NCD- Neurocognitve Disorders Flashcards
Was dementia redefined in the DSM 5 as an NCD?
Yes
What are some recognized NCDs?
Vascular
Frontotemporal
NCDLB (Lewy Bodies)
AD (Alzheimer’s)
What differentiates major and mild NCD?
Level of function
True or false
To be a major NCD, independence in ADLs is impaired
FALSE: IADL
True or false
In mild NCD may be capacity for independence in IADLs though the person may need more time, more effort, and compensatory strategies
True
What is Alzheimer’s disease (AD)?
A progressive dementia that causes cognitive, functional, and behavioral changes
Does the prevalence of AD approximately double every 5 years after the age of 65 in developed nations?
Yes
In the US, AD is the 6th leading cause of death for what age groups?
ALL age groups
True or false
AD isn’t the single major cause of institutionalization of aged people
FALSE: IS THE MAJOR CAUSE
What is the etiology of AD?
Poorly understood
Diagnosis made by exclusion (ruling out other disease processes abs considering PMH)
Diagnostic tools not completely accurate (ex MRI, PET)
Research in diagnostics not a priority due to lack of effective treatments
What is the neuropathology of AD?
Cortical atrophy
Widened sulci
Ventricular enlargement
Caused by Neurofibrillary tangles and beta-amyloid plaques
Beta amyloid plaques
Plaques collected outside and around neurons
Neurofibrillary tangles
Tau protein
Abundance of abnormal structure of beta amyloid plaques and neurofibrillary tangles
Neurotransmitter abnormalities
What does Neurofibrillary tangles and beta-amyloid plaques cause?
Shrink in brain structure
What are beta amyloid plaques caused by?
Defective breakdown of amyloid precursor protein
What does plaques collected outside and around the neurons cause?
Neuronal death
What does neurofibrillary tangles contaminate?
Tau protein
What does the tau protein do?
Serves as connectors throughout cell body- transports nutrients and molecules
Do the structural changes listed cause AD?
No but they are the end products of a pathological process
Is AD caused by a gene mutation?
No
What age is early onset of AD?
Before 65
What age is late onset of AD?
At or after age 65
MORE COMMON
Is Down syndrome a risk factor? Why?
Yes
Downs has extra chromosome which contains APP gene
Is there a risk for developing cardiovascular disease?
Yes
What are some AD risk factors?
Low education level
History of head trauma with loss of consciousness
History of depression
Later maternal age
Environmental & occupational therapy (ECT)
Alcohol abuse
Analgesic abuse
Long- standing physical abuse
Vascular risk (high bp, high cholesterol)
Type 2 diabetes
Black or Hispanic ethnicity
High waist to hip ratio
What is the global deterioration scale for assessment of primary degenerative dementia?
Stages of dementia
Stage 1-3 = pre dementia
Stage 4-7 = dementia stages
Stage 5 = beginning of dependent stage
What is the 1st step of the GDS scale?
No symptoms
Resident is not aware
What is the 2nd step of the GDS scale?
No One knows there is a problem not even the resident
President may have subjective complaints that they have trouble recalling names or they lose objects
The resident uses comp and Citori strategies that work for them (writing everything down, repeating numbers in their head)
What is the 3rd step of the GDS scale?
Resident starts to realize there is an issue
Compensatory strategies start to break down
The resident usually does not tell anyone there is an issue
What is the 4th step of the GDS scale?
Others start to realize there is an issue
Resident can follow two-step directives
Do you still have the ability for a new learning at this stage. This is important to know because if you resident has dementia and you believe they may need an assistive device in the future You must teach them how to use it and have them use it one time per week in order for it to be remembered as the dementia progresses
Residence at this stage can usually function in their own environment but have difficulty adapting to a new environment
Depression occurs at this stage
What is the 5th step of the GDS scale?
No new Learning occurs at this stage
If they did not use AE prior to the stage they will not independently use it
Residence at this stage do not know they have a problem
They are able to carry a conversation and look and act normally, however they only have five minutes of memory
They will frequently ask the same questions throughout the day
What is the 6th step of the GDS scale?
Physiological changes are occurring
Eye gaze lowers to as far as 32 inches from the floor, loss of peripheral vision and loss of depth perception
The hypothalamus is affected and therefore they may perceive they are cold even if it is 70 degrees out and they will wear multiple layers of clothes
What is the 7th step of the GDS scale?
At this stage they are dominated by their senses
If you feel good, taste good, smells good it is good
They stop talking or only make noises
As they progress they are unable to hold up their head
What are the 7 stages of the functional assessment staging scale (FAST)?
1- normal adult
2- normal older adult
3- early dementia
4- mild dementia
5- moderate dementia
6- moderately severe dementia
7- severe dementia
What is the 3 stages approach?
Correlates to DSM 5
Mild, moderate and severe
What are the 4 pillars to complete dementia care?
1) supportive care for the patient
2) supportive care for the family and/ or caregiver
3) disease treatment
- pharmacotherapy
4) symptom treatment
- cognitive
- mental
- behavioral
- environmental
