Cognitive Disorders (Lauren 🌭) Flashcards
Who is doing all the tests that are used to assess the Neurocognitive domains?
Neuropsychologists
What are the 6 neurocognitive domains?
*****
- Complex attention 🤔🧐
- Executive function🙋🏻♂️
- Learning and Memory🤓
- Language🤬
- Perceptual-Motor👀💪🏼
- Social cognition🧠
What sorts of things fall into the perceptual-motor domain?
Visual perception
Visuoconstructional reasoning
Perceptual-motor coordination
(Probably not on test)
What sorts of things fall into the executive function domain?
Planning
Decision-making
Working memory
Responding to feeedback
Inhibition
Flexibility
What sorts of things fall into the complex attention domain?
Sustained attention- (ex: 2 hr lecture)
Divided attention (ex: taking notes while also shopping online)
Selective attention (ex: listening to the lecturer when all the turkeys behind you are whispering to each other)
What sorts of things fall into the social cognition domain?
Recognizing emotions/facial expressions
Theory of mind (you understand that other people have thoughts like you)
Insight
What is this:
“An ACUTE, rapidly progressive change in cognition characterized by INATTENTION and DISTURBANCE OF CONSCIOUSNESS in which symptoms FLUCTUATE over the course of 24 hours”
Delirium
Delirium is (acute/chronic)
ACUTE⭐️⭐️⭐️⭐️⭐️
What group of people is usually associated with developing delirium?>
Old people in the hospital post-op
Definitely not the only time delirium happens though
What are the DSM5 criteria for Delirium?
A. Disturbance in attention and awareness
B. Develops over short period of time, is a change from baseline in attention or awareness, fluctuates during course of the day
C. An additional disturbance in cognition: memory, disorientation, language, visuospatial, perception
D. A and C are not better explained by NCD and do not occur in coma or other severely reduced level of arousal
E. Evidence that it IS a physiological consequence to a medical condition, substance or toxin
What are the risk factors for delirium?
Age >70
Poor functional status
Hearing/visual impairment
Dehydration
Sleep deprivation
Metabolic derangement
Infection (UTI, anyone?)
Polypharmacy (old people like to do this ;)
What 3 treatments are NOT recommended for delirium, especially in old folks?
Benzos
Physical restraints
Antipsychotics
How DO you treat delirium?
ORIENT THEM:
Hearing aids/glasses
Update white board in hospital room
Educate family
Round the clock attendant/sitter
Calm and reassuring behavior
Re-establish sleep/wake cycle
Expedite return to familiar environment
Delirium or dementia:
Acute, rapid onset
Delirium
**
Dementia or delirium:
Disturbance of consciousness
Delirium
Dementia or delirium:
Fluctuation of symptoms during 24hour period
Delirium
Dementia or delirium:
Attention deficit
Delirium
What are the 2 types of neurocognitive disorder?
Major
Minor
What are the DSM5 criteria for MAJOR Neurocognitive Disorder?
A. SIGNIFICANT cognitive decline from previous level in one or more cognitive domains, based on: 1. Concern of the individual, a clinician, or a knowledgeable informant (aka family) 2. SUBSTANTIAL impairment in cognitive performance as determined by a domain test
B. Deficits INTERFERE with independence in everyday life
C. Not due to delirium
D. Not better explained by another disorder
SPECIFY: Severity of interference
Mild: difficulty with INSTRUMENTAL activities of daily living (housework, managing money)
Moderate: difficulty with BASIC activities of family living (feeding, dressing)
Severe: fully DEPENDENT
What are the 3 specifiers for Major Neurocognitive Disorder that you need to know?
Mild: difficulty with INSTRUMENTAL activities of daily living (housework, managing money, more complicated stuff)
Moderate: difficulty with BASIC activities of daily living (feeding, getting dressed)
Severe- fully DEPENDENT
If someone has Mild Severity of Major Neurocognitive Disorder, which of the following activities do you think they would have trouble with?
A.) using the toilet
B.) washing their hands
C.) organizing the DVD collection in reverse alphabetical order
C
Mild severity of Major NCD has trouble with complicated activities of daily living
What are the DSM5 criteria of MILD Neurocognitive Disorder?
A. Modest cognitive decline from previous level in one or more cognitive domains, based on: 1.) concern of the individual, a clinician, or a knowledgeable informant 2.) Modest impairment in cognitive performance as determined by a domain test
B. Deficits DO NOT INTERFERE with independence in everyday activities, but require greater effort
C. Not due to delirium
D. Not better explained by other Disorder
What is the main difference between Major NCD and Mild NCD?
In Mild NCD, deficits do NOT interfere with independence in everyday activities, but they require greater effort
What level of NCD:
Needs help eating
Moderate severity of Major NCD
What level of NCD:
Has trouble mowing the lawn, but does not need help
Mild NCD
What level of NCD:
Needs help with literally everything
Severe form of Major NCD
What level of NCD:
Needs help getting dressed
Moderate severity of Major NCD
What are the DSM5 criteria for “NCD due to Alzheimer’s Disease”
A. Criteria met for major or mild NCD
B. Insidious onset, gradual progression in one or more cognitive domains
C. Probable or Possible Alzheimers: Evidence of causative agent (genetic mutation or family history) PLUS: 1.) clear memory decline plus one other domain 2.) steadily progressive, gradual, no extended plateaus 3.) no evidence of mixed etiology👨👨👧👦
D. Not better explained by something else
What’s the important part of the DSM for “NCD due to Alzheimers Disease”
That there is EVIDENCE of it being Alzheimers, either a genetic mutation or a family history
What is the only way to confirm that someone has Alzheimers?
Autopsy after they die
Alzheimer’s Dementia that occurs before age ______ is referred to as “early onset”
65
Alzheimer’s patients typically lose about ___ points per year on their MMSE (Mini Mental Status Exam)
3
Which two conditions are associated with higher rates of Alzheimer’s?
repeated head trauma
Down syndrome
How would you be able to tell if your anatomy lab cadaver had suffered from AlzheimerS?
There would lots of brain atrophy in the hippocampus
Just so you know, NCD can be caused by:
Frontotemporal Degeneration
Lewy Body Disease
Vascular Disease
Traumatic Brain Injury
Prion disease
Parkinson’s
HIV
Huntington’s
Got it
What is the DSM5 criteria for NCD due to Frontotemporal Degeneration?
A. Criteria met for major or mild NCD
B. Insidious onset, gradual progression
C. Either (1) or (2):
1. Behavioral variant: 3 of these- disinhibition, apathy, loss of sympathy/empathy, perseverative or stereotyped behavior, hyperorality, and mist have prominent decline in social cognition or executive function
- Language Variant- decline in speech, word finding, naming, grammar or comprehension
D. Relative sparking or learning/memory and perceptual-motor
E. Not better explained by something else
What are the DSM5 for Lewy Body Disease?
A. Criteria met for major or mild NCD
B. Insidious onset, gradual progression in one or more cognitive domains
C. Core Diagnostic Features:
- Fluctuating cognition with variations in attention and alertness
- Recurrent visual hallucinations that are formed and detailed
- Spontaneous features of Parkinsonism
D. Suggestive Diagnostic Features:
- REM sleep disorder
- Severe neuroleptic sensitivity (antipsychotics)
E. Not better explained by something else
What are the DSM5 of NCD due to Vascular Disease (aka stroke)
A. Criteria met for major or mild NCD
B. Consistent with vascular etiology with either:
- Onset is temporally related to cerbrovascular event
- Prominent decline in complex attention and frontal-executive functions
C. Evidence of cerebrovascular disease- H+P or imaging
D. Not better explained by something else
What are the DSM5 for NCD due to Traumatic Brain Injury
A. Criteria met for major or mild NCD
B. Evidence of TBI with at least 1:
- loss of consciousness
- post-traumatic amnesia
- disorientation and confusion
- neurological signs (injury on imaging, new seizures, visual field cuts, anosmia, hemiparesis)
C. NCD presents immediately after the occurrence of the TBI or after the acute post-injury period
What is a prion?
A virus-like particle
What are the DSM5 for NCD due to Prion Disease?
A. Criteria met for major or mild NCD
B. Insidious onset, usually RAPID** progression
C. Motor features- myoclonus or ataxia, or biomarker evidence
D. Not better exposed by other disorder or disease
Creutzfeldt-Jakob disease, Kuru, and mad cow disease are examples of:
Prion disease
Prion disease usually has a (long/short) course
SHORT****
LESS THAN 6 MONTHS
If someone has NCD due to Parkinsons Disease, which came first?
Parkinson’s
Can HIV directly cause NCD?
Yes
How do you get Huntington’s Dementia?
You inherit it from one of your parents
“Boxcar Ventricles” on imaging
Choreiform movements
Huntington’s Dementia
True or False:
In NCD, the patient typically presents with a chief complaint of memory loss
False
usually brought in by a spouse/friend who notices
What are some of the symptoms that will make your husband worried that you may have NCD
Difficulty with:
Retaining new information
Handling complex tasks (paying the bills)
Reasoning (inability to deal with something unexpected)
Spatial ability and orientation (Getting lost while driving a familiar route***)
Language (word finding) “what’s the word…ohhh its on the tip of my tongue”
Behavior
What are the 4 drugs that we can use for management of dementia??
Donepezil (Aricept)
Galantamine (Razadyne)
Rivastigmine (Exelon)
Memantine (Namenda)
Which 3 drugs for dementia work by inhibiting Acetylcholinesterase
Denepezil (Aricept)
Galantamine (Razadyne)
Rivastigmine (Exelon)
What is the MOA of Memantine (Namenda)
NMDA blocker (blocks effect of excess glutamate)
What are the modifiable risk factors for dementia?
Education and cognitive training
Cardiovascular fitness
Healthy diet
What are the only 2 MOAs for drugs used to treat dementia?
- Inhibit acetylcholinesterase (Donepezil, Galantamine, Rivastigmine)
OR
- Block NMDA (Memantine)
What are the side effects of dementia drugs that block acetylcholinesterase?
Cholinergic effects: nausea, vomiting, diarrhea
If someone has Parkinson’s and NCD, which one came first?
Parkinson’s
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