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chapter 10: neurodevelopmental & neurocognitive Flashcards

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1
Q

what is the difference between neurodevelopmental and neurocognitive

A

neurodevelopmental occurs during childhood and neurocognitive is later in life

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2
Q

ADHD

A

persistent issues with attention and impulsivity
- combined presentation: 6+ inattention and 6+ hyperactivity/impulsivity
- predominantly inattentive: 6+ inattentive and less than 6 of other
- predominately hyperactive/impulsive: 6+ impulsive and less of other
3.4-6% school aged across the world
- symptoms must be present before age 12 and seen in multiple settings
- boys more diagnosed, but girls show more inattentive features so less diagnosed

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3
Q

typical symptoms seen for ADHD

A
  • poor school performance: inability to focus can hinder ability to learn information and perform below their capabilities
  • can cause poor social relationships can be intrusive, irritable, and demanding and can show mood and temper problems
  • common to have comorbid learning disorders: reading, written expression, developmental coordination disorder (20-25% have in addition to ADHD a specific learning disorder)
  • behavioral problems can become severe enough to cause a conduct disorder diagnosis (usually seen in combined ADHD diagnosis) acting uncaring and antisocial
  • 45-60% of children with ADHD will develop conduct disorder, abuse drugs, alcohol, and/or violate the law
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4
Q

long-term outcomes for children with ADHD

A

impairing symptoms into adulthood can persist in 50-78% of cases
increased risk for: antisocial, substance abuse, mood & anxiety disorders, marital problems, traffic accidents, legal infractions, frequent job changes
- 4.4% of adults could be diagnosed with ADHD (most likely male)
- 2X risk of premature death from unnatural causes

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5
Q

biological factors for ADHD

A

-prefrontal cortex: control of cognition, motivation, behavior
-striatum: working memory and planning
- cerebellum: motor behaviors
- cerebral cortex: less connectivity between frontal areas that influence emotional reactions, attention

thought that ADHD children are develop cognitively slower than normal children so its hard to maintain attention and behavioral control at age-appropriate level

  • catecholamine neurotransmitters: dopamine & norepinephrine
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6
Q

psychological and social factors

A

families that experience frequent disruptions and parents prone to aggressive and hostile behavior, substance abuse ( could be shared genetic component)
-family interaction patterns especially during early childhood has big influence on severity of ADHD

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7
Q

treatment for ADHD bio

A

usually stimulant drug (ritalin, dexedrine, and adderall) and 70-85% respond with decrease in demanding, disruptive, and noncompliant behavior
- may increase levels of dopamine in synapse, enhance release, and inhibit reuptake
- drugs that impact norepinephrine levels (guanfacine) help reduce tics and increase cognitive performance but have side effects (constipation, dizziness, dry mouth, etc)

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8
Q

therapy for ADHD

A

reinforcing attentive, goal-directed and prosocial behaviors and extinguishing impulsive and hyperactive behaviors
- behavioral therapy highly effective

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9
Q

autism spectrum disorder

A
  1. deficit in social interactions and communications
    - usually beginning of life will see not smiling, or cooing as a baby.
    - they usually do not cuddle and will not make eye contact, delayed language development
  2. restricted, repetitive patterns of behavior, interests, and activities
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10
Q

typical symptoms seen in Autism spectrum disorder

A
  • 25-30% of school aged children do not develop useful speech or do not use speech as expected for age
  • instead of engaging in play with toys they become preoccupied with one feature
  • routines and rituals are extremely important
  • usually symptoms are seen early childhood by age 2 (most predictive is language development and IQ before 6)
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11
Q

what is echolalia

A

in autism instead of generating words individuals just repeat what they hear and will reverse pronouns saying you instead of I

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12
Q

contributors to autism spectrum disorder

A
  • definite genetic component - higher rate of other genetic disorders associated with cognitive impairment (fragile X, PKU)
  • several gene abnormalities not just one associated with autism
  • seizure disorder
  • greater head and brain size
  • abnormalities in cerebellum, cerebrum, amygdala, and possibly hippocampus
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13
Q

prenatal environment and ASD

A
  • possible maternal gut microbiome imbalance could be associated with abnormalities in brain function and behavior in offspring
    -MIA (maternal inflammatory response) response due to stress, infection, asthma, allergies, etc acts like disease primer to fetus and makes them vulnerable to more “hits”
  • too many cytokines
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14
Q

treatment for autism spectrum disorder

A
  • selective serotonin reuptake: reduce repetitive behavior and aggression
  • atypical antipsychotic medications: more reliable to reduce obsessive and repetitive behaviors, improve self-control
    -stimulants: improve attention

Therapy:
- operant conditioning: reduce repetitive/ritualistic behaviors tantrums, and aggression and deficits or delays in communication and interactions
- behavioral: reinforce socially acceptable behaviors and decrease/eliminate undesirable ones

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15
Q

intellectual disorder

A

significant deficits in intellectual abilities and life functioning: abstract thinking, reasoning, learning, problem solving, planning

deficits in three domains (conceptual, social, practical)

1-3% of population has

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16
Q

levels of severity of ID

A

mild: some limitations in typical academic and job skills but can hold a job

moderate: can be physically clumsy and usually dont achieve beyond 2nd grade academic skills, but with special education could. need training for personal needs

severe: require support in all aspects of daily living, they can feed themselves with spoon and dress but have to be simple clothing

profound: co-occuring sensory and motor impairments and limit participation to usually just watching, require assistance with everything

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17
Q

what do intelligence tests measure

A

verbal comprehension, working memory, perceptual reasoning, quantitative reasoning, abstract thought, processing speed

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18
Q

intellectual developmental disorder (biological)

A

chromosomal, gestational disorders, exposure to toxins, brain injury, metabolism and nutritional problems seizure disorders

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19
Q

genetic factors in ID

A
  • 300 genes associated with
  • PKU cant metabolize phenylalanine and builds up to cause brain damage 1:20,000 births
  • tay-sachs child around 3-6 months will experience degeneration of nervous system and will pass by age 6
  • down syndrome (triple 21 chromosome)
  • fragile X (tip of X chromosome - usually seen more in males)
  • fetal alcohol syndrome
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20
Q

fetal alcohol syndrome

A

2-15 children per 10,000
- 10% of women around the world drink during pregnancy and 1:67 will deliver baby with alcohol syndrome highest in European region

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21
Q

other ways during early childhood ID can occur

A
  • shaken baby syndrome ( bleeding in brain or behind eyes as a result can lead to seizures, partial/total blindness, paralysis, ID, and death)
  • toxins: lead, arsenic, mercury
  • accidents that lead to brain trauma -> ID
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22
Q

sociocultural factors of ID

A
  • more likely from lower SES background
  • poor mothers are less likely to receive good quality prenatal care, etc. lower income schools have less favorable teaching environments
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23
Q

treatments for ID: drugs

A
  • meds to reduce seizures which are common
  • neuroleptic meds: reduce aggressive, destructive, antisocial behavior
  • atypical antipsychotics to help aggression and self-injury
  • antidepressants
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24
Q

behavioral treatment: ID

A

enhance positive behavior and reduce negative ones
- work in steps towards one large major goal
- parent training

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25
Q

social programs for ID

A
  • the early intervention the better outcome, may start days after birth to reduce social conditions (abuse, malnutrition, exposure to toxins, etc) that could have an adverse effect on children’s development

ex: infant health and development program for those under 5.5 lbs or born before 37 weeks. health provider visit house within 3 years to enhance development

-mainstreaming:opportunities for inclusion for student with ID and special needs are combined into traditional classrooms with peers
- group homes: provide assitance with daily tasks can help with social and vocational skills

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26
Q

specific learning disorder

A

deficit in 1 or more academic skills: reading, written expression, mathematics. for diagnosis their performance has to be significantly lower than what is expected for age, schooling/ overall intelligence
- 40% never finish high school because they have to work extremely hard to sometimes still fail

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27
Q

reading: SLD

A

dyslexia: poor reading accuracy, slow reading rate, and reading comprehension weakness
- 7% of children, more in boys

28
Q

math: SLD

A

problem with understanding mathematical terms, recognizing numeric symbols, clustering objects, counting, mastering math facts, understanding mathematical principles
- occurs in 1% of children

29
Q

communication disorders

A
  • language: difficulties with spoken, written, sign language problem with vocabulary, grammar, narrative
  • speech sound: difficulty producing speech, substitution of letters in words, omitting final consonant (high prevalence in preschool age)
  • childhood-onset fluency disorder: stuttering usually worse with under pressure speaking
  • social communication: problem using verbal and nonverbal for social purposes
30
Q

brain structure differences in those with learning disorders

A
  • reading: use broca’s ares for analyzing words. parietotemporal: map visual perception of printed words in basic structures of language, occipitotemporal: rapid, automatic identification of words
31
Q

treatment learning disorders

A

through disabilities education act each individual has individualized education act (IEP) to help with schooling which can change brain functioning

32
Q

tic motor disorders

A
  • tourettes and persistent motor/ vocal tic disorder
  • have to be present for at least 12 months
  • prevalence of 1% (tourettes) and 3-4% motor/vocal tic
  • individuals can usually tell when a tic is imminent and urge is reduced by tic behavior, tics increases under stress and don’t have other activities to do
  • comorbid with OCD, ADHD, ASD, anxiety and affective disorders
33
Q

what is a “tic”

A

sudden rapid, recurrent non-rhythmic motor movements or vocalizations
- motor: neck stretching, facial grimacing, eye blinking, jerking arm leg or head
- vocal: throat clearing, sniffing, and grunting

34
Q

Tourette’s

A
  • usually have multiple motor tics, and one or more vocal tics
  • 1-% have complex vocal tic includes uttering/ shouting obscenities
  • usually more debilitating and comorbid with other disorders (OCD and ADHD)
35
Q

persistent motor/ vocal tic disorder

A

have only motor or vocal tics NOT both

36
Q

stereotypic movement disorder

A

repetitive purposeless motor behavior (hand shaking, hair twirling, body rocking, head banging, self-biting)

  • differ from tics because they engage for an extended period
  • usually seen in people with other disorders like ASD, ID, ADHD
37
Q

what are the similarities of torette’s, vocal/motor disorder, and stereotypic movement disorder

A
  • usually begin in childhood, increase during adolescents and decline in adulthood
  • dysfunction in dopamine systems in area of brains that control motor behavior (cerebrum, basal ganglia, and frontal cortex)
  • Tourette’s & persistent motor/vocal tic respond to drugs that alter dopamine system
  • habit reversal therapy: triggers and signs of tics are identified and taught to engage in competing behaviors
  • tic awareness training, relaxation, contingency management all part of behavioral therapy
38
Q

developmental coordination disorder

A

deficits or delays in developing motor skills like sitting or crawling and writing or coloring
CANNOT be due to medical conditions like muscular dystrophy
- 5-6% prevalence in children more boys than girls

39
Q

mild and major neurocognitive disorders

A

result from medical conditions that cause impairment in cognition or from substance intoxication or withdrawal

  • cognitive problems include: memory loss, language disturbances, perceptual disturbances
40
Q

major neurocognitive disorder

A
  • dementia known for degenerative disorders like Alzheimers
  • cant remember fundamental facts about themselves or be able to complete basic daily tasks
  • 5-10% prevalence in those over 65
  • 30% over 85
41
Q

symptoms of major cognitive disorder

A
  • in beginning will have usually memory lapses like others but memory does not return simultaneously or with cues
  • will repeat questions because they do not remember asking them moments before
  • lose of executive functioning: can plan, initiate, monitor, or complex behaviors
  • inability to control impulses like shoplifting and exhibitionism
42
Q

aphasia

A

deterioration of language, and experience difficulty producing name of object or person and will often refer to items as things or a vague discription

43
Q

palilalia

A

repeating sounds or words over and over

44
Q

echolaia

A

repeating what they hear

45
Q

apraxia

A

impairment of ability to execute common actions like waving or putting on a shirt - not due to motor functioning, sensory, or comprehending the action asked

46
Q

agnosia

A

failure to recognize objects or people

47
Q

neurocognitive disorder due to Alzheimer’s disease

A
  • progressive cognitive decline, usually starts with inability to form recent memories and begin to experience psychiatric symptoms like irritability and dysphoria
  • can become violent and could experience hallucinations or delusions
  • usually pass within 8-10 yrs of diagnosis
48
Q

brain abnormalities in those with Alzheimers

A

neurofibrillary tangles (rare in those without NCD): protein called tau stop nutrients moving through cell and it dies around nerve cells

plaque: beta-amyloid proteins in cells around cerebral cortex, hippocampus, amygdala and other structures for memory and cognition

  • cell death resulting is shrinkage of cortex and enlargement of ventricles of brain
49
Q

causes of Alzheimer’s disease

A
  • highly heritable
  • lifetime risk 1.8-4x higher in those with a family history
  • ApoE egen on chromosome 19 has three alleles if someone gets e4 allele from 1 parent have 2-4x greater risk then those who did not have e4. if someone has 2 e4 from both parents they are 8-12x greater risk
  • brain imaging of those with e4 show reduced cortex and hippocampus volume compared to those without (even as children and adolescent)
  • possible another allele on chromsome 21 - reason for those with down syndrome are more likely to have AD (abnormal production and buildup of amyloid proteins
50
Q

how many people have alzheimers

A

5.5 million people in US and 18 million worldwide, this is suppose to increase by 300% by 2050 and cost $400 million

51
Q

vascular neurocognitive disorder

A

declines in processing speed, ability to pay attention, and executive functioning - have to have evidence of cerebrovascular disease (blood supply to areas of brain is blocked)
- greater risk in those who have had a stroke, are older, have less education, and history of stroke or diabetes
-greater risk in those with oxygen or blood deficiency like seizures, cardiac arrhythmias, congestive heart failure, and pneumonia

52
Q

what are some neurocognitive disorders associated with medical conditions

A
  1. parkinsons
  2. lewy body disease
  3. HIV
  4. Huntington’s
53
Q

what are the primary symptoms of parkinson’s

A

tremors, muscle rigidity, inability to initiate movement
- 75% of those with the disease will develop neurocogntive disease

54
Q

lewy body disease ( NCD due to this disease is the leading cause of non-Alzheimers related NCD)

A

progressive cognitive impairment, motor, and sleep dysfunction
- can experience visual hallucinations, delusions, and depressive symptoms (overlap in symptoms with parkinsons disease

55
Q

HIV

A

impacts roughly 38 million and an cause mild/major NCD
- 50% have HIV associated ND called HAND that occurs from chronic neuroinflammation from the presence in the brain and persistent disruptions of microorganisms in the gut
- suffer from cognitive impairment: attention, processing speed, executive functioning
- once symptoms become global and severe impacting daily activities they will give a diagnosis

56
Q

huntingtons disease

A

usually seen between 25-55 yrs of age, will develop major NCD chorea (irregular jerks, grimaces, and twitches)
- transmitted through single dominant gene on chromosome 4 (if one parent has child will have 50% change of inheriting)

57
Q

NCD due to TBI

A

usually from penetrating injuries (gunshot) or concussive forces (car accident)
- can experience disruption in emotional functioning, irritability, personality changes, speech and gait abnormalities

58
Q

veterans

A

9.6% diagnosed with TBI
75-80% classified as mild

59
Q

treatments and prevention of neurocognitive disorder

A

drugs:
- cholinesterase inhibitors (prevent breakdown of acetylcholine) but has side effects
- 2nd class of drug regulates glutamate breakdown (neurotransmitter for memory and learning)
many other drugs around but help secondary symptoms: antidepressants, antipsychotics
therapy:
- behavioral to control outbursts

59
Q

alzheimers disease stats

A

30 mill worldwide and 4.6 mil new cases annually
- women more likely to be diagnosed and with greater cognitive impairment
- african amercian and caribbean hispanics higher rates than european americans (more likely to have vascular NCD but europeans higher genetic component)

60
Q

delirium

A

disorientation, memory loss, clouding of attention
- signs arise suddenly, fluctuate throughout day and can be worse at night (sundowning)
- can experience incoherent speech, delusions, hallucinations
- 11-42% of patients admitted to hospital over 65
- usually short term than long term memory goes
- usually sign of serious medical condition, when condition is treated it can temporary and reversible

61
Q

what causes delirium

A

neurocogntive disorder, stroke, congestive heart failure, infectious disease, higher fever, illicit drugs, HIV, electrolyte imbalances, med side effects, toxic substances
- 18-35% of older adults admitted to hospital present with and 11-14% will present during stay at hospital
- sensory isolation (ICU psychosis from unfamilar surroundings and machine sounds they think are people talking

62
Q

risk factors for delirium

A
  • older the more at risk
  • men
    -pre-existing brain damage or neurocogntivie disorder
  • african american higher rates
63
Q

treatment for delirium

A
  • treat condition that is causes it
  • antipsychotics for confusion and agitation
  • familiar surroundings
    -psychosocial to help sleep, address sensory issues, mobility, etc)
64
Q

childhood disintegrative disorder (heller’s syndrome)

A

rare condition where children develop normally till 3 and then suddenly lose language, motor, social, and other learned skills can be part of autism spectrum disorder

65
Q

Rett Syndrome

A

usually only seen in females and affects nervous system of all body movement
- speech problems, inability to learn to speak or loos speech
- difficulty walking and purposeful hand use

Psych Exam 3 (4 decks)

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