Neurocignitive Disorders. 1 Flashcards
What are neurocognotive disorders?
Disorders in which the core feature is acquired dysfunction in a cognitive domain that occurs after “early life”
What are the domains of cognition?
Memory
Language
Executive function
Visuospatial functioning
What are the common neurocognitive conditions ?
- delirium
- amnesia
- aphasia
- dementia
What is delirium?
- A disturbance in awareness and attention:
Awareness is usually assessed by one’s alertness/orientation to the environment
Attention (one’s ability to direct, focus, sustain, and shift attention) can be assessed qualitatively and/or quantitatively.
- An additional disturbance in a cognitive domain (e.g., memory, language thoughts/delusion, perceptual (including hallucinations ))
- The sudden onset of symptoms (over hrs to a few days) that typically fluctuate during the day
- Evidence for a direct physiological cause (I.e., a medical condition, substance intoxication or withdrawal)
What are the diagnostic 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 the course of a day
C. An additional disturbance in cognition (e.g., memory deficit, disorientation, language, visuospatial ability, or perception)
D. The disturbances in criteria A or criteria C are not 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
What is the pathology of delirium?
Numerous medical conditions and drugs can induce a delirium
Delirium’s are often seen in an ICU
In order for a delirium to be induced, primitive brain structures (the brain stem) are affected
Describe the risk factors and course of delirium
Risk factors:
Non-modifiable: e.g. poor health, older age, male gender
Modifiable: e.g. immobilization, sleep disturbance, ICU setting
Symptoms persist until causal factors are treated
Resolution typically occurs within 3-7 days
Amnesia for events during delirium is common
Delirium is a poor prognostic sign for long-term survival and associated with longer ICU stays
How can delirium be treated?
- Treat underlying medical condition
- Use medications (antipsychotics) for associated symptoms (insomnia, psychosis, agitation)
Note: benzodiazepines are a risk factor for a delirium, so they are used only to treat a delirium causes specifically by alcohol withdrawal)
How can we use environmental support measures to treat delirium?
Balanced stimulation(not under or over)
Provide orienting stimuli (e.g. lighting, personal effects, sensory perception aids)
Provides for safety needs (e.g. presence of an attendant, bedrails, and possibly restraints)
What is a dementia?
Refers to multiple and severe cognitive impairment without impaired consciousness
Is usually progressive and irreversible
Is most common in the elderly (>5% incidence 65 and higher with rate doubling every five years)
Note: if problems don’t result in impairment in activities of daily living, then the disorder is refferred to as “Mild Cognitive impairment”—MCI (not a DSM term)
What does Ahlzeimer’s dementia involve?
Significant memory impairment plus impairment in at least 1 other cognitive domain
A gradual onset with steadily progressive gradual decline
Exclusion of other causes of the symptoms (e.g. stroke)
Give the epidemiology of Ahlzeimers dementia
Most common dementia with onset typically 65 and higher
No notable gender bias
Give the general course of Ahlzeimer’s dementia (+10 years)
Early stage: memory deficits (rapid forgetting) and word-finding problems
Middle stage: further decline in memory and language, visuospatial deficits, agnosias [inability to identify/comprehend meaning of stimuli ], mood changes, personality changes and psychosis
End stage: global cognitive impairment, motor deficits, death from opportunistic infections
Describe symptoms of Mild Ahlzeimer’s disease early stage
person may function independently, may have memory lapses
Friends and family begin to notice difficulties
Problems coming up with the right word or crime
Trouble remembering names names when introduced to new people
Challenges performing tasks in social or work settings
Forgetting material that one has just read
Losing or misplacing s valuable object
Increasing trouble with planning or organizing
Give the symptoms of Moderate Ahlzeimer’s disease (middle stage)
- forgetfulness of events or about one’s own personal history
- feeling moody or withdrawn, especially in socially or mentally challenging situations
- being unable to recall their own address or telephone number or the high school or college from which they graduated
- confusion about where they are or what day it is
- the need for help choosing proper clothing for the season or the occasion
- trouble controlling bladder and bowels in some individuals
- Changes in sleep patterns, such as sleeping during the day and becoming restless at night
- An increased risk of wandering and becoming lost
- Personality and behavioral changes, including suspiciousness and delusions or compulsive, repetitive behavior like hand-winging or tissue shredding
Give a description (not symptoms ) moderate Ahlzeimer’s/middle stage
A person may have greater difficulty performing tasks, such as paying bills, but they may still remember significant details about their life
May notice person with Ahlzeimer’s confusing words, getting frustrated or angry, or acting in unexpected ways, such as refusing to bathe. Damage to nerve cells in the brain can make it difficult to express thoughts and perform routine tasks
What are the symptoms of severe Ahlzeimer’s disease(late stage)?
Individuals may:
- need round the clock assistance with daily activities and personal care
- lose awareness of recent experiences as well as of their surroundings
- experience changes in physical abilities, including the ability to walk, sit and, eventually, swallow
- have increasing difficulty communicating
- become vulnerable to infections, especially pneumonia
Give a raw description (not symptoms) severe Ahlzeimer’s disease
Individuals lose the ability to respond to their environment, to carry on a conversation and, eventually, to control movement. They may still say words or phrases, but communicating pain becomes difficult. As memory and cognitive skills continue to worsen, significant personality changes may take place and individuals need extensive help with daily activities
