chapter 14 Flashcards
what determines impact and range of symptoms in disorders
Psychological and environmental factors play key roles in determining the impact and range of the symptoms in these disorders
Think neuroCOGNITIVE
Neurocognitive disorders
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
types of Neurocognitive disorders
Delirium
Major neurocognitive disorder
Mild neurocognitive disorder
Subtypes of major and mild neurocognitive disorders
Causes of neurocognitive disorders
Physiology
Medical conditions
Drug use
Drug withdrawal
Exposure to toxins
impacts of Neurocognitive disorders
Specific brain regions and neural pathways in the brain
Cognitive functions
- Thinking
- Memory
- Attention
Extent and location → range and severity of problems
Delirium
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
criteria of Delirium
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
specify if (delirium)
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
Major Neurocognitive Disorder
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
criteria of Major Neurocognitive Disorder
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).
specify due to (Major Neurocognitive Disorder)
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
Mild Neurocognitive Disorder
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
criteria of Mild Neurocognitive Disorder
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).
Alzeheimer’s Disease
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
general paresis
“Relaxation” of the brain in its most negative connotation
Resulted form neurosyphilis
neurosyphilis
A form of later stage syphilis
syphilis
A secually transmited diseased caused by the bacterium Trephonema Pallidum
Late-onset dementia
Beginning after the age 65
Early-onset dementia
Beginning at 65 or earlier
criteria of Alzeheimer’s Disease
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:
For major neurocognitive disorder (AD)
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).
For mild neurocognitive disorder (AD)
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).
Symptoms of Alzheimer’s Disease
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
Causal Factors
Unknown
Biochemical process of AD and the cerebral cortex?
Genes
Environmental factors
Treatment of AD
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
Cerebrovascular accident (CVA)
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
Vascular Neurocognitive Disorder
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
criteria of Vascular Neurocognitive Disorder
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
Probable vascular neurocognitive disorder is diagnosed if one of the following is present; otherwise possible vascular neurocognitive disorder should be diagnosed:
- Clinical criteria are supported by neuroimaging evidence of significant parenchymal injury attributed to cerebrovascular disease (neuroimaging-supported).
- The neurocognitive syndrome is temporally related to one or more documented cerebrovascular events.
- 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
Pick’s disease
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
amnesia
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
Retrograde amnesia
Loss of memory of past events and personal information
Anterograde amnesia
Inability or difficulty forming or storing new memories
Other causes of amnesia include brain surgery
hypoxia
infraction
hypoxia
Sudden loss of oxygen to the brain
Infarction
Blockage of the blood vessels supplying the brain
Frontotemporal Neurocognitive Disorder
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.
criteria of Frontotemporal Neurocognitive Disorder
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.
Probable frontotemporal neurocognitive disorder is diagnosed if either of the following is present; otherwise, possible frontotemporal neurocognitive disorder should be diagnosed:
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.
criteria of Neurocognitive Disorder due to Traumatic Brain Injury
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.
criteria of Substance/Medication Induced Neurocognitive Disorders
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.
Korsakoff’s Syndrome:
Associated with chronic alcoholism, characterized by irreversible memory loss due to brain damage resulting from deficiency of vitamin B1
Wernicke’s Disease:
Associated with chronic alcoholism, characterized by confusion, disorientation, and difficulty maintaining balance by walking (loss of muscle coordination: ataxia)
Neurocognitive Disorder with Lewy Bodies
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
criteria of Neurocognitive Disorder with Lewy Bodies
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
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.
- 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. - Suggestive diagnostic features:
A. Meets criteria for rapid eye movement sleep behavior disorder.
B. Severe neuroleptic sensitivity.
Neurocognitive Disorder due to Parkinson’s
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
criteria of Parkinson’s
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.
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:
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.
Neurocognitive Disorder due to Huntington’s
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
criteria of Neurocognitive Disorder due to Huntington’s
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.
Neurocognitive Disorder due to HIV
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.
criteria of Neurocognitive Disorder due to HIV
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.
Neurocognitive Disorder due to Prion disease
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.
criteria of Neurocognitive Disorder due to Prion disease
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.
Anixety x Aging
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
Depression x Aging
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!
Sleep Problems x Aging
Loneliness, difficult thoughts and anxiety, low coping strategies
Sleep problems are common among older people - 50%
Sleep medication, but can cause side effects
