FOR BLOCK: TRANS 061 Delirium, Dementia, Cognitive Flashcards
is characterized by a notable disturbance in attention
or awareness and cognitive performance that is significantly
altered from one’s usual behavior.
Delirium
The onset of delirium is abrupt, occurring for several hours. T or F?
T
Criteria for delirium
• A. A disturbance in attention (i.e., reduced ability to direct,
focus, sustain, and shift attention) and awareness (reduced
orientation to the environment).
• B. The disturbance develops over a short period of time
(usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in
severity during a day.
• C. An additional disturbance in cognition (e.g., memory
deficit, disorientation, language, visuospatial ability, or
perception).
• D. The disturbances in Criteria A and C are not better
explained by another preexisting, established, or evolving
neurocognitive disorder and do not occur in the context of a
severely reduced level of arousal, such as coma.
• E. There is evidence from the history, physical examination,
or laboratory findings that the disturbance is a direct
physiological consequence of another medical condition,
substance intoxication or withdrawal (i.e., due to a drug of
abuse or to a medication), or exposure to a toxin, or is due to
multiple etiologies.
Indiviiduals with this condition show a
significant decline in both overall cognitive functioning as well
as the ability to independently meet the demands of daily
living such as paying bills, taking medications, or caring for
oneself.
• While it is not necessary, it is helpful to have documentation
of the cognitive decline via neuropsychological testing within
a controlled, standardized testing environment.
Major Neurocognitive disorder I
Within the umbrella of major neurocognitive disorder is
__________ a striking decline in cognition and self-help skills
due to a neurocognitive disorder.
dementia
whereas
_______________is the preferred term used to describe
conditions affecting younger individuals such as impairment
due to traumatic brain injuries or other medical conditions.
Neurocognitive disorder
Criteria For Major Neurocognitive Disorder
DIAGNOSTIC CRITERIA
• A. Evidence of significant cognitive decline from a previous
level of performance in one or more cognitive domains
(complex attention, executive function, learning and memory,
language, perceptual-motor, or social cognition) based on:
o 1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a significant decline in cognitive function; and
o 2. A substantial impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment.
• B. The cognitive deficits interfere with independence in everyday activities (i.e., at a minimum, requiring assistance with complex instrumental activities of daily living such as paying bills or managing medications).
• C. The cognitive deficits do not occur exclusively in the context of a delirium.
• D. The cognitive deficits are not better explained by another mental disorder (e.g., major depressive disorder, schizophrenia).
what are the cognitive domains?
complex attention, executive function, learning and memory,
language, perceptual-motor, or social cognition
It should be noted that the primary difference between major and mild neurocognitive disorder is
the severity of the decline and independent functioning.
Diagnostic criteria of Mild Cognitive Disorder?
• A. Evidence of modest cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual motor, or social cognition) based on:
o 1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a mild decline in cognitive function; and
o 2. A modest impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment.
• B. The cognitive deficits do not interfere with capacity for independence in everyday activities (i.e., complex instrumental activities of daily living such as paying bills or managing medications are preserved, but greater effort, compensatory strategies, or accommodation may be required).
• C. The cognitive deficits do not occur exclusively in the context of a delirium.
• D. The cognitive deficits are not better explained by another mental disorder (e.g., major depressive disorder, schizophrenia).
is a complex neurodegenerative disease with multifactorial etiology involving multiple neurotransmitter systems
AD
is the most important risk factor for AD;
age
the prevalence of AD is estimated to double with every ___ year increment in age, after 65 years
5 year
the most commonly diagnosed neurocognitive disorder, is observed in nearly 5.5 million Americans
AD
The most common causes of TBI are
falls, automobile accidents, and accidental head strikes
• Genetic factors directly linked to early-onset AD
o Familial cases account for 1-5% of cases
o Mutations in APP (Amyloid Precursor Protein), PSEN(Presenellin)1, and PSEN2 genes
evidence of link to chromosome 1, 14, and 21
Genetics of sporadic AD
o ApoE ε4 – increased risk of AD (3-13 times)
o ApoE ε2 - moderately decreased risk of AD in some studies
Education is preventive of dementia. T or F?
T
• In practice, AD can be clinically diagnosed by:
• In practice, AD can be clinically diagnosed by:
o Medical history from the patient and, separately, from an informant who knows the patient
o Clinical signs and symptoms
o Neuropsychological tests