Chapter 15

Question 1

delirium

Answer 1

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

Question 2

delerium prevalence and course

Answer 2

• 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

Question 3

what percentage of dementia cases involve delirium?

Answer 3

50% of cases involve temporary delirium

Question 4

medical conditions related to delirium

Answer 4

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

Question 5

treatment and prevention for delirium

Answer 5

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

Question 6

Nature of dementia

Answer 6

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

Question 7

how often is a new neurocognitive disorder identified?

Answer 7

every 7 seconds

Question 8

prevalence of neurocognitive disorder

Answer 8

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

Question 9

how many people have major neurocognitive disorder in the US?

Answer 9

5 million

Question 10

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

Answer 10

yes dramatic rise in cases predicted through 2050

Question 11

neurocognitive disorder due to Alzheimers disease

Answer 11

• 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

Question 12

prevalence of neurocognitive disorder due to alzheimers

Answer 12

• 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.)

Question 13

what is the cognitive reserve hypothesis?

Answer 13

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

Question 14

neurocognitive disorder due to alzheimers post-diagnosis survival

Answer 14

8 years

Question 15

onset of neurocognitive disorder due to alzheimers

Answer 15

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

Question 16

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

Answer 16

60-70%

Question 17

aphasia

Answer 17

difficulty with language (seen in alzheimers)

Question 18

apraxia

Answer 18

impaired motor functioning (seen in alzheimers)

Question 19

agnosia

Answer 19

failure to recognize objects (seen in alzheimers)

Question 20

vascular neurocognitive disorder

Answer 20

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

Question 21

what is the second leading cause of neurocognitive disorder?

Answer 21

vascular neurocognitive disorder

Question 22

prevalance of vascular neurocognitive disorder

Answer 22

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

Question 23

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

Answer 23

men

Question 24

Frontoteporal neurocognitive disorder

Answer 24

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

Question 25

two types of impairment: frontotemporal neurocognitive disorder

Answer 25

Declines in appropriate behavior * Declines in language

Question 26

Picks disease

Answer 26

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

Question 27

Neurocognitive Disorder Due to Traumatic Brain injury

Answer 27

* 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

Question 28

Neurocognitive Disorder Due to Lewy Body Disease

Answer 28

* 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

Question 29

Neurocognitive Disorder Due to Parkinson’s Disease

Answer 29

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

Question 30

Neurocognitive Disorder due to HIV Infection

Answer 30

* 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

Question 31

Neurocognitive Disorder Due to Huntington’s Disease

Answer 31

* 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

Question 32

Neurocognitive Disorder Due to Prion Disease

Answer 32

* 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

Question 33

Substance/Medication-Induced Neurocognitive Disorder

Answer 33

* 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

Question 34

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

Answer 34

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

Question 35

Deterministic genes causes of neurocognitive disorder: the example of alzheimers

Answer 35

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

Question 36

susceptibility genes causes of neurocognitive disorder: the example of alzheimers

Answer 36

* 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

Question 37

The Contributions of Psychosocial Factors in Neurocognitive Disorders

Answer 37

* 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

Question 38

Medical Treatment of Neurocognitive Disorders

Answer 38

* 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

Question 39

Psychosocial Treatment of Neurocognitive Disorders

Answer 39

* 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

Question 40

Psychosocial Treatment of Neurocognitive Disorders: Caregivers

Answer 40

* 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

Question 41

Prevention of Neurocognitive Disorders

Answer 41

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