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behavior disorders > Chapter 15 > Flashcards

Chapter 15 Flashcards

1
Q

delirium

A

impaired consciousness and cognition
* Develops rapidly over several hours or days
* Appear confused, disoriented, and inattentive
* Marked memory and language deficits
* Drugs such as Ecstasy, “Molly,” and “bath salts” can cause substance - induced delirium

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2
Q

delerium prevalence and course

A
  • Affects up 20% of adults in acute care facilities (e.g., ER)
  • More prevalent in certain populations, including:
  • Older adults
  • Those undergoing medical procedures
  • People with AIDS or cancer
  • People in hospitals/critical care
  • Full recovery often occurs within several weeks
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3
Q

what percentage of dementia cases involve delirium?

A

50% of cases involve temporary delirium

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4
Q

medical conditions related to delirium

A
  • Drug intoxication, poisons, withdrawal from drugs
  • Infections
  • Head injury and several forms of brain trauma
    sleep deprivation, immobility, and excessive stress
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5
Q

treatment and prevention for delirium

A

Treatment
* Attention to underlying causes
* Psychosocial interventions
* Reassurance/comfort, coping strategies, inclusion of patients in
treatment decisions

Prevention
* Address proper medical care for illnesses, proper use of, and adherence
to therapeutic drugs

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6
Q

Nature of dementia

A
  • Gradual deterioration of brain functioning
  • Deterioration in judgment and memory
  • Deterioration in language and advanced cognitive processes
  • Has many causes and may be irreversible
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7
Q

how often is a new neurocognitive disorder identified?

A

every 7 seconds

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8
Q

prevalence of neurocognitive disorder

A

5% prevalence in adults 65+; 20% prevalence in adults 90+

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9
Q

how many people have major neurocognitive disorder in the US?

A

5 million

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10
Q

Are Alzheimer’s cases increasing as the years go on?

A

yes dramatic rise in cases predicted through 2050

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11
Q

neurocognitive disorder due to Alzheimers disease

A
  • Clinical features
  • Typically develop gradually and steadily
  • Memory, orientation, judgment, and reasoning deficits
  • Additional symptoms may include
  • Agitation, confusion, or combativeness
  • Depression and/or anxiety
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12
Q

prevalence of neurocognitive disorder due to alzheimers

A
  • More common in less educated individuals but people who attain a higher level of education decline more rapidly once the symptoms become more severe
  • Slightly more common in women (Possibly because women lose estrogen as they age; estrogen may be protective.)
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13
Q

what is the cognitive reserve hypothesis?

A

the more synapses a person develops throughout life, the more neuronal death must take place before the signs of dementia are obvious

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14
Q

neurocognitive disorder due to alzheimers post-diagnosis survival

A

8 years

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15
Q

onset of neurocognitive disorder due to alzheimers

A

60s or 70s (early onset 40s to 50s)

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16
Q

what percentage of the cases of neurocognitive disorder result from Alzheimer’s?

A

60-70%

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17
Q

aphasia

A

difficulty with language (seen in alzheimers)

18
Q

apraxia

A

impaired motor functioning (seen in alzheimers)

19
Q

agnosia

A

failure to recognize objects (seen in alzheimers)

20
Q

vascular neurocognitive disorder

A

Caused by blockage or damage to blood vessels
* Onset is often sudden (e.g., stroke)
* Patterns of impairment are variable
* Most require formal care in later stages

  • Risk slightly higher in men
21
Q

what is the second leading cause of neurocognitive disorder?

A

vascular neurocognitive disorder

22
Q

prevalance of vascular neurocognitive disorder

A
  • Prevalence 1.5% in people 70 to 75 and 15% for people over 80
23
Q

Is vascular neurocognitive disorder seen more commonly in men or women?

A

men

24
Q

Frontoteporal neurocognitive disorder

A

Broadly refers to damage to the frontal or temporal regions of the
brain, affecting
* Personality
* Language
* Behavior

25
Q

two types of impairment: frontotemporal neurocognitive disorder

A

Declines in appropriate behavior
* Declines in language

26
Q

Picks disease

A

a frontotemporal neurocognitive disorder, produces a cortical dementia like Alzheimer’s
* Occurs relatively early in life (around 40s or 50s)

27
Q

Neurocognitive Disorder Due to Traumatic Brain injury

A
  • Accidents are leading cause
  • Symptoms last for at least one week after head injury, including
    problems with executive function, learning, memory
  • Memory loss is the most common symptom
  • Risk factors include age (most common among teens and young
    adults), excessive alcohol use, and lower socioeconomic status
28
Q

Neurocognitive Disorder Due to Lewy Body Disease

A
  • Lewy bodies are microscopic protein deposits that damage the brain over time
  • Symptoms onset gradually
  • Symptoms include impaired attention and alertness, visual
    hallucinations, motor impairment
29
Q

Neurocognitive Disorder Due to Parkinson’s Disease

A

Degenerative brain disorder
* Dopamine pathway damage
* 1 out of 1,000 people are affected worldwide
* Chief difficulty: motor problems
* Tremors, posture, walking, speech
* Not all with PD will develop dementia
* 75% survive 10+ years after diagnosis

30
Q

Neurocognitive Disorder due to HIV
Infection

A
  • HIV-1 can cause neurological impairments and dementia in some
    individuals
  • Cognitive slowness, impaired attention, and forgetfulness
  • Apathy and social withdrawal
  • Typically occurs in later disease stages
  • Now occurs in <10% of individuals with HIV; HAART decreases risk
31
Q

Neurocognitive Disorder Due to
Huntington’s Disease

A
  • Huntington’s Disease = genetic autosomal dominant disorder
  • Caused by a gene on chromosome 4
  • Manifests initially as involuntary limb movements (chorea), usually later in life
  • Somewhere between 20% and 80% display neurocognitive disorder
  • Dementia follows a subcortical pattern
32
Q

Neurocognitive Disorder Due to Prion Disease

A
  • Disorder of proteins in the brain that reproduce and cause damage
  • No known treatment, always fatal
  • Can only be acquired through cannibalism or accidental transmission
    (e.g., contaminated blood transfusion)
  • Example: Creutzfeldt-Jakob disease*
  • Affects 1 out of 1,000,000 people
  • Linked to mad cow disease
33
Q

Substance/Medication-Induced
Neurocognitive Disorder

A
  • Memory impairment
  • Aphasia, apraxia, agnosia
  • Disturbed executive functioning

50% to 70% of chronic heavy alcohol users show some cognitive
impairment; 7% of those meet criteria for neurocognitive disorder

  • Results from prolonged drug use, especially in combination with poor
    diet
  • May be caused by alcohol, sedative, hypnotic, anxiolytic, or inhalant drugs
  • Brain damage may be permanent
34
Q

Causes of Neurocognitive Disorder: The Example of Alzheimer’s Disease

A

Features of brains with Alzheimer’s disease
* Neurofibrillary tangles (strand-like filaments)
* Amyloid plaques (gummy deposits between neurons)
* Brains of people with Alzheimer’s tend to atrophy
* Multiple genes are involved in Alzheimer’s disease
* Chromosome 14: Associated with early-onset Alzheimer’s
* Chromosome 19: Associated with late-onset Alzheimer’s

35
Q

Deterministic genes causes of neurocognitive disorder: the example of alzheimers

A

Rare genes that inevitably lead to Alzheimer’s
* Beta-amyloid precursor gene
* Presenilin-1 and Presenilin-2 genes

36
Q

susceptibility genes causes of neurocognitive disorder: the example of alzheimers

A
  • Make it more likely but not certain to develop Alzheimer’s
  • ApoE4 gene is located on chromosome 19 and associated with late onset
    Alzheimer’s
37
Q

The Contributions of Psychosocial Factors in Neurocognitive Disorders

A
  • Psychosocial factors such as education, coping skills, and social
    support do not cause dementia directly
  • May influence onset and course
  • Lifestyle factors include drug use, diet, exercise, stress
  • Risk for certain conditions vary by ethnicity
38
Q

Medical Treatment of Neurocognitive Disorders

A
  • Few primary treatments exist
  • Most treatments attempt to slow progression of deterioration, but
    cannot stop it

Future directions
* Glial cell-derived neurotrophic factor, stem cells: may slow deterioration
* Some drugs target cognitive deficits. Cholinesterase-inhibitors
* Long-term effects not well demonstrated

39
Q

Psychosocial Treatment of Neurocognitive Disorders

A
  • Aims of psychosocial treatments
  • Enhance lives of patients and their families
  • Teach compensatory skills
  • Use memory enhancement devices, if needed
    Example: “Memory wallets” containing statements about one’s life
  • Cognitive stimulation can delay onset of more severe symptoms
40
Q

Psychosocial Treatment of Neurocognitive Disorders: Caregivers

A
  • Caregivers get instructions on how to handle problematic behavior,
    including
  • Wandering
  • Socially inappropriate behavior
  • Aggressive or rebellious behavior
  • Impact of care on their own health
  • Caregivers are also under great deal of stress and may need mental health treatment
41
Q

Prevention of Neurocognitive Disorders

A
  • Reducing risk in older adults
  • Control blood pressure
  • Don’t smoke
  • Lead active physical and social life

behavior disorders (8 decks)

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