Cognitive Disorders

Question 1

A rapidly developing, fluctuating state of reduced awareness. The patient has trouble with awareness (operationally defined as orientation) and shifting or focusing attention, and has at lease one defect of memory, orientation, perception, visuospatial skills, or language, and the symptoms are not better explained by coma or another cognitive disorder.

Duration: hours to days; generally brief, but can endure

Answer 1

Delirium

Question 2

Delirium, hyperactive
Delirium, hypoactive
Delirium, Mixed level of activity

Answer 2

Hyperactive: agitation or otherwise increased level of activity
Hypoactive: reduced level of activity
Mixed level of activity: normal or fluctuating activity level

Question 3

Delirium, acute

Delirium, persistent

Answer 3

Acute: lasts hours to a few days
Persistent: lasts weeks or longer

Question 4

Someone (the patient, a relative, the clinician) suspects that there has been a {marked}-{modest} decline in cognitive functioning. On formal testing, the patient scores below accepted norms by {2+}{1-2} standard deviations. Alternatively, a clinical evaluation reaches the same conclusion. The symptoms {materially}-{do not materially} impair the patient’s ability to function independently. That is, the patient {cannot}{can} negotiate activities of daily life (paying bills, managing medications) by putting forth increased effort or using compensatory strategies such as keeping lists. Cause can usually be found within the central nervous system.

Duration: weeks to months; relatively slow

Answer 4

{Major}{Mild} Neurocognitive Disorder

Question 5

The patient has a {major}{mild} neurocognitive disorder that begins slowly and progresses inexoably. Most common cause of NCD.

Answer 5

Neurocognitive Disorder due to Alzheimer’s Disease

Question 6

The patient has a {major}{minor} neurocognitive disorder. Beginning slowing and progressing gradually, the disease has these core features: wide fluctuation in attentiveness; elaborate, clear hallucinations; and symptoms of parkinsonism that begin a year or more after the cognitive symptoms

Answer 6

Neurocognitive disorder due to Lewy Bodies

Question 7

Immediately following head trauma that causes rapid movement of the brain inside the skull, the patient becomes unconscious or may develop amnesia, disorientation and perplexity, or neurological signs such as seizures, blind spots in the visual field, loss of smell, hemiparesis, or an injury demonstrated by imaging (CT, MRI).

Answer 7

Neurocognitive disorder due to Traumatic Brain Injury

Question 8

The patient has a mild/major neurocognitive disorder. The symptoms begin slowly and progress gradually. The patient symptoms will be mainly of one of these two types: behavioral variant (inappropriate behavior; poor manners, loss of decorum, rash impulsivity; apathy or inertia; reduced capacity for compassion; compulsive behavior; hyperorality and alterations of diet) or language variant (loss ability to produce speech, find the right words, attach names to objects, grammar and meaning of words)

Answer 8

Frontotemporal Neurocognitive disorder

Question 9

The patient has a mild/major neurocognitive disorder. The symptoms begin after a vascular event and often progress stepwise. There is often prominent decline in complex attention and frontal/executive functioning.

Answer 9

Vascular Neurocognitive disorder

Question 10

Delirium can be caused by trauma to the brain, infections, epilepsy, endocrine disorders, toxicity from medications, poisons, and various other diseases affecting almost any part of the body.

Answer 10

Delirium due to another medical condition

Question 11

Alcohol and other sedative drugs of abuse, as well as nearly every class of street drug, can cause delirium in both intoxication and withdrawal. Medications can also be implicated.

Answer 11

Substance intoxication delirium, substance withdrawal delirium, and medication-induced delirium

Question 12

Delirium can have multiple causes in the same patient

Answer 12

Delirium due to multiple etiologies

Question 13

Use one of these categories when you don’t know the cause of a patient’s delirium or when it doesn’t fully meet diagnostic criteria.

Answer 13

Other specified, and unspecified, delirium

Question 14

Learning and memory: PEWS

Answer 14

• Procedural memory (remember skills such as typing and playing an instrument; allows us to learn a sequence of behaviors and repeat them)
• Episodic memory (events of personal history; personal point of view)
• Working memory (short-term data storage; immediate memory)
• Semantic memory (general knowledge; where most of what we learn ends up)