Demantia & Neurocognitive Flashcards
An acquired syndrome that results from a disease or disorder of the brain that affects cognition, or thinking, and memory. It disrupts perception, information processing, problem solving, judgment, sequencing of tasks, recognition and naming objects, mood and affect, writing and calculating, and other functions necessary to carry out daily activities
Dementia
The gradual or acute decline in abilities follows a predictable pattern:
Thinking: abstract thought to concrete processes to object centered
Memory: short-term memory impairment to long term memory impairment
Problem-solving: complex, high-impact decisions to inability to make simple decisions
Calculating: noticeable problems with complex math procedures to errors with simple calculations
Judgment: lack of awareness of factors in decision-making to inattention to problem- solving processes
Most common type of dementia
Alzheimer’s — age-related, neurological, degenerative
disorder that predominantly affects persons older than 65
Dementing diseases that can affect a person in mid to late life
Lewy body disease
Vascular or multi-infarct dementia
Frontotemporal lobe or Pick disease
Parkinson disease
Huntington disease
Normal pressure hydrocephalus
CONTRIBUTORS TO DEMENTIA
Creutzfeldt-Jakob disease (Mad Cow Disease)
HIV/AIDS-related dementia
Brain tumors
Brain trauma
Infectious diseases
Toxic exposures
Vitamin B12 deficiency
DEMENTIA SYMPTOMS IN YOUNGER ADULTS are Frequently due to the following:
Metabolic disorders
Substance abuse
Immune-mediated diseases
Infectious diseases
inability to learn new information and/or recall
past information
Memory impairment
absence or impairment of the ability to communicate
through speech, writing or signs because of brain dysfunction
Aphasia
inability to perform purposive movements although there is
no sensory or motor impairment
Apraxia
loss of comprehension of visual, auditory, or other sensations although sensory sphere is intact
Agnosia
ability to think abstractly and plan, initiate,
sequence, monitor, and stop complex behavior
Executive function
IN DSM 5, NEUROCOGNITIVE DISORDERS….
The grouping is unusual among the mental disorders because their etiology of each condition is specific and biological.
the term ‘neurocognitive’ describes cognitive functions closely linked to the functions of particular brain regions, neural pathways, or cortical/subcortical networks in the brain…parallel with the designations ‘neurocognitive,’ neuropsychology focuses on psychological processes and behaviors related to known structural or metabolic brain disease
the diagnostic criteria include disturbance in attention that
develops over a short time period, a change from the person’s normal state, and fluctuation over time . Disturbance in cognition is also evident
Global. Loss of cognitive func
The primary differences between the two are the rate of onset (rapid for delirium) and altered consciousness (characteristic of delirium but not dementia)
DELIRIUM
Most common in hospital or nursing home settings and among older adults
Almost always associated with a medical condition such as high fever, head injury, or as a postsurgical syndrome
Causes dysfunction in every occupation; disrupts habits, patterns, and roles
Impairs cognitive skill and attention
ETIOLOGY, PROGNOSIS & IMPLICATIONS FOR FUNCTION w/ delirium
Referred to as major NCD
Symptoms include significant cognitive decline from the previous level of performance in one or more cognitive domains based on concern of individual, an informant, or a clinician
Substantial impairment documented by neuropsychological or other quantifiable assessment, and the deficits interfere with independence in daily activities.
MAJOR NEUROCOGNITIVE DISORDER
Referred to as mild NCD
A modest cognitive decline from the previous level of performance in 1 or more cognitive domains; the deficits do not interfere with independence in daily activities, but greater effort, compensatory strategies, or accommodations may be required
Risk factors include genetic factors. Lower risk is associated with better visual acuity, mental activity, and odor identification. Increased risk: high homocysteine, heart disease, slow walk, hx of depression, and lack of challenging mental activity
MILD NEUROCOGNITIVE DISORDER
MAJOR NEUROCOGNITIVE DISORDER ETIOLOGICAL SUBTYPES
Alzheimer’s Disease (AD)
Frontotemporal Lobar Degeneration (FTLD)
Lewy Body Disease (LBD)
Vascular Disease
Traumatic Brain Injury (TBI)
Substance/Medication-Induced NCD
HIV Infection
Prion Disease
Parkinson’s Disease
Huntington’s Disease
The Allen Cognitive Level (ACL) Screen is used to rate dementia levels based on thought process:
used to rate dementia levels
based on thought process: planning/abstract to goal
directed/concrete to automatic/object centered
Cognitive Performance test (CPT)
a cognitive
functional assessment that scores individuals on the ACL six-level scale
The Clinical Dementia Rating scale is used to
used to track memory,
orientation, judgment and problem-solving, community affairs, home
and hobbies, and personal care
The Mini-Mental Status Examination (MMSE)
standardized screen
used by many disciplines for global cognition. It is the most common,
evidence supported standardized cognitive screening assessment.
The Draw a Clock Test measures
measures cognitive and spatial domains.
Weaker evidence supports this too
A social services assessment is used to determine…
used to determine the needs and types
of support the person needs in the living environment (or to make
changes in residential to meet their needs). Family interviews
determine the interactional needs as they adjust to the diagnosis.
AChEI (acetylcholinesterase inhibitors) or Aricept, Exelon, and Razadyne/Reminyl
are the drugs of choice; may cause GI problems
With advanced disease process, Namenda may also be used with AChEI therapy
Alzheimer’s Disease, Lewy body dementia, vascular dementia, and Parkinson’s dementia
Insidious onset
Gradual progression
Initial: Executive function, memory, and work
Intermediate: IADL, ADL, and social
Long term: All functions, including motor
Spared: None
Alzheimer’s
Insidious onset
Progressive
Behavioral disinhibition; perseveration, stereotyped, or obsessive behavior; hyperorality and dietary changes; social cognition and executive function
Spared: learning, memory and perceptual motor
FTDL
Insidious onset
Progressive
Fluctuating cognition; attention/alertness; visual hallucinations; difficulty maintaining social conventions; Parkinsonian tremors and pronounced motor deficits
Nothing spared
Lewy body
Abrupt onset
May or may not progress
Complex attention; executive function; other dependent on site and frequency of lesions
Depends what is spared
Vascular
Abrupt onset
Not progressive
Dependent on area of damage
Spared: dependent on area of damage
TBI
Abrupt or progressive onset
Not progressive
Dependent on area of damage
Spared: dependent on area of damage
Substance/medication induced
Insidious onset
Progressive
Impaired memory, apathy, social withdrawal, and difficulty concentrating
Spared: Varies
HIV
Insidious onset
Progressive
Motor deficits may be noted first; characteristic pill-rolling, tremor, gait disturbance, and motor rigidity; anxiety, depression, and memory loss
spared: cognitive loss is variable
Parkinson’s
Insidious
Progressive - rapid
Problems with muscular coordination; personality changes, including impaired memory, judgment, and thinking; impaired vision; insomnia and depression
Spared: None
Prion
Insidious onset
Progressive
Irritability, anxiety, and depression, progresses to severe dementia; psychotic behavior; involuntary jerky movements, muscle weakness, clumsiness, and gait disturbance
Spared: none
Huntington’s
Implications for OT
Few effective medical treatments exist; management of behaviors and enhancement of function are frequently the focus of the individual’s intervention
Examples:
Leisure activity
Gardening interventions
Behavioral strategies
Environmental strategies
Exercise (including computer based cognitive practice)
Management of self-care activities (Ex. Medication Management)
3 main interventions for OT
- Environmental intervention
- Caregiver education
- Behavioral intervention
Adapt the environment to meet the changing needs
Establish consistent performance contexts
Reinforce well-developed habits and routines
Environmental intervention
Includes education about the disease or disorder,
Strategies to adapt activities or compensate for declining
performance in areas of occupation, and
Communication training
Caregiver education intervention
Training to use aids (early stage tendency to get lost in familiar areas)
Mange fatigue and maintain sleep/wake cycles
Middle stage: structured activities that have meaning and purpose
Mid- to late stage: exploration of non pharmacological interventions including reminiscence, distraction, sensory stimulation, and calming procedures like rocking chairs, aviaries, manipulative tasks, music, massage, dimmed lighting, oral reading, and clutter reduction
Behavioral intervention
Cultural beliefs and practices of the individual and caregiver have a significant impact on the nature of the intervention and the probable outcomes of care.
Implications on structuring of the environments, expectations of and support for caregiving, and even caregiver instructions
Cultural considerations of Neuro cognitive d/o
What is the focus for OT in neurocog d/o?
Determining the optimal types and amount of supports to facilitate performance and to educate the caregiver on adaptations and strategies to achieve the desired goals.
encourages various cognitively challenging act
Cognitive stimulation therapy
Implications for OT with neurocog d/o
Cognitive stimulation therapy
Realistic framing of goals necessary; unrealistic to believe individual will improve dramatically. Slowing/delaying functional decline can be a positive outcome and can enhance sense of enjoyment and usefulness
Focus on quality of life; focus on familiar activities and individual strengths
