Major/Mild Neurocog D/O Due to TBI Flashcards

1
Q

criterion A for M/M NCD due to TBI

A

criteria are met for M/M NCD

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2
Q

criterion B for M/M NCD due to TBI

A

there is evidence of a traumatic brain injury

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3
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)

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4
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

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5
Q

what specifiers are there for M/M NCD due to TBI

A

severity specifier

rate the severity of the NCD, NOT the underlying TBI

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6
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

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7
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

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8
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

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9
Q

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

A

disinhibition

apathy

suspiciousness

aggression

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10
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

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11
Q

what % of the population lives with a TBI associated disability

A

2%

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12
Q

what % of TBIs are in males

A

59% (in the USA)

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13
Q

what are the most common etiologies of TBI in the USA

A

falls

vehicular accidents

being struck on the head

*collisions and blows to the head that occur in the course of contact sports are increasingly recognized as sources of mild TBI with a concern that repeated mild TBI may have a cumulatively persisting sequelae

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14
Q

what are the severity levels of TBI and when are they rated

A

rated AT TIME OF INJURY

mild–> moderate–> severe

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15
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)

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16
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)

17
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

18
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

19
Q

does the severity rating of the TBI correspond to the severity of the resulting NCD?

A

no not necessarily

20
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
21
Q

when are neurobehavioural symptoms most severe after TBI

A

in immediate aftermath

22
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

23
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

24
Q

what may happen in the case of repeated mild TBI

A

may have persisting neurocognitive disturbance

25
Q

list some of the symptoms that can persist in the cases of moderate and severe TBI

A

seizures (particularly in the first year)

photosensitivity

hyperacusis

irritability

aggression

depression

sleep disturbance

fatigue

apathy

inability to resume occupational and social functioning at pre-morbid level

deterioration in interpersonal relationships

26
Q

moderate and severe TBI increases risk for which disorders

A

depression

aggression

possible NCDs like alzheimers

27
Q

how might persisting-TBI related impairment present in a child

A

delays in reaching milestones

worse academic performance

impaired social development

28
Q

how might persisting-TBI related impairments present in a teen or adult

A

various neurocognitive deficits

irritability

hypersensitivity to light and sound

easy fatigability

mood changes (including depression, anxiety, hostility or apathy)

29
Q

which populations are at highest risk for TBI

A

kids younger than age 4

older adolescents

adults older than 65 years

30
Q

what is the most common cause of TBI

A

falls (then MVAs)

sports concussions are frequent cause of TBI in older kids, teens and young adults

31
Q

what are some risk factors for neurocognitive disorder after TBI

A

repeated concussions –> can lead to clinical NCD and neuropathological evidence of traumatic encephalopathy

co-occuring intoxication with substance may increase severity of TBI from MVA but not sure if it affect cognitive outcome

32
Q

list factors associated with worse outcome from moderate to severe TBI

A

older age (above 40)

initial clinical parameters (low GCS, worse motor function, pupillary nonreactivity, CT evidence of brain injury)

33
Q

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

A

petechial hemorrhages

SAH

contusion

34
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

35
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
36
Q

what psychiatric disorder can often co occur with TBI, and also have overlapping symptoms

A

PTSD (especially in military populations)