Cognitive Assessment Flashcards
Where does Serotonin arise from in the CNS?
- Raphe nuclei make Serotonin
(Brainstem) - Projects extensively to all levels of the CNS
What does Serotonin help regulate ?
- Mood
- Arousal
- Cognition
Where does Norepinephrine arise from in the CNS?
- From the Locus coeruleus (brainstem)
- Extends to areas of the CNS including the spinal cord, cerebellum, thalamus, & cerebral cortex
What does Norepinephrine regulate
- Mood
- Arousal
- Attention
- Cognition
Where does Dopamine arise from in the CNS?
From the Substantia nigra & the ventral tegmental area (brainstem & midbrain)
What does Dopamine regulate?
- Mood
- Arousal
- Cognition
- Motor control
Where does Acetylcholine arise from in the CNS?
- From the Basal forebrain & brainstem (cerebral cortex, including the hippocampus)
What does Acetylcholine (ACh) regulate?
- Sleep
- Arousal
- Attention
Depressive symptoms arise with what chemical imbalance?
- Low levels of Serotonin, Norepinephrine, & Dopamine
Anxiety symptoms arise with what chemical imbalance?
- Low levels of Serotonin
- High levels of Norepinephrine
Psychosis & Mania symptoms arise with what chemical imbalance?
- High levels of Dopamine
- Low levels of Serotonin
Dementia symptoms arise with what chemical imbalance?
- Low levels of Acetylcholine
What is classified as a mental disorder
- Any condition or syndrome with clinical manifestations characterized by Significant impairment in:
- Cognition, Emotion regulation, & Behavior
Leading to significant distress &/or disability in social, occupational, or other important activities of daily life. “DSM-5”
- Cognition, Emotion regulation, & Behavior
What are the 4 most common or concerning symptoms in a cognitive assessment?
- Anxiety/ excessive worrying
- Depressed mood
- Memory problems
- Medically unexplained symptoms
6 Common risk factors for Anxiety
- Family Hx
- Personal Hx or mood disorder
- Childhood stressful life events or trauma
- Female
- Chronic medical illness
- Behavioral inhibition
Generalized Anxiety Disorder
- Excessive worrying predominates over a 4 week period
Social Anxiety Disorder
- Avoidance due to unreasonable fear of situations or activities that could lead to embarrassment, marked by anticipatory anxiety in social situations
Obsessive Compulsive Disorder
- Characterized by intrusive thoughts & ritualistic behaviors
Panic Disorder
- Often presents with recurrent sudden episodes/ spells/ attacks of intense fear or discomfort that are unexpected or w/ intervening periods of living in fear or worrying of having another attack or facing the consequences of the attack
Post Traumatic Stress Disorder
- Characterized by re-experiencing, avoidance, persistent negative alterations in cognition & mood, & alterations in arousal & reactivity
Other potential causes that can mimic Anxiety
- OTC & prescription medications
- Illicit substances/ caffeine/ alcohol
- Mood disorders
- Hyperthyroidism
- Cardiopulmonary disorders
- TBI
- Untreated pain in PACU
5 Risk factors for Depression
- Personal Hx of a depressive episode**
- Family Hx of 1st degree family members w/ depression
- Personal Hx of recent stressful life events or significant childhood adversity
- Chronic/ disabling medical illness
- Female
Premenstrual Dysphoric Disorder (PMDD)
- Depressive symptoms worsen in sync w/ a female’s menstrual cycle
Major Depressive Disorder (MDD)
- At least 2 weeks of depressed/irritable mood, with at least 4 of the following:
- Anhedonia
- Insomnia/hypersonic
- Decreased self-esteem
- Low energy
- Poor concentration/indecision
- Changes in appetite
- Feeling slowed or restless
- Thoughts of death/ suicide
Persistent Depressive Disorder (PDD)
- Depressive/ irritable mood lasting for at least 2 years & > 2+ of the MDD symptoms
MDD & PDD are frequently comorbid with what 3 findings
- Anxiety
- Personality disorders
- Substance use
What 6 other conditions mimic Depression
- Alcohol/drug use
- Parkinson disease
- TBI
- Recent MI
- Stroke
- Hypothyroidism
10 Key components of the mental status examination
- Appearance/ behavior (LOC)
- Posture/ motor behavior
- Grooming
- Affect (appropriate/flat)
- Manner (detached/anxious)
- Speech/language
- Mood
- Thoughts & perception (organized/hallucinations)
- Insight/judgement
- Cognition
Incoherence
- Speech that is incomprehensible & illogical
- Lack of meaningful connections
- Abrupt changes in topic
- Disordered grammar or word use
- Seen in severe psychotic disturbances: schizophrenia
Neologisms
- Invented or distorted words
- Seen in: Schizophrenia, psychotic disorders, & aphasia
Blocking
- Disordered thought process with sudden interruption of speech midsentence
- Can occur in normal people
- Seen in schizophrenia
Clanging
- Disordered thought process where choice of words is based on sound rather than meaning (rhyming)
- Seen in Schizophrenia & manic episodes
Flight of Ideas
- Disordered thought process that has continuous flow of accelerated speech with abrupt changes from one topic to the next
- Changes are based on associations, play on words, or distracting stimuli
- Ideas are not well connected
- Seen in Manic episodes
Broca aphasia
- Expressive aphasia
- Preserved comprehension w/ slow, non-fluent speech
(Can understand what you are saying but the words come out gibberish)
Wernicke aphasia
- Receptive aphasia
- Impaired comprehension with fluent speech
Paranoia affect findings during mental assessment
- Anger, hostility, suspiciousness, or evasiveness
Mania affect findings during mental assessment
- Elation & euphoria
Schizophrenia affect findings during mental assessment
- flat affect & remoteness
Dementia, anxiety, & depression affect findings during mental assessment
- Dulled affect w/ detachment & indifference & apathy
What are 3 conditions that can cause hallucinations assessed during your affect assessment for mental health
- Schizophrenia
- Alcohol withdrawal
- Systemic toxicity
Cognition definition
- The mental processes involved in gaining knowledge and comprehension
Includes: Orientation, Attention, & Memory (recent, remote, new learning)
- as well as higher cognitive functions: information & vocabulary, calculation, abstract thinking, constructional ability
What cognitive function is usually unaffected by mental disorders?
Vocabulary
Amnestic disorder key findings
- Impair memory or new learning ability, reduce social or occupational functioning & lacks the global features of delirium or dementia (recent memory is impaired, but remote is intact)
Poor constructional ability suggests?
- Dementia or parietal lobe damage
Mental illness increases risks for what 5 things
- Chronic medical conditions
- Decreased life expectancy
- Disability
- Substance abuse
- Suicide
5 high risk patients for depression
- Young females who are single, divorced or separated
- Seriously or chronically ill
- Bereaved
- Hx of other psychiatric disorders including substance abuse
- Personal or family Hx of depression
Definition of Dementia
- An acquired condition that is characterized by decline in at least two cognitive domains (e.g., loss of memory, attention, language, or Visuospatial or executive funct.) that is severe enough to affect social or occupational functioning
What are 6 Major Dementia syndromes
- Alzheimer’s disease
- Vascular dementia
- Frontotemporal dementia
- Lewy body dementia
- Parkinson disease w/ dementia
- Dementia of mixed etiology
What is the best known screening test for dementia?
Mini-Mental State Examination
What is the most commonly performed screening tests?
- The Mini-COG
- 3 minute test w/ 91% sensitivity & 86% specificity
- Montreal Cognitive Assessment
- 10 minute test comparable to mini-cog
- 91% sensitivity & 81% specificity (not as good at diagnosing, rather who needs further help or not)
Age- related cognitive decline
- Mild forgetfulness, difficulty remembering names, & mildly reduced concentration
- Sporadic symptoms & do not affect daily function
Mild cognitive impairment
- Daily function is preserved, but evidence of MODEST cognitive decline in 1 or more cognitive domains based on objective tasks (orientation, memory, vocabulary, calculation, abstract thinking)
- Alertness & Attention are preserved (unlike delirium)
- Can progress to AD
Alzheimer’s Disease**
- affects 10% over the age 65 (2/3 women)
- Memory difficulties take the form of:
- Repeating questions
- Loosing objects
- Confusion when performing tasks (shopping)
Alzheimer’s Disease risk factors**
- Advancing age
- Family Hx
- Gene mutation Apolipoprotein
- risk doubles w/ one mutation
- risk is 5x’s w/ 2
Alzheimer’s Disease late stage signs & symptoms **
- Impaired judgement & Disorientation
- Progresses to aphasia, apraxia, left-right confusion & ultimately dependence of instrumental activities of daily living
- Psychosis & agitation may also occur
Vascular Dementia
- Vascular risk factors or cerebrovascular disease assoc. w/ cognitive impairment
- Stepwise decline (especially in executive function) correlating with the onset of a cerebrovascular event
- Can have gait changes & focal findings
Lewy Body Dementia
- Evidence of Parkinsonism
- Visual hallucinations, delusions, & gait disorder
- Extrapyramidal symptoms, fluctuating mental status, & sensitivity to antipsychotic medications
Frontotemporal dementia
- Prominent behavioral or language disorders
- Personality changes including impulsivity, aggression, & apathy
- Excessive eating & drinking
- Preservation of memory & visual-spatial
Delirium
- An acute confusional state marked by sudden onset, fluctuating course, inattention, & at times, changing levels of consciousness
3 Risk factors for Delirium
- Hospitalized general medical patients
- Major elective surgery
- ICU admissions
What is a positive CAM
- positive screening for delirium that includes the presence of acute change in mental status/ fluctuating course (1) w/ inattention (2) plus either disorganized thinking (3) or abnormal level of consciousness (4)
- 1 & 2 have to be present plus either 3 or 4
(Score highest = 7)
Somatic symptom disorder
- Excessive & disproportionate thoughts, feelings, & behaviors related to those symptoms
- somatic symptoms are either very distressing or results in significant disruption of functioning
Illness anxiety disorder (somatic)
- Preoccupation with having or acquiring a serious illness where somatic symptoms, if present are only mild in intensity
Fictitious disorder (somatic)
- Falsification of physical/psychological signs or symptoms, or induction of injury or disease, assoc. w/ identified deception
Body dysmorphic disorder (somatic)
- Preoccupation w/ 1 or more perceived defects or flaws in physical appearance that are not observable or appear only slight to others
Dissociative disorder (somatic)
- Disruption of &/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, & behavior
