Chapter 14 Neurocognitive Disorders Flashcards
What are the six cognitive domains of neurocognitive disorders?
- Complex attention
- Executive function
- Learning and memory
- Language
- Perceptual-motor – Includes any abilities related to visual perception, gnosis, perceptual-motor praxis, or visuo-constructional
- Social cognition
Describe how delirium presents.
- Disturbance to attention with difficulty to focus, shift or sustain attention
- Reduced awareness of their surroundings
- Diminished cognitive performance
- Confusion
Note: Most people recover from delirium within or without medical attention although institutionalization may be needed
Describe how major neurocognitive disorder presents.
- Significant decline in cognitive functioning
- Can’t manage daily tasks effectively
- Dementia is a term for these symptoms in old age. But if it occurs prior them it does not fall under dementia’s umbrella
Describe how mild neurocognitive disorder presents.
- Shows a modest decline in one of the cognitive domains
- Not as extensive as Major Neurocognitive disorder
- Require additional time to do tasks but overall can act independently
Define delirium. How does this differ from mild and major neurocognitive disorders?
Delirium fluctuates and eventually recovers
What are the main differences between mild and major neurocognitive disorders?
They are different ends of a spectrum of cognitive impairment. With less severe on the mild end and more severe on the major end
Epidemiology of Delirium
1-2% US and Finland.
8-17% for older individuals entering the ER
Prevalence rates are lower in African Americans when compared to whites of the same age
Major and Mild NCD subtypes epidemiology
- Alzheimer’s is observed in 5.5 million Americans.
- 11% of those aged 65 and older and 32% older than 85 having dementia due to Alzheimer’s disease
- 60-90% of dementias are attributable to Alzheimer’s disease
- 2.87 million Traumatic Brain Injuries (TBI) happen each year. Most commonly from falls and car accidents but also sports.
- mild NCD among older individuals range from 2% to 10% at age 65 and 5% to 25% at age 85
- In the U.S., incidence is highest in African Americans followed by American Indians/Alaska Natives, Latinx, Pacific Islanders, non-Latinx Whites, and Asian Americans
Define degenerative.
Symptoms and cognitive defects become worse over time
Note: you cannot be diagnosed with both a major and mild NCD. It’s one or the other.
What disorders discussed in this module are considered degenerative?
Alzheimer’s, Dementia with Lewy bodies, Parkinson’s, Huntington Disease
Alzheimer’s Disease (AD) symptoms
- Severe cognitive decline and memory impairment. Eventual death.
- Early onset appears before 65, and late onset appears after 65.
- Early onset has a genetic link and late onset has less to with family influence.
- Lacking the APOE gene along with lifestyle factors such as stress and bad health increases the chances of AD
Alzheimer’s Disease (AD) Causes
- Evidence can only be proven of Alzheimer’s via genetic testing or clear cognitive decline
- Caused by a buildup of Beta-Amyloid Plagues (between neurons) and Neurofibril Tangles (Within Neurons) that cause neuron inflammation and death
- The above structures affect the hippocampus, amygdala and cerebral cortex
- The e4 allele steps the production of APOE which helps reduce the plagues and tangles
- neurons shrinking or dying within the hypothalamus, thalamus, and the locus ceruleus have been linked to declining cognition
- Acetylcholine-secreting neurons within the basal forebrain also appear to shrink or die, contributing to Alzheimer’s disease symptoms
- Lead and overconsumption of Zinc could be environmental factors
- Effects women more typically
Describe the symptoms and causes of traumatic brain injury (TBI).
- Head trauma and persistent cognitive impairment with one or more of the following in part 2
- loss of consciousness, posttraumatic amnesia, disorientation and confusion, or neurological impairment
- Depends heavily on the location of the coup or countercoup and the severity of the blow
- On the light end symptoms can be headaches, disorientation, confusion, irritability, fatigue, poor concentration, and emotional and behavioral changes
- On the heavy end can be seizures, paralysis, and visual disturbances.
- 10% suicide rate and comorbid with Anxiety, depression, Personality disorders and PTSD
- Concussions are the most common type of TBI with CTE happening with repeated head trauma
- Typically effects men more
Describe the symptoms and causes of vascular disorders.
- Caused by disrupted blood flow in the brain caused by atherosclerosis or a buildup of plague
- This plague builds up, causes arteries to narrow then causes a stroke
- Stokes have two types. a hemorrhagic stroke that occurs when a blood vessel bursts within the brain and an ischemic stroke, which is when a blood clot blocks the blood flow in an artery within the brain
- Like TBI, the types of symptoms depend on what parts of the brain are damaged and to what severity.
- Most Common NCD after Alzheimer’s with prevalence estimates are 0.98% for those between the ages of 71-79 years, 4.09% for individuals aged 80-89 years, and 6.19% for those aged 90 years and up
- 20-30 of stroke victims escalate to dementia
- Effects women more
Describe the symptoms and causes of substance/medication-induced major or mild NCD .
Delirium caused by heavy intoxication withdraw. Might remain in effect till after a long abstinence period
Describe the symptoms and causes of dementia with Lewy bodies.
- significant fluctuations in attention and alertness
- Visual hallucinations
- Impaired mobility
- Sleep disturbances such as rapid eye movement disorder
- Higher trajectory than Alzheimer’s but a similar time to death
- Lewy Bodies are irregular brain cells that develop abnormal proteins that deplete the cortex of Acetylcholine
- The Lewy Bodies deplete dopamine in the brain stem
Describe the symptoms and causes of frontotemporal NCD.
- Causes progressive development of behavioral and personality change and/or language impairment
- Behavior symptoms must have one of the following: behavioral disinhibition, apathy or inertia, loss of sympathy or empathy, preservative or compulsive behavior, or hyperorality and dietary changes.
- Typically happens in the 50s but has a range of 20-80 years
- Survival rate is typically 6-11 years
Describe the symptoms and causes of Parkinson’s disease.
- Affected Mart McFly. (Michael J. Fox)
- Tremors
- Rigidity in limbs and trunk
- Bad posture, balance and coordination
- Slowness to initiate movement
- Onset is 50-89 years
- Comorbid with Alzheimer’s and cerebrovascular disease
- Depression, psychosis, REM sleep behavior disorder, apathy, and motor symptoms can make functional impairment worse
Describe the symptoms and causes of Huntington’s disease.
- life-expectancy as death typically occurs 15-20 years
- rare
- involves involuntary movement, progressive dementia, and emotional instability.
- As symptoms progress symptoms such as facial grimaces, difficulty speaking, and repetitive movements occur
- Needs full time care and there is no cure
- Suicide is a common cause of death
Describe the symptoms and causes of HIV infection.
slower mental processing, impaired executive function, problems with more demanding attentional tasks, and difficulty learning new information are among the most common early signs of HIV.
Antiretroviral therapies are effective in reducing and preventing the cognitive impairments
NCD’s Pharmacological treatments
- Effect Acetylcholine and glutamate typically for Alzheimer’s
- Slow the progress but don’t cure
- Since these drugs have a lot of side-effects the are prescribed in early to middle stages of Alzheimer’s and not in advanced stages of the disease
- Parkinson’s medications increase dopamine but side effects include hallucinations and psychotic symptoms
NCD Psychological treatments:
- CBT
- Reading
- Social skills
- Achievable goal setting
