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Collège royal > Gérontopsychiatrie > Flashcards

Gérontopsychiatrie Flashcards

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1
Q

what are the 3 elements of the biological diagnosis of alzheimers disease

A

ATN

amyloid beta deposition

pathological Tau

Neurodegeneration

*premature to use in general medical practice

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2
Q

should you use amyloid or tau imaging to assess people without memory decline

A

no, not outside research setting (as presence of these factors is of uncertain significance)

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3
Q

what imaging technique is recommended to investigate VASCULAR cognitive impairment

A

MRI > CT

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4
Q

what tools are recommended for the diagnosis of vascular mild cognitive impairment and vascular dementia

A

use of STANDARDIZED criteria

i.e one of:

Vascular Behavioural and Cognitive Disorders Society criteria (VAS-COG)

DSM 5

Vascular Impairment of Cognition Classification Consensus Study

or American Heart Assoc consensus statement

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5
Q

why should you treat HTN

A

treatment of HTN may reduce the risk of dementia and thus clinicians should assess, diagnose and treat HTN according to HTN Canada guidelines

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6
Q

which patients should be treated with antihypertensives

A

those with cognitive disorders in which vascular contribution is known or suspected–> if avg. diastolic is at or above 90mmHG and /or systolic at or above 140mmHG

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7
Q

is the use of aspirin recommended for patients with MCI or dementia who have brain imaging evidence of covert white matter lesions of presumed vascular origin without history of stroke or infarcts

A

no

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8
Q

are cholinesterase inhibitors or memantine recommended for treatment of vascular cognitive impairment

A

may be considered in selected patients

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9
Q

is cognitive screening recommended in asymptomatic patients

A

no

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10
Q

list risk factors for cognitive disorders

A
  1. late onset depressive disorder or lifetime history of MDD
  2. untreated sleep apnea
  3. hx stroke or TIA
  4. unstable metabolic or CV morbidity
  5. a recent episode of delirium
  6. first major psychiatric episode at an advanced age (i.e psychosis, anxiety, depression)
  7. recent head injury
  8. parkinsons disease
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11
Q

what rapid, objective assessments of cognitive function are recommended by the guidelines

A
  1. Memory Impairment Screen (MIS) + clock drawing test
  2. the Mini-Cog
  3. the AD8
  4. the four item version of the MoCA
  5. GP Assessment of Cognition (GPCOG)
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12
Q

what are the four items included on the four item MoCA

A

clock drawing

tap at letter A

delayed recall

orientation

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13
Q

why might you use the MoCA over the MMSE

A

more sensitive to MCI

use when MCI is suspected or when there is suspicion for cognitive impairment or concern about patients cognitive status but the MMSE score is within normal range

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14
Q

what is the normal range on the MMSE

A

24+/30

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15
Q

what are the more comprehensive psychometric screening tools listed in the guidelines

A

Modified Mini Mental State (3MS) exam

MMSE

Rowland University dementia assessment scale (RUDAS)

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16
Q

what is a questionnaire a caregiver or informant could fill out about dementia in a patient

A

AD-8

IQCODE (informant questionnaire on cognitive decline)

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17
Q

what tools can be used to assess BPSD in a patient if a behavioural, personality or mood change has been observed

A

short version of the Neuropsychiatric Inventory (NPI-Q)

Mild Behavioural Impairment Checklist (MBI-C)

(or PHQ-9 if mood change)

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18
Q

what are 2 tools that can be used for rapid screening of functional autonomy in suspected dementia

A

the Pfeffer Functional Activities Questionnaire (FAQ)

or the Disability Assessment for Dementia (DAD)

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19
Q

in which disorders might the DCQ be particularly helpful

A

behavioural variant FTD

primary progressive aphasia

alzheimers disease variants

as it is based on updated criteria for atypical syndromes like these –> MMSE, MoCA were not designed for screening for atypical syndromes and are often not sufficient to capture subtle cognitive and social cognition changes associated with atypical dementia

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20
Q

why is getting corroborative history essential when someone has subjective concerns about their cognition

A

has prognostic significance

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21
Q

what is recommended as one of the primary tools for tracking cognitive response and change over time

A

folstein’s MMSE

*has been used in several clinical trials of cholinesterase inhibitors

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22
Q

what is one major determinant of hospitalization or nursing home placement for patients with dementia

A

caregiver burnout

should be regularly assessed in followup of patients with dementia

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23
Q

what is a structured scale to measure caregiver burnout

A

Zarit Burden Interview

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24
Q

is MRI or CT preferred? why?

A

MRI–> higher sensitivity to some vascular lesions as well as for some subtypes of dementia and rarer conditions

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25
Q

what should you look for on CT when assessing dementia

A

hippocampal atrophy

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26
Q

should you do CT or non contrast CT when assessing dementia

A

non con

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27
Q

what type of imaging can be helpful in assessing/diagnosing cognitive imapirment linked to Lewy Body Disease

A

SPECT scan (where diagnosis is suspect but remains unclear)

consider PET scan first due to cost

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28
Q

what motor marker is suggestive of future dementia

A

slower gait speed

when slow gait speed + cognitive impairment the risk is higher

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29
Q

by how much does parkinsonism increase risk of developing dementia

A

up to 3x

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30
Q

what are two other factors associated with development of dementia

A

sleep disturbance

hearing impairment

–> should assess both of these in primary clinics as dementia risk factor

(insufficient evidence to support assessment of vision as dementia risk)

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31
Q

what diet is recommended to decrease risk of cognitive decline

A

mediterranean

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32
Q

what type of exercise interventions have been shown to improve cognitive outcomes in older adults

A

dance

mind body (ie yoga, qi gong)

aerobic and/or resistance exercise

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33
Q

how does OSA affect risk of dementia

A

treatment with CPAP in presence of OSA may improve cognition and decrease risk of dementia

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34
Q

for those on a cholinesteras inhibitor for alzheimers, parkinsons dementia, lewy body or vascular dementia for MORE THAN 12 months, when should you consider discontinuation of the medication

A

when:
1. there has been a CLINICALLY MEANINGFUL WORSENING of dementia as reflected by changes in cognition, functioning, global ax over the past 6 MONTHS in absence of other medical condition or enviro factors

  1. NO clinically meaningful benefit was observed at any time during treatment
  2. person has severe or end stage dementia
  3. development of intolerable side effects
  4. medication adherence is poor and precludes safe ongoing use of meds

**this is the same for deprescription of memantine in those taking for same indications

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35
Q

should you prescribe cholinesterase inhibitors for frontotemporal dementia or other neuro-degenerative conditions

A

these should be discontinued

*same for memantine

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36
Q

what characteristics unify those disorders listed under “neurocognitive disorders” listed in the DSM

A
  1. the primary clinical deficit is in cognitive function 2. they are acquired rather than developmental –> they represent a DECLINE in previous levels of functioning *although cognitive deficits are present in many if not all mental disorders, only disorders whose core features are cognitive are included in the NCD category
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37
Q

list the cognitive domains on which the criteria for the various NCDs are based

A
  1. complex attention 2. executive function 3. learning and memory 4. language 5. perceptual-motor 6. social cognition
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38
Q

what are the elements included in complex attention

A

sustained attention divided attention selective attention processing speed

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39
Q

define the following cognitive domain, and give an example of an assessment for: sustained attention

A

maintenance of attention over time, i.e pressing a button every time a tone is heard, over a period of time

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40
Q

define the following cognitive domain, and give an example of an assessment for: selective attention

A

maintenance of attention despite competing stimuli and/or distractors i.e hearing numbers and letters read out loud and asked to count only letters

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41
Q

define the following cognitive domain, and give an example of an assessment for: divided attention

A

attending to two tasks within the same time period i.e rapidly tapping while learning a story being read

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42
Q

define the following cognitive domain, and give an example of an assessment for: processing speed

A

can be quantified on any task by timing it i.e time to put together a design of blocks

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43
Q

describe what might be observed in a patient with MAJOR deficits in the domain of: complex attention

A

has increased difficulty in environments with multiple stimuli easily distracted by completing events in the environment is unable to attend unless input is restricted and simplified has difficulty holding new information in mind, such as recalling phone numbers or addresses just given or reporting what was just said is unable to perform mental calculations all thinking takes longer than usual and components to be processed must be simplified to one or a few

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44
Q

list the components of executive function

A

planning decision making working memory responding to feedback/error correction overriding habits/inhibition mental flexibility

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45
Q

define the following cognitive domain, and give an example of an assessment for: planning

A

ability to find the exit to a maze, or interpret a sequential picture or object arrangement

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46
Q

define the following cognitive domain, and give an example of an assessment for: decision making

A

performance of tasks that assess process of deciding in the face of competing alternative i.e simulated gambling

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47
Q

define the following cognitive domain, and give an example of an assessment for: working memory

A

ability to hold information for a brief period and to manipulate it i.e adding up a list of numbers or repeating a series of numbers or words backwards

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48
Q

define the following cognitive domain, and give an example of an assessment for: feedback/error utilization

A

ability to benefit from feedback to infer the rules for solving a problem

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49
Q

define the following cognitive domain, and give an example of an assessment for: overriding habits/inhibition

A

ability to choose a more complex and effortful solution to be correct (i.e looking away from direction indicated by an arrow, naming the color or words font instead of naming the word)

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50
Q

define the following cognitive domain, and give an example of an assessment for: mental/cognitive flexibility

A

ability to shift between two concepts, tasks or response rules i.e from number to letter, from verbal to key press response

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51
Q

define the following cognitive domain, and give an example of an assessment for: mental/cognitive flexibility

A

ability to shift between two concepts, tasks or response rules i.e from number to letter, from verbal to key press response

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52
Q

describe what might be observed in a patient with MILD deficits in the domain of: executive function

A

increased effort required to complete multistage projects has increased difficulty multitasking or difficulty resuming a task interrupted by a visitor or a phone call may complain of increased fatigue from the extra effort required to organize, plan and make decisions may report that large social gatherings are more taxing or less enjoyable because of increased effort required to follow shifting conversations

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53
Q

what are the components of learning and memory relevant to NCDs

A

immediate memory recent memory (including free recall, cued recall, and recognition memory) very long term memory (semantic, autobiographical, implicit learning)

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54
Q

define the following cognitive domain, and give an example of an assessment for: immediate memory span

A

ability to repeat a list of words or digits *immediate memory sometimes is subsumed under “working memory” in executive function

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55
Q

define the following cognitive domain, and give an example of an assessment for: recent memory

A

assesses the process of encoding new information (i.e word lists, diagrams) aspects of recent memory: 1. free recall 2. cued recall 3. recognition memory

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56
Q

how to test free recall

A

person asked to recall as many words, diagrams or elements of a story as possible

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57
Q

how to test cued recall

A

examiner aids recall by providing semantic cues

58
Q

how to test recognition memory

A

examiner asks about specific items i.e was apple on the list?

59
Q

describe what might be MAJOR deficits in the domain of: learning and memory

A

repeats self in conversation, often within the same conversation cannot keep track of short list of items when shopping or of plans for the day requires frequent reminders to orient to task at hand

60
Q

which types of learning and memory are generally preserved in NCDs

A

except in severe forms of major NCD, semantic, autobiographical, and implicit memory are relatively preserved, compared with recent memory

61
Q

what are the components of language

A

expressive language (naming, word finding, fluency, grammar and syntax) receptive language

62
Q

define the following cognitive domain, and give an example of an assessment for: expressive language

A

confrontational naming (ID objects or pictures) fluency (name as many items as possible in a semantic or phonemic category)

63
Q

define the following cognitive domain, and give an example of an assessment for: grammar and syntax

A

errors observed during naming and fluency tests are compared with norms to assess frequency of errors and compare with normal slips of the tongue

64
Q

define the following cognitive domain, and give an example of an assessment for: receptive language

A

comprehension (word definition and object pointing tasks involving animate and inanimate stimuli)–> performance of actions based on a verbal command

65
Q

what are the elements included under “perceptual motor” cognitive domain

A

visual perception visuoconstructional perceptual-motor praxis gnosis

66
Q

how do you test visuoconstructional skills

A

assembly of items requiring hand eye coordination such as drawing, copying

67
Q

how do you test perceptual-motor skills

A

integrating perception with purposeful movement–> inserting blocks into form board without visual cues

68
Q

how do you test praxis

A

integrity of learned movements, such as ability to imitate gestures (wave goodbye) or pantomime use of objects to command (show me how you would use a hammer)

69
Q

how would you test gnosis

A

perceptual integrity of awareness and recognition such as recognition of faces and colors

70
Q

describe what might be MILD deficits in the domain of: perceptual motor

A

may need to rely more on maps or others for directions uses notes and follows others to get to a new place may find self lost or turned around when not concentrating on task is less precise in parking needs to expend greater effort for spatial tasks such as carpentry, knitting, sewing, assembly

71
Q

describe what might be MAJOR deficits in the domain of: perceptual motor

A

has significant difficulties with previously familiar activities (using tools, driving motor vehicle), navigating in familiar environments often more confused at dusk, when shadows and lowering levels of light change perceptions

72
Q

what are the elements of social cognition

A

recognition of emotions theory of mind

73
Q

how do you test recognition of emotions

A

ID of emotions in images of faces representing a variety of both positive and negative emotions

74
Q

how do you test theory of mind

A

ability to consider another persons mental state or experience–> story cards with questions to elicit info about the mental state of the individuals portrayed

75
Q

describe what might be MILD deficits in the domain of: social cognition

A

has subtle changes in behaviour or attitude often described as change in personality, such as less ability to read facial expressions, decreased empathy, increased extraversion or introversion, decreased inhibition or subtle or episodic apathy or restlessness

76
Q

What is criterion A for major neurocognitive disorder

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, social cognition) based on: 1. concern of the INDIVIDUAL, a knowledgeable INFORMANT or the CLINICIAN that there has been a SIGNIFICANT decline in the cognitive function AND 2. a SUBSTANTIAL impairment in cognitive performance, preferably documented by a standardized neuropsychological testing or, in its absence, another quantified clinical assessment

77
Q

what is criterion B for major neurocognitive disorder

A

the cognitive deficits interfere with INDEPENDENCE in everyday activities (i.e at a minimum, requiring assistance with complex iADLs such as paying bills or managing meds)

78
Q

list the etiologic specifiers listed in the DSM 5 for major/minor neurocognitive disorder

A
  1. alzheimers disease 2. frontotemporal lobar degeneration 3. lewy body disease 4. vascular disease 5. traumatic brain injury 6. substance/medication use 7. HIV infection 8. Prion disease 9. Parkinsons disease 10. Huntington’s disease 11. Another medical condition 12. Multiple etiologies 13. Unspecified
79
Q

what other specifiers are present in the DSM for major /mild neurocognitive disorder

A
  1. without behavioural disturbance–> if the cognitive disturbance is not accompanied by any clinically significant behavioural disturbance 2. with behavioural disturbance–> *specify disturbance* if the cognitive disturbance is accompanied by a clinically significant behavioural disturbance (i.e psychotic symptoms, mood disturbance, agitation, apathy, or other behavioural symptoms)
80
Q

define moderate major neurocognitive disorder

A

difficulties with basic ADLs (feeding, dressing)

81
Q

define severe major neurocognitive disorder

A

fully dependent

82
Q

what is criterion A for mild neurocognitive disorder

A

evidence of MODEST cognitive decline from a previous level of performance in one or more cognitive domains based on: 1. concern of the INDIVIDUAL, a knowledgeable INFORMANT or the CLINICIAN that there has been a MILD decline in the cognitive function AND 2. a MODEST impairment in cognitive performance, preferably documented by a standardized neuropsychological testing or, in its absence, another quantified clinical assessment

83
Q

what is criterion B for mild neurocognitive disorder

A

the cognitive deficits DO NOT interfere with capacity for independence in everyday activities (i.e complex iADLs like paying bills, managing meds are preserved, but greater effort, compensatory strategies, or accommodation may be required)

84
Q

in which NCDs are psychotic features common? what are common psychotic features?

A

alzheimers lewy body Frontotemporal lobar degeneration *paranoia and other delusions are common features and often a persecutory theme may be a prominent aspect of delusional ideation

85
Q

how do you distinguish psychotic disorders with onset later in life (i.e schizophrenia) from NCDs with psychotic features

A

disorganized speech and behaviour seen in other psychotic disorders are not characteristic of psychosis in NCDs

86
Q

how might hallucinations differ when seen in NCDs vs other disorders

A

visual hallucinations are more common in NCDs compared to other disorders (though hallucinations can occur in any modality)

87
Q

in which NCDs are depression common early in the course of the illness

A

alzheimers and parkinsons

88
Q

define apathy, and indicate how it might manifest in NCDs

A

typically characterized by diminished motivation, and reduced goal oriented behaviour accompanied by decreased emotional responsiveness may manifest early in course of NCDs when loss of motivation to pursue daily activities or hobbies may be observed

89
Q

what are the DSM criteria for substance/medication induced Major or Mild NCD

A

A–> criteria are met for a major or mild NCD

B–> neurocognitive impairments do not occur exclusively during the course of a delirium and persist beyond the usual duration of intoxication and acute withdrawal

C–> involved substance or medication and duration and extent of use are capable of producing the neurocognitive impairment

D–> temporal course of the neurocognitive deficits is consistent with the timing of substance or medication use and abstinence (i.e deficits remain stable or improve after a period of abstinence)

E–> neurocognitive disorder not attributable to another medical condition and is not better explained by another disorder

90
Q

what types of alcohol relayed NCDs are there

A

major NCD: nonamnestic-confabulatory type

major NCD: amnestic-confabulatory type

mild NCD

91
Q

what are the 4 types of substances listed in the DSM for substance/medication induced Major or Mild NCD

A

alcohol

inhalant

sedative/hypnotic/anxiolytic

other or unknown

92
Q

what is a specifier for substance/medication induced Major or Mild NCD

A

persistent–> neurocognitive impairment continues to be significant after an extended period of abstinence

93
Q

what neurocognitive impairment is seen most predominantly in NCDs due to sedative/anxiolytic/hypnotic drugs/meds

A

greater disturbances in MEMORY than in other cognitive functions

94
Q

NCD due to alcohol frequently manifests with a combination of what impairments

A

impairments in EXECUTIVE FUNCTIONING and MEMORY and LEARNING domains

95
Q

what are the features of alcohol-induced amnestic confabulatory NCD (korsakoffs)

A

prominent amnesia (severe difficulty learning new information with rapid forgetting)

tendency to confabulate

*may co occur with signs of thiamine encephalopathy (wernicke’s) with associated features such as nystagmus and ataxia

96
Q

what ocular abnormality is associated with wernicke’s encephalopathy

A

lateral gaze paralysis (ophthalmoplegia)

97
Q

what are the more common neurocognitive symptoms related to methamphetamine use? what kind of overall NCD profile is seen in methamphetamine use

A

difficulties with learning and memory

difficulties with executive function

*most common neurocognitive profile approximates that seen in vascular NCD

98
Q

is major NCD due to alcohol abuse common

A

no–> MAJOR NCD is rare, may result from concomitant nutritional deficits as in alcohol-induced amnestic confabulatory NCD

99
Q

what are the criteria for major/mild NCD due to HIV infection

A

A–The criteria are met for major or mild neurocognitive disorder.
B–There is documented infection with human immunodeficiency virus (HIV).
C–The neurocognitive disorder is not better explained by non-HIV conditions, including secondary brain diseases such as progressive multifocal leukoencephalopathy or cryptococcal meningitis.
D–The neurocognitive disorder is not attributable to another medical condition and is not better explained by a mental disorder.

100
Q

what pattern of NCD is seen in major/mild NCD due to HIV infection

A

“subcortical pattern”

–> prominently impaired EXECUTIVE FUNCTION, slowing of processing speed, problems with more demanding attentional tasks, difficulty in learning new information

–> in major NCD due to HIV, SLOWING may be prominent

101
Q

major/mild NCD due to HIV infection show relatively preserved function in what cognitive areas

A

recall of learned information is relatively preserved

language difficulties are uncommon

102
Q

what % of those infected with HIV have at least mild neurocognitive disturbance

A

1/3 to 1/2

*may not meet full criteria for NCD

estimated 25% meet criteria for mild NCD
estimated fewer than 5% meet criteria for major NCD

103
Q

what are the criteria for major/mild NCD due to Prion disease

A

A–The criteria are met for major or mild neurocognitive disorder.
B–There is insidious onset, and rapid progression of impairment is common.
C–There are motor features of prion disease, such as myoclonus or ataxia, or biomarker evidence.
D–The neurocognitive disorder is not attributable to another medical condition and is not better explained by another mental disorder.

104
Q

what type of onset and progression would you expect for major/mild NCD due to Prion disease

A

insidious onset, rapid progression of impairment (i.e progression to major NCD over as little as 6 months)

105
Q

what are some motor features of prion disease

A

myoclonus

ataxia

106
Q

what is the most common spongiform encephalopathy/prion disease

A

sporadic creutzfeldt-jakob disease (CJD)

107
Q

how do those with CJD typically present

A

neurocognitive deficits

ataxia

abnormal movements–> myoclonus, chorea, dystonia

startle reflex is common

108
Q

what are the characteristic biomarker features of prion disease

A

recognized lesions on MRI with DWI or FLAIR

tau or 14-3-3 protein in CSF

characteristic TRIPHASIC waves on EEG

(family history or genetic testing for rare familial forms)

109
Q

what would be seen on EEG in prion diseases

A

characteristic triphasic waves

110
Q

what proteins would be seen in CSF in prion diseases

A

tau or 14-3-3 protein

111
Q

what are prodromal symptoms of prion disease

A

fatigue, anxiety, problems with appetite or sleeping, difficulties with concentration

112
Q

what is the most sensitive diagnostic test for prion diseases currently

A

MRI with DWI–> see multifocal gray matter hyper-intensities in subcortical and cortical regions

113
Q

what is the expected onset and progression of major/mild NCD due to parkinsons disease

A

insidious onset

GRADULE progression of impairment

114
Q

list features that are frequently present in the context of major/mild NCD due to parkinsons disease

A

apathy

depressed mood

anxious mood

hallucinations

delusions

personality changes

REM sleep behaviour disorder

excessive daytime sleepiness

115
Q

what % of those with parkinsons disease will develop a major NCD sometime in the course of their illness

A

75%

116
Q

what type of neuroimaging may be helpful to distinguish lewy body vs non-lewy body dementias

A

dopatmine transporter scans i.e DaT scans or structural neuroimaging scans

117
Q

how do you distinguish between the two lewy body dementias (parkinsons and dementia with lewy bodies)

A

onset and timing–> for parkinsons, motor and other symptoms must have been present for about a year before onset of cognitive symptoms

for dementia with lewy bodies, cognitive symptoms begin at the same time or shortly before motor symptoms

118
Q

what are the early cognitive changes seen in huntingtons disease

A

executive function (rather than learning and memory)

often precede the emergence of the typical motor abnormalities of huntingtons disease

119
Q

what are the typical motor abnormalities of huntingtons disease

A

bradykinesia and chorea

120
Q

what is the genetic abnormality responsible for huntingtons disease

A

CAG trinucleotide repeat expansion in the HTT gene on chromosome 4

*fully penetrant, autosomal dominant (repeat length of 36 or more is invariably associated with huntingtons disease)

121
Q

what psychiatric symptoms may be associated with huntingtons disease

A

depression

irritability

anxiety

obsessive-compulsive symptoms

apathy

psychosis–more rare

122
Q

what is the average age at diagnosis of huntingtons disease

A

40

123
Q

what is the median survival after motor symptom diagnosis of huntingtons disease

A

about 15 years

*psychiatric and cognitive symptoms of huntingtons disease can predate motor symptoms by as much as 15 years

124
Q

define traumatic brain injury

A

“brain trauma”–>an impact to the head or other mechanisms of rapid movement or displacement of the brain within the skull, with one or more of the following:

loss of consciousness

posttraumatic amnesia

disorientation and confusion

neurological signs (i.e neuroimaging demonstrates injury; a new onset of seizures; a marked worsening of preexisting seizure disorders; visual field cuts; anosmia; hemiparesis)

125
Q

criterion C for M/M NCD due to TBI

A

the NCD presents immediately after the occurrence of the TBI or immediately after recovery of consciousness and persists past the acute post injury period

126
Q

what is the cognitive presentation of M/M NCD due to TBI

A

variable

commonly see difficulties in the domains of:

  • -complex attention
  • -executive ability
  • -learning
  • -memory
  • -slowing speed of info processing
  • -disturbances in social cognition

*in more severe TBI, there may be additional neurocognitive deficits like aphasia, neglect, or constructional dyspraxia

127
Q

what are some other categories of symptoms that may be associated with M/M NCD due to TBI

A

disturbances in emotional function

personality changes

physical disturbances

neurological symptoms and signs

orthopedic injuries

128
Q

what deficits in emotional function may be present in those with M/M NCD due to TBI

A

irritability

easy frustration

tension

anxiety

affective lability

129
Q

what personality changes may accompany M/M NCD due to TBI

A

disinhibition

apathy

suspiciousness

aggression

130
Q

what physical disturbances may accompany M/M NCD due to TBI

A

headache

fatigue

sleep disorders

vertigo, dizziness

tinnitus or hyperacuity

photosensitivity

anosmia

reduced tolerance to psychotropic medications

131
Q

what are the three injury characteristics taken into consideration when judging the severity of a TBI

A

loss of consciousness (length of time)

posttraumatic amnesia (length of time)

disorientation and confusion at initial assessment (GCS)

132
Q

list the characteristics of a mild TBI

A

loss of consciousness less than 30 min

posttraumatic amnesia less than 24 hours

GCS 13-15 at initial assessment (not below 13 at 30 min)

133
Q

list the characteristics of moderate TBI

A

loss of consciousness 30 min-24 hours

posttraumatic amnesia 24 hours - 7 days

GCS 9-12 at initial assessment

134
Q

list the characteristics of severe TBI

A

loss of consciousness over 24 hours

posttraumatic amnesia more than 7 days

GCS 3-8 at initial assessment

135
Q

what are factors that affect course of recovery from TBI

A

course of recovery is variable

depends on:

  • -specifics of injury
  • -age
  • -prior history of brain damage
  • -hx of substance use
136
Q

what is the usual recovery course in the case of mild or moderate TBI

A

typical course is that of complete or substantial improvement in associated neurocognitive, neurological and psychiatric symptoms and signs

137
Q

how quickly do neurocognitive symptoms associated with mild TBI tend to resolve

A

within days to weeks after the injury

complete resolution typical by 3 months

*other symptoms that co occur with the neuro symptoms, like photosensitivity, headache, irritability, fatigue, sleep disturbance) tend to also resolve in the WEEKS following mild TBI

138
Q

moderate and severe TBI increases risk for which disorders

A

depression

aggression

possible NCDs like alzheimers

139
Q

how might persisting-TBI related impairment present in a child

A

delays in reaching milestones

worse academic performance

impaired social development

140
Q

what might you see on CT scan in the setting of TBI

A

petechial hemorrhages

SAH

contusion

141
Q

what might people notice functionally in the case of MILD NCD due to TBI

A

reduced cognitive efficiency

difficulty concentrating

lessened ability to perform usual activities

142
Q

what might people notice functionally in the case of MAJOR NCD due to TBI

A

may have difficulty with independent living and self care

may have prominent neuromotor features like:

  • -severe incoordination
  • -ataxia
  • -motor slowing

Collège royal (18 decks)

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