chapter 14

Question 1

what determines impact and range of symptoms in disorders

Answer 1

Psychological and environmental factors play key roles in determining the impact and range of the symptoms in these disorders

Think neuroCOGNITIVE

Question 2

Neurocognitive disorders

Answer 2

Arise when the brain is either damaged or impaired in its ability to function due to injury, illness, exposure to toxins, or use or abuse of psychoactive drugs

Not psychologically based

May become completely dependent on others to meet basic needs in feeding, toileting, and grooming

Question 3

types of Neurocognitive disorders

Answer 3

Delirium
Major neurocognitive disorder
Mild neurocognitive disorder
Subtypes of major and mild neurocognitive disorders

Question 4

Causes of neurocognitive disorders

Answer 4

Physiology
Medical conditions
Drug use
Drug withdrawal
Exposure to toxins

Question 5

impacts of Neurocognitive disorders

Answer 5

Specific brain regions and neural pathways in the brain
Cognitive functions
- Thinking
- Memory
- Attention
Extent and location → range and severity of problems

Question 6

Delirium

Answer 6

A state of extreme mental confusion, disorientation, and difficulty focusing attention

Causes: head trauma, higher fevers due to infections, metabolic disorders, adverse medication interactions, underlying medical conditions, drug abuse, fluid/electrolyte imbalances, seizure disorders, etc

Question 7

criteria of Delirium

Answer 7

A) A disturbance in attention accompanied by reduced awareness of the environment
B) The disturbance develops over a short period of time, represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day
C) An additional disturbance in cognition
D) The disturbance in Criteria A and C are not twitter explained by another preexisting, established, or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal, such as comma
E) There is evidence from the history, physical examination, or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal, or exposure to a toxin, or is due to multiple etiologies

Question 8

specify if (delirium)

Answer 8

Timeline
- Acute
- Persistent

Activity level
- Hyperactive
- Hypoactive
- Mixed level of activity

Etiology
- Substance intoxication delirium
- Substance withdrawal delirium
- Medication-induced delirium
- Delirium due to another medical condition
- Delirium due to multiple etiologies

Question 9

Major Neurocognitive Disorder

Answer 9

AKA dementia

Usually occurs in people over the age of 80 - not a consequence of normal aging
- A sign of degenerative brain disease such as AD

A decline or deterioration in mental functioning characterized by significant impairment of memory, thinking processes, attention, and judgment and by specific cognitive deficits

Question 10

criteria of Major Neurocognitive Disorder

Answer 10

A) Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition) based on:
1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a significant decline in cognitive function; and
2. A substantial impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment.

B) The cognitive deficits interfere with independence in everyday activities (i.e., at a minimum, requiring assistance with complex instrumental activities of daily living such as paying bills or managing medications).

C) The cognitive deficits do not occur exclusively in the context of a delirium.

D) The cognitive deficits are not better explained by another mental disorder (e.g., major depressive disorder, schizophrenia).

Question 11

specify due to (Major Neurocognitive Disorder)

Answer 11

Specify severity:
Mild: Difficulties with instrumental activities of daily living (e.g., housework, managing money).
Moderate: Difficulties with basic activities of daily living (e.g., feeding, dressing).
Severe: Fully dependent.

Specify:
With agitation: If the cognitive disturbance is accompanied by clinically significant agitation.
With anxiety: If the cognitive disturbance is accompanied by clinically significant anxiety.
With mood symptoms: If the cognitive disturbance is accompanied by clinically significant mood symptoms (e.g., dysphoria, irritability, euphoria).
With psychotic disturbance: If the cognitive disturbance is accompanied by delusions or hallucinations.
With other behavioral or psychological disturbance: If the cognitive disturbance is accompanied by other clinically significant behavioral or psychological disturbance (e.g., apathy, aggression, disinhibition, disruptive behaviors or vocalizations, sleep or appetite/eating disturbance).
Without accompanying behavioral or psychological disturbance: If the cognitive disturbance is not accompanied by any clinically significant behavioral or psychological disturbance.

Aphasia, Apraxia, Agnosia, Disturbance in executive functioning

Question 12

Mild Neurocognitive Disorder

Answer 12

Mild deterioration of cognitive functioning in which a person is able to perform tasks of daily living but needs to put in greater effort or compensate in other ways to maintain independent functioning

New name for a clinical syndrome widely identified as mild cognitive impairment (MCI)
- Increases with age
- Occurs frequently in the early stages of neurodegenerative diseases like AD

Question 13

criteria of Mild Neurocognitive Disorder

Answer 13

A) Evidence of modest cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition) based on:
1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a mild decline in cognitive function; and
2. A modest impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment.

B) The cognitive deficits do not interfere with capacity for independence in everyday activities (i.e., complex instrumental activities of daily living such as paying bills or managing medications are preserved, but greater effort, compensatory strategies, or accommodation may be required).

C) The cognitive deficits do not occur exclusively in the context of a delirium.

D) The cognitive deficits are not better explained by another mental disorder (e.g., major depressive disorder, schizophrenia).

Question 14

Alzeheimer’s Disease

Answer 14

A progressive brain disease characterized by gradual loss of memory and intellectual functioning, personality changes, and eventual loss of ability to care for oneself

Form of dementia: general paresis

Question 15

general paresis

Answer 15

“Relaxation” of the brain in its most negative connotation
Resulted form neurosyphilis

Question 16

neurosyphilis

Answer 16

A form of later stage syphilis

Question 17

syphilis

Answer 17

A secually transmited diseased caused by the bacterium Trephonema Pallidum

Question 18

Late-onset dementia

Answer 18

Beginning after the age 65

Question 19

Early-onset dementia

Answer 19

Beginning at 65 or earlier

Question 20

criteria of Alzeheimer’s Disease

Answer 20

A) The criteria are met for major or mild neurocognitive disorder.
B) There is insidious onset and gradual progression of impairment in one or more cognitive domains (for major neurocognitive disorder, at least two domains must be impaired).
C) Criteria are met for either probable or possible Alzheimer’s disease as follows:
- For major neurocognitive disorder:
- For mild neurocognitive disorder:

Question 21

For major neurocognitive disorder (AD)

Answer 21

Probable Alzheimer’s disease is diagnosed if either of the following is present; otherwise, possible Alzheimer’s disease should be diagnosed.

A. Evidence of a causative Alzheimer’s disease genetic mutation from family history or genetic testing.
B. All three of the following are present:
1. Clear evidence of decline in memory and learning and at least one other cognitive domain (based on detailed history or serial neuropsychological testing).
2. Steadily progressive, gradual decline in cognition, without extended plateaus.
3. No evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease, or another neurological, mental, or systemic disease or condition likely contributing to cognitive decline).

Question 22

For mild neurocognitive disorder (AD)

Answer 22

Probable Alzheimer’s disease is diagnosed if there is evidence of a causative Alzheimer’s disease genetic mutation from either genetic testing or family history

Possible Alzheimer’s disease is diagnosed if there is no evidence of a causative Alzheimer’s disease genetic mutation from either genetic testing or family history, and all three of the following are present:
1. Clear evidence of decline in memory and learning.
2.Steadily progressive, gradual decline in cognition, without extended plateaus.
3. No evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease, or another neurological or systemic disease or condition likely contributing to cognitive decline).

Question 23

Symptoms of Alzheimer’s Disease

Answer 23

Trouble managing their finances and basic information
Not aware of their deficits
Movement and coordination functions deteriorate
Talking to themselves; hallucinations and delusions
May lose ability to speak or control body movement

Question 24

Causal Factors

Answer 24

Unknown
Biochemical process of AD and the cerebral cortex?
Genes
Environmental factors

Question 25

Treatment of AD

Answer 25

Drugs - Donepezil → increases levels of the neurotransmitter acetylcholine (ACh) - Azura → blocks the neurotransmitter glutamate Engaging in cognitive activities - puzzles, reading, word games Working out Socializing Avoid smoking

Question 26

Cerebrovascular accident (CVA)

Answer 26

Aka a stroke Occurs when part of the brain becomes damaged because of a disruption in its blood supply, usually as the result of a blood clot that becomes lodged in an artery that services the brain and obstructs circulation Disabilities ini motor, speech, and cognitive functions

Question 27

Vascular Neurocognitive Disorder

Answer 27

Vascular neurocognitive disorder (formerly called vascular dementia or multi-infarct dementia) is a form of major or mild neurocognitive disorder resulting from cerebrovascular events (strokes) affecting the brain. Cerebrovascular accident = stroke Aphasia = loss of ability to understand or express speech, caused by brain damage

Question 28

criteria of Vascular Neurocognitive Disorder

Answer 28

A) The criteria are met for major or mild neurocognitive disorder. B) The clinical features are consistent with a vascular etiology, as suggested by either of the following: 1.Onset of the cognitive deficits is temporally related to one or more cerebrovascular events. 2. Evidence for decline is prominent in complex attention (including processing speed) and frontal-executive function. C) There is evidence of the presence of cerebrovascular disease from history, physical examination, and/or neuroimaging considered sufficient to account for the neurocognitive deficits D) The symptoms are not better explained by another brain disease or systemic disorder

Question 29

Probable vascular neurocognitive disorder is diagnosed if one of the following is present; otherwise possible vascular neurocognitive disorder should be diagnosed:

Answer 29

1. Clinical criteria are supported by neuroimaging evidence of significant parenchymal injury attributed to cerebrovascular disease (neuroimaging-supported). 2. The neurocognitive syndrome is temporally related to one or more documented cerebrovascular events. 3. Both clinical and genetic (e.g., cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) evidence of cerebrovascular disease is present. Possible vascular neurocognitive disorder is diagnosed if the clinical criteria are met but neuroimaging is not available and the temporal relationship of the neurocognitive syndrome with one or more cerebrovascular events is not established

Question 30

Pick’s disease

Answer 30

A form of dementia, similar to Alzheimer’s disease, but distinguished by specific abnormalities (Pick’s bodies) in nerve cells and the absence of neurofibrillary tangles and plaques Men more than women Runs in families

Question 31

amnesia

Answer 31

Memory loss that frequently follows a traumatic event, such as a blow to the head, an electric shock, or a major surgical operation Retrograde amnesia anterograde amnesia

Question 32

Retrograde amnesia

Answer 32

Loss of memory of past events and personal information

Question 33

Anterograde amnesia

Answer 33

Inability or difficulty forming or storing new memories

Question 34

Other causes of amnesia include brain surgery

Answer 34

hypoxia infraction

Question 35

hypoxia

Answer 35

Sudden loss of oxygen to the brain

Question 36

Infarction

Answer 36

Blockage of the blood vessels supplying the brain

Question 37

Frontotemporal Neurocognitive Disorder

Answer 37

Frontotemporal neurocognitive disorder is characterized by deterioration (thinning or shrinkage) of brain tissue in the frontal and temporal lobes of the cerebral cortex. This disorder typically takes the form of progressive dementia symptomatically similar to AD. → Frontal lobe has control over many abilities, including the way you think, how you move and how you remember things. It's also a key part in your social skills, and helps you understand and control how you talk, behave and interact with others.

Question 38

criteria of Frontotemporal Neurocognitive Disorder

Answer 38

A) The criteria are met for major or mild neurocognitive disorder. B) The disturbance has an insidious onset and gradual progression. C) Either (1) or (2): 1.Behavioral variant: a. Three or more of the following behavioral symptoms: 1. Behavioral disinhibition. 2. Apathy or inertia 3. Loss of sympathy or empathy. 4. Perseverative, stereotyped or compulsive/ritualistic behavior. 5. Hyperorality and dietary changes. I. Prominent decline in social cognition and/or executive abilities. 2.Language variant: b. Prominent decline in language ability, in the form of speech production, word finding, object naming, grammar, or word comprehension. D) Relative sparing of learning and memory and perceptual-motor function. E) The disturbance is not better explained by cerebrovascular disease, another neurodegenerative disease, the effects of a substance, or another mental, neurological, or systemic disorder.

Question 39

Probable frontotemporal neurocognitive disorder is diagnosed if either of the following is present; otherwise, possible frontotemporal neurocognitive disorder should be diagnosed:

Answer 39

a.Evidence of a causative frontotemporal neurocognitive disorder genetic mutation, from either family history or genetic testing. b.Evidence of disproportionate frontal and/or temporal lobe involvement from neuroimaging. Possible frontotemporal neurocognitive disorder is diagnosed if there is no evidence of a genetic mutation, and neuroimaging has not been performed.

Question 40

criteria of Neurocognitive Disorder due to Traumatic Brain Injury

Answer 40

A) The criteria are met for major or mild neurocognitive disorder. B) There is evidence of a traumatic brain injury—that is, an impact to the head or other mechanisms of rapid movement or displacement of the brain within the skull, with one or more of the following: 1. Loss of consciousness. 2. Posttraumatic amnesia. 3. Disorientation and confusion. 4. Neurological signs (e.g., neuroimaging demonstrating injury; visual field cuts; anosmia; hemiparesis; hemisensory loss; cortical blindness; aphasia; apraxia; weakness; loss of balance; other sensory loss that cannot be accounted for by peripheral or other causes). C) The neurocognitive disorder presents immediately after the occurrence of the traumatic brain injury or immediately after recovery of consciousness and persists past the acute post-injury period.

Question 41

criteria of Substance/Medication Induced Neurocognitive Disorders

Answer 41

A) The criteria are met for major or mild neurocognitive disorder. B) The neurocognitive impairments do not occur exclusively during the course of a delirium and persist beyond the usual duration of intoxication and acute withdrawal. C) The involved substance or medication and duration and extent of use are capable of producing the neurocognitive impairment. D) The temporal course of the neurocognitive deficits is consistent with the timing of substance or medication use and abstinence (e.g., the deficits remain stable or improve after a period of abstinence). E) The neurocognitive disorder is not attributable to another medical condition or is not better explained by another mental disorder.

Question 42

Korsakoff’s Syndrome:

Answer 42

Associated with chronic alcoholism, characterized by irreversible memory loss due to brain damage resulting from deficiency of vitamin B1

Question 43

Wernicke’s Disease:

Answer 43

Associated with chronic alcoholism, characterized by confusion, disorientation, and difficulty maintaining balance by walking (loss of muscle coordination: ataxia)

Question 44

Neurocognitive Disorder with Lewy Bodies

Answer 44

Neurocognitive disorder due to Lewy body dementia results from abnormal protein deposits that form within the nucleus of cells in parts of the brain Appearance of fluctuating alertness and attention, marked by frequent periods of drowsiness and staring into space No cure

Question 45

criteria of Neurocognitive Disorder with Lewy Bodies

Answer 45

A) The criteria are met for major or mild neurocognitive disorder. B) The disorder has an insidious onset and gradual progression. C) The disorder meets a combination of core diagnostic features and suggestive diagnostic features for either probable or possible neurocognitive disorder with Lewy bodies. D) The disturbance is not better explained by cerebrovascular disease, another neurodegenerative disease, the effects of a substance, or another mental, neurological, or systemic disorder

Question 46

For probable major or mild neurocognitive disorder with Lewy bodies, the individual has two core features, or one suggestive feature with one or more core features. For possible major or mild neurocognitive disorder with Lewy bodies, the individual has only one core feature, or one or more suggestive features.

Answer 46

1. Core diagnostic features: A. Fluctuating cognition with pronounced variations in attention and alertness. B. Recurrent visual hallucinations that are well formed and detailed. C. Spontaneous features of parkinsonism, with onset subsequent to the development of cognitive decline. 2. Suggestive diagnostic features: A. Meets criteria for rapid eye movement sleep behavior disorder. B. Severe neuroleptic sensitivity.

Question 47

Neurocognitive Disorder due to Parkinson’s

Answer 47

Parkinson’s disease is characterized by involuntary shaking or tremors, motor disabilities, and possible cognitive impairment. Parkinson’s disease involves destruction of brain tissue in the substantia nigra of the brain, which plays a role in controlling body movements. The disease also involves reductions in the level of dopamine in the brain. A progressive disease characterized by muscle tremors and shakiness, rigidity, difficulty walking, poor control of fine motor movements, lack of facial muscle tone, and in some cases, cognitive impairment

Question 48

criteria of Parkinson’s

Answer 48

A) The criteria are met for major or mild neurocognitive disorder. B) The disturbance occurs in the setting of established Parkinson’s disease. C) There is insidious onset and gradual progression of impairment. D) The neurocognitive disorder is not attributable to another medical condition and is not better explained by another mental disorder.

Question 49

Major or mild neurocognitive disorder probably due to Parkinson’s disease should be diagnosed if 1 and 2 are both met. Major or mild neurocognitive disorder possibly due to Parkinson’s disease should be diagnosed if 1 or 2 is met:

Answer 49

There is no evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease or another neurological, mental, or systemic disease or condition likely contributing to cognitive decline). Parkinson's disease clearly precedes the onset of the neurocognitive disorder.

Question 50

Neurocognitive Disorder due to Huntington’s

Answer 50

Huntington’s disease is a genetically transmitted disease that involves progressive deterioration in the basal ganglia. The symptoms usually first appear between the ages of 30 and 45 and involve involuntary, jerky movements of the face (grimaces), neck, limbs, and trunk, or so-called choreiform movements, which are accompanied by neurocognitive decline. The disease is progressive, and death usually occurs within 15 to 20 years of the onset of symptoms. An inherited degenerative disease that is characterized by jerking and twisting movements, paranoia, and mental deterioration Caused by a mutation on a single gene

Question 51

criteria of Neurocognitive Disorder due to Huntington’s

Answer 51

A) The criteria are met for major or mild neurocognitive disorder. B) There is insidious onset and gradual progression. C) There is clinically established Huntington’s disease, or risk for Huntington’s disease based on family history or genetic testing. D) The neurocognitive disorder is not attributable to another medical condition and is not better explained by another mental disorder.

Question 52

Neurocognitive Disorder due to HIV

Answer 52

The human immunodeficiency virus can attack the central nervous system, causing progressive decline in mental and motor functioning. Few people develop HIV-related dementia without having full- blown AIDS. As AIDS progresses, the dementia grows more severe, and in later stages it may resemble the profound deficiencies found among people with advanced AD.

Question 53

criteria of Neurocognitive Disorder due to HIV

Answer 53

A) The criteria are met for major or mild neurocognitive disorder. B) There is documented infection with human immunodeficiency virus (HIV). C) The neurocognitive disorder is not better explained by non-HIV conditions, including secondary brain diseases such as progressive multifocal leukoencephalopathy or cryptococcal meningitis. D) The neurocognitive disorder is not attributable to another medical condition and is not better explained by a mental disorder.

Question 54

Neurocognitive Disorder due to Prion disease

Answer 54

Prion disease can cause brain damage when clusters of abnormal prion molecules spread within the brain. Creutzfeldt-Jakob disease is a rare but fatal brain disease characterized by the formation of small cavities in the brain. A variant of Creutzfeldt-Jakob disease is related to mad cow disease, a fatal illness spread by eating infected beef.

Question 55

criteria of Neurocognitive Disorder due to Prion disease

Answer 55

A) The criteria are met for major or mild neurocognitive disorder. B) There is insidious onset, and rapid progression of impairment is common. C) There are motor features of prion disease, such as myoclonus or ataxia, or biomarker evidence. D) The neurocognitive disorder is not attributable to another medical condition and is not better explained by another mental disorder.

Question 56

Anixety x Aging

Answer 56

GAD and Phobic disorders are most common - Fear of outdoors, lack of support - Anxiety over loss of control of livelihood and contention with aging - Anti-anxiety meds are useful, but what else could we use? Anxiety tends to be less prevalent among older adults than among their younger counterparts

Question 57

Depression x Aging

Answer 57

Highest in nursing homes Higher in people of color (institutional and race related stress) Acculturative stress and aging Cooccurrences with neurocognitive disorders Difficulties coping with life changes - THERAPY HELPS!

Question 58

Sleep Problems x Aging

Answer 58

Loneliness, difficult thoughts and anxiety, low coping strategies Sleep problems are common among older people - 50% Sleep medication, but can cause side effects