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
The most widely investigated biomarkers for AD fall into two
classes:
o Biomarkers of amyloid-beta protein deposition
o Biomarkers of downstream neuronal degeneration or
injury (such as elevated tau, decreased brain
metabolism, and brain atrophy).
Diagnostic marker of AD?
Amyloid precursor protein
Presenilin 1
Presenilin 2
help differentiate AD from vascular dementia and frontotemporal dementia
SPECT (single-photon emission computed tomography or PET (positron emission tomography
`a definitive diagnosis of AD could only be obtained by autopsy. T or F?
T
In clinical practice, patients are diagnosed with ‘probable AD’ based on cognitive assessment, laboratory tests, and imaging techniques, among other procedures. T or F?
T
is an objective assessment of orientation, registration, attention and calculation, recall, language, and praxis (the performance of an action)
MMSE
was designed to screen for cognitive impairment, and is less suitable for tracking the progression of AD.
MMSE
In total MMSE score ranges from
0-30
MMSE cut-off scores
▪ Mild: 20-26 pts
▪ Moderate: 10-19 pts
▪ Severe: <10 pts
▪ Other cutoffs also exist.
The most common type of TBI is a
Concussion
is when there is a significant blow to the head, followed by changes in braining functioning. It often causes immediate disorientation or loss of consciousness, along with headaches, dizziness, nausea, and sensitivity to light
concussio
which is a progressive, degenerative conditions due to repeated head trauma.
are most seen in athletes (I.e., football players) and military personnel (Baugh et al, 2012). in addition to the neurological symptoms, psychological symptoms such as depression and poor impulse control have been observed
chronic traumatic encephalopathy (CTE)
Symptoms include significant fluctuations in attention and alertness; recurrent visual hallucinations; impaired mobility; and sleep disturbance
neurocognitive disorder due to Lewy bodies
most individuals do not survive longer than ____ years post-diagnosis of Lewy Body Dementia
8 years
are irregular brain cells that result from the buildup of abnormal proteins in the nuclei of neurons. These brain cells deplete the cortex of acetylcholine, which causes the behavioral and cognitive symptoms
Lewy Bodies
rare genetic disorder that involves involuntary movement, progressive dementia, and emotional instability. Due to the degenerative nature of the disorder, there is a shortened life-expectancy as death typically occurs 15-20 years post-onset of symptoms
Huntington’s Disease
meaningful therapeutic goals for the treatment of beurocognitive disorders?
alleviating the symptoms of AD, and delaying symptom progression
In mild AD, treatment outcomes should focus on
memory functions
In more severe AD, treatment outcomes should focus on
effects on activities of daily living (ADLs) and psychiatric behavioral disturbances are more clinically relevant.
The current treatments for AD are symptomatic; disease-modifying treatments are not yet available. T or F?
T
Pharmacological therapies indicated for the treatment of AD are:
o Acetylcholinesterase inhibitors (AChEIs)
o NMDA receptor antagonist
o Other pharmacological therapies used in AD include:
▪ Antipsychotics for psychosis and agitation
▪ Antidepressants for depression
▪ Sedatives for sleep disturbance
Psychosocial therapies for AD include:
o Behavioral-oriented approaches o Stimulation-oriented approaches o Emotion-oriented approaches o Cognition-oriented approaches o Sleep hygiene
Examples of stimulation interventions are
Examples of stimulation interventions are recreational activities or therapies (e.g., crafts, games, pets), art therapies (e.g., music, dance, art), and exercise.
The aims of emotion-oriented treatments are to
address issues of loss, and to improve mood and behavior.
The aim cognition-oriented treatments is to
is to restore cognitive deficits, often in a classroom setting.
Examples of cognition interventions are reality orientation cognitive retraining, and skills training
reality orientation cognitive retraining, and skills training
Cognition interventions may provide modest and transient improvements; however, they are associated with
adverse emotional consequences (such as frustrations)
Medications aimed at improving cognition are prescribed [based/independent] on disease stage, whereas nonpharmacological interventions and psychiatric medications are used [based/independent] of disease stage, based on the patient’s need.
Medications aimed at improving cognition are prescribed based on disease stage, whereas nonpharmacological interventions and psychiatric medications are used independent of disease stage, based on the patient’s need.
In terms of pharmacotherapy, the addition of an __________receptor antagonist to an AChEI may be beneficial in delaying symptom progression among patients with moderate AD;
NMDA;
In terms of pharmacotherapy, patients with mild AD should be offered a trial of an _________
AchEI