6. Major and minor neurocognitive disorders (Dementia): etiology, diagnostic criteria, and clinical management Flashcards

1
Q

Neurocognitive disorder def

A

a group of conditions defined by a decline from a previous level of cognitive functioning.

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2
Q

six cognitive domains that may be affected in neurocognitive disorders

A

1) Complex attention
*
2) Executive function
*
3) Learning and memory

4) Language
*
5) Perceptual-motor skills
*
6) Social cognition (interaction

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3
Q

The DSM-5 divides the NCDs into

A

three main categories:
* delirium,
* minor NCDs, and
* major NCDs (dementia).

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4
Q

Minor NCDs

A

individuals with mild cognitive impairment.

These individuals have trouble with some of the more complex activities of living but are able to maintain their independence

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5
Q

Major NCDs

A

: these individuals require assistance with independent activities of daily living (e.g., paying bills, managing medications, or shopping for groceries).

Over time, the basic activities of daily living (e.g., feeding, toileting, and bathing) are affected, eventually leading to total dependence.

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6
Q

The dementias are —- and —–

A

progressive and irreversible major NCDs that primarily affect the elderly.

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7
Q

what is dementia

A

Dementia is not a disease,
but rather a set of symptoms comprising poor memory, and difficulties with learning and language.

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8
Q

dementia dsm5

A
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9
Q

name other major NCDs present similarly to the dementias, but their progression may be arrested or even reversed with treatment

A
  • vitamin B12 deficiency,
  • thyroid dysfunction)
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10
Q

Pseudodementia def

A
  • symptoms of major depression in the elderly often include problems with memory, concentration, and cognitive functioning.
  • Because this clinical picture may be mistaken for a major NCD (dementia), it is termed pseudodementia; the presence of apparent cognitive deficits in patients with major depression.
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11
Q

Diagnosis dementia

A
  • Mini Mental State Exam (MMSE):
    *Assess orientation, attention/concentration, language, constructional ability, immediate and delayed recall
  • Mini-Cog: item recall (3 items) and clock-drawing tasks
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12
Q

Mini Mental State Exam (MMSE is sensitive for which NCDs

A

Sensitive for major NCDs (dementias), particularly moderate-to-severe forms

Maximal score: 30,
dysfunctional score: < 25

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13
Q

etiology of dementia

A
  • Alzheimer’s disease (most common)
  • Vascular dementia
  • Lewy body dementia
  • Frontotemporal dementia
  • Prion disease
  • Normal pressure hydrocephalus
  • HIV infection
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14
Q

Alzheimer’s disease characteristics

A

Gradual progressive decline in cognitive functions; primary domains affected are memory, learning, and language

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15
Q

etiology of alzheimers

A

Accumulation of
* extra-neuronal beta-amyloid plaques and
* intra-neuronal tau protein tangles
→ result in brain atrophy

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16
Q

Alzheimer’s disease types

A

o Sporadic type: 95%
▪Late onset
▪Genetic and environmental factors

o Familial type:
▪Early onset
▪Dominant gene

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17
Q

Alzheimer’s disease treatment

A

o Cholinesterase inhibitors (rivastigmine, galantamine)
o NMDA receptor antagonist (memantine)
o Supportive care via behavioral, social, and environmental interventions

Lecanemab

18
Q

Vascular dementia how does it happen

A

Cognitive decline 2° to: large vessel strokes, small vessel strokes, or microvascular disease affecting the periventricular white matter

oLong-term poor blood flow to the brain → ischemic stroke → permanent tissue damage
▪The brain tissue liquefies → liquefactive necrosis
▪As a result, there is a loss of mental function

19
Q

which cognitive domains are lost in vascular dementia

A

Complex attention and executive function are the cognitive domains typically affected in small vessel disease

20
Q

in vascular dementia Symptoms vary depending on

A

the region of damage

21
Q

Vascular dementia treatment

A

o
Prevent further strokes
o
Supportive and symptomatic care

eg. prevent Hypertension

22
Q

Lewy body dementia

A

Lewy bodies (accumulation of alpha-synuclein) in the brain, primarily in the basal ganglia

23
Q

which cognitive domain affective in lewy body dementia

A

Waxing and waning of cognition esp
attention and alertness

24
Q

symptoms in lewy body dementia

A
  • Visual hallucinations (usually vivid, colorful, well-formed images)
  • REM sleep behavior disorders
  • Called Lewy body dementia if there is development of extrapyramidal signs (Parkinsonism) and cognitive decline start less than 1 year apart
25
Q

Lewy body dementia treatment

A

o Cholinesterase inhibitors → for cognitive and behavioral symptoms
o Quetiapine or clozapine → for psychotic symptoms
o Levodopa-carbidopa → for Parkinsonism
o Melatonin or clonazepam → for sleep disorder

26
Q

Frontotemporal dementia

A
  • Marked atrophy of the frontal and temporal lobes (visible on brain imaging)
  • Early changes in personality and behavior
27
Q

Frontotemporal dementia subtypes

A

o Behavioral variant: disinhibited verbal, physical, or sexual behavior

o Language variant: difficulties with speech and comprehension

28
Q

Frontotemporal dementia treatment

A

o Symptom-focused approach
o Serotonergic medications (SSRIs) → may help reduce disinhibition, anxiety, impulsivity, and repetitive behavior

29
Q

Prion disease what is it

A

Subacute spongiform encephalopathy caused by proteinaceous infectious particles

The most common type is Creutzfeldt-Jakob disease

30
Q

Prion disease onset

A

Insidious onset with rapidly progressive cognitive decline

31
Q

prion disease symptoms

A
  • Difficulties with concentration, memory, and judgment occur early
  • More than 90% of patients experience myoclonus
  • nystagmus, and hypokinesia (due to Basal ganglia and cerebellar dysfunction)
32
Q

Prion disease: definitive diagnosis done by

A

brain tissue analysis (biopsy or autopsy)

33
Q

Prion disease treatment

A

no effective treatment is available; most patients die within 1 year of diagnosis

34
Q

Normal pressure hydrocephalus

A

*
Enlarged ventricles with an episodic elevation of CSF pressure

35
Q

Normal pressure hydrocephalus etiology

A

*
Idiopathic
or
secondary to obstruction of CSF reabsorption sites

36
Q

Normal pressure hydrocephalus Characteristic triad of:

A

1) gait disturbance
2) urinary incontinence
3) cognitive impairment → executive dysfunction, psychomotor retardation

37
Q

Normal pressure hydrocephalus treatment

A

o
Lumbar puncture
o
Ventriculoperitoneal shunt

38
Q

HIV infection

A

The most common infectious agent to cause cognitive impairmen

39
Q

HIV infection: neurocognitive impaiment presentation

A

Variable presentation depending on the part of the brain affected

40
Q
A
41
Q

in HIV infection congntive impairement
Decline may be observed in

A

executive functioning,
attention,
working memory and
motor activity

42
Q

HIV infection treatment

A

antiretroviral therapy