensitivity
What is the DSM-5 criteria specific to vascular disease? (2)
- Consistent w/ vascular etiology w/
- onset related to CV event OR
- decline in complex attn/ frontal-exec functions
- Evidence of CV disease (H+P or neuroimaging)
Vascular dementia/ NCD is aka?
Multi-infarct dementia
What condition is a/w vascular RFs (HTN, hypercholesterolemia) and usually has neuro deficit from previous CVA?
Vascular dementia/ NCD
What is useful for dx of vascular dementia/ NCD?
Imaging (CT)
What is the DSM-5 criteria specific to traumatic brain injury? (2)
- Evidence of TBI w/ 1+ of:
- LOC
- Post-traumatic amnesia
- Disorientation/ confusion
- Neuro signs
- NCD presents immediately after TBI or after acute post-injury period
What conditions are a/w poorer outcomes for a TBI? (4)
Repeated concussions
> 40 yo
Poor motor function
Non-reactive pupils
What is the DSM-5 criteria specific to Prion disease?
- Insidious onset, rapid progression
- Motor features (myoclonus, ataxia, biomarker evidence)
Creutzfeldt-Jakob disease, Kuru, and ‘mad cow’ are examples of what condition?
Prion disease
What disease usually lasts < 6 months and is a/w psychiatric sxs and characteristic EEG patterns?
Prion disease
NCD due to Parkinson’s disease exhibits what sxs and is exacerbated by what?
Motor sxs- tremor, rigidity, bradykinesia, postural instability
Exacerbated by depression
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?
HIV (can usually isolate in CSF)
What NCD is a/w an autosomal dominant gene, has an onset in late 30s to 40s and exhibits choreiform movements?
Huntington’s dementia
What imaging finding is a/w Huntington’s dementia?
Boxcar ventricles
Does a pt with an NCD typically present with complaint of “memory loss”?
NO- spouse, family, friend usually notices/ reports to clinician
How do NCDs affect neuro processing?
Affect ALL steps
(difficulty: retaining new info, complex tasks, reasoning, spatial ability/ orientation, language, behavior)
What cognitive tests are used to eval dementia?
Neuropsych testing
MMSE (high false negatives)
How is dementia diagnosed?
Clinically
Postmortem pathology only definitive confirmation
What is included in the general management of dementia? (4)
Tx of cognitive sxs
Behavioral management
EDU/ caregiver support
Prevention
What drugs are FDA approved for the tx of AD? (4)
Donepezil
Galantamine
Memantine
Rivastigmine
What supplements may have a small benefit for dementia?
Vit E/ Selegiline
Anti-oxidants
Anti-inflammatories
What modifiable RFs are a/w dementia?
Level of EDU/ cognitive training
CV fitness
Healthy diet
