Neurocognitive Disorders Flashcards
Examples of normal aging behaviors (6)
- Inappropriate self disclosure
- Memory complaints; slower retrieval
- Mild hypochondrial concerns
- Overinclusive thinking (i.e. “back in my day”)
- Hyper-vigilance (i.e. “get off my lawn!”)
- Fear of victimization
Examples of abnormal behaviors as people age (9)
- Disinhibition (walking around naked)
- Affective lability (I need to do this….what was I doing…what’s this)
- Disorientation
- Problems with new learning
- Excessive dependency
- Fear of being alone
- Anxiety or panic
- Prompts and clues don’t help memory
- Social isolation (hermit)
Differences between delirium and neurocognitive disorders
- DELIRIUM vs. NCDs
- Acute or sub-acute vs. sub-acute or chronic
- Disturbance is cognition and/or perception vs. memory + one other cognitive function
- Disturbances in sensorium / level of arousal vs. intact sensorium (nomral arousal)
- Waxes and wanes vs. stable over time
- Caused by direct physiological consequence of a general medical condition or substance vs. have many causes
Similarities between delirium and neurocognitive disorders (5)
They both have:
- Decline in previous functioning
- Confusion
- Multiple cognitive domains impaired
- Accompanied by Behavior changes
- Psychosis may be present (i.e. delusions and hallucinations)
Delirium: treatment (8)
- Safet: patient and staff
- Quiet restful setting
- Orienting devices in the patient’s room (clocks, familiar objects)
- Optimize sensory input (glassses, hearing aids)
- Remote offending agents
- Treat underlying morbidity
- Avoid benzodiazepines hypnotics for sedation (unless related to EtOH withdrawal)
- Avoid restraints
Why should restraints be avoided when treating delirium?
They remove the perception of safety in restfulness and add potential issues such as injuries, skin breakdown and psychological issues
Define delirium according to the DSM-5 criteria (4)
- encephalapathy (defined as any diffuse disease of the brain that alters function or structure)
- Disturbance of attention and awareness
- Change of cognition
- Disturbance develops over short period of time & fluctuates over the course of the day
COVID-19 delirium: most commonly affected group & contributing factors
- elderly (70%)
- isolated from family & sedative/pain medication use
COVID-19 delirium symptoms (4)
- Confusion
- Change in consciousness
- Hallucination
- Anxiety
(increases risk of dying and dementia)
COVID-19 delirium treatment (4)
- Physical therapy
- Occupational therapy
- Speech therapy
- Cognitive Rehabilitation
Risk factors for delirium associated with anesthesia and surgery (4)
- Age
- Compromised cognitive skills
- Procedure characteristics: invasiveness, duration, urgency
- Postoperative admissions to ICU
Alternatives to using restraints when treating a patient with delirium (5).
- Sitters (professional, family, friends)
- Frequent reassurance and reorientation
- Clear communication with one step commands
- Adequate lighting
- Limit noise
What term is preferred over dementia? Why?
- Major neurocognitive disorder
- Dementia refers to diseases occurring in older populations (i.e. Alzheimer, Lewy Body Dementia)
- Major neurocognitive disorder includes a broad range of possible etiologies (more inclusive)
What is to be included in the neurocognitive disorder history and exam (5)?
- Age at onset
- Pattern of progression (slow or stepwise)
- Cognitive changes
- Behavioral changes
- Motor symptoms: gait, fall, tremor (including tongue), slowness
Lab evaluation for reversible causes of neurocognitive disorder (7).
- B12, folate
- T3, T4, TSH
- Vit D
- RPR, HIV
- UA
- CT or MRI
- Sleep Study (sleep apnea)
How do you screen for neurocognitive disorder (4)?
- Substantial decline from Baseline functioning
- Patient alert and cooperative (rules out delirium)
- Symptoms not explained by another psychiatric condition like Major Depressvie Disorder
- Functional impairment
Difference between Major NCD characteristics & Mild NCD characteristics (3)
MAJOR
- Significant cognitive decline
- Substantial impairment in cognitive performance (neuropsych testing)
- Cognitive deficits interfere with Independence & ADLs
(mild is modest/mild changes in cog. decline/impairment and no interference w/ADLs & independence
6 Cognitive domains
- Complex attention
- Learning and memory
- Language
- Executive functioning
- Perceptual/motor function
- Social cognition
How do you assess the attention (cognitive domain)?
- Digit span (memorize a set of 7 numbers)
- serial 7’s
Types of attention (cognitive domain) (5)
- Alertness
- Vigilance
- Sustained attention
- Selective attention
- Divided attention
(sustained, selective & divided are complex attention)
Sustained attention definition and how to test it
- Maintain detention overtime
- Pressing a button when a tone is heard
Selective attention definition and how to test it
- Maintenance despite competing stimuli
- Hearing numbers and letters and asked to only repeat the letters
Divided attention definition and how to test it
- Do two tasks simultaneously
- Tapping finger while learning a story being read
Major NCD signs in attention deficits (3)
- Easily distracted
- Difficulty holding new information
- Unable to perform mental calculations
Mild NCD signs in attention deficits (3)
- Mental tasks take longer
- Work needs more double-checking
- Tasks easier without distractions
The cognitive domains of learning and memory (5)
- Immediate memory
- Recent memory
- Declarative/explicit memory
- Procedural memory
- Working memory
What is the difference between immediate memory and recent memory?
- Immediate memory: ability to repeat a list of words or digits
- Recent memory: ability to describe a recent event in detail
What is the difference between procedural memory and working memory?
- Procedural memory: Cannot be consciously recalled (i.e. muscle memory of riding a bike)
- Working memory: ability to maintain information temporarily (i.e. phone #s, emails, appts)
What is the difference between declarative / explicit memory and prospective memory?
- Declarative explicit memory: consciously recall memories that can be episodic (personal experiences) or semantic (facts)
- Prospective memory: episodic memory for future events or something that will be done once cue is received (i.e. pick up Kaia at 5pm)
Immediate memory testing
Give a list of words or digits and ask them to repeat it back
Recent memory testing (2)
- Give a word list and ask the patient how many words they can recall, notice and error
- Give a short story and ask the patient to recall the details
Declarative / explicit memory testing (2)
- Have the patient describe a recent memory (i.e. The last meal they had)
- Have the patient describe a favorite memory
Major NCD signs: learning and memory deficits (3)
- Repeat self in conversation
- Cannot keep track of short shopping list
- Loses track of daily activity plan
Mild NCD signs: learning and memory deficits (3)
- Relies increasingly on a list keeping and calendar
- Needs reminders to keep track of characters in a novel or movie
- Loses track of bill payments
Perceptual/motor domain is the ability to _______
integrate structure, detail and spatial relationships
(this help us to navigate our environment; req. visual acuity)
How do you assess the perceptual/motor cognitive domain (2)?
- clock drawing
- design copying
visual perception is the ability to ______ (2)
(perceptual/motor cognitive domain)
- recognize faces
- patch figures
Visuoconstructional: the ability to _______
(perceptual/motor cognitive domain)
assemble items requiring eye-hand coordination (drawing, copying, block assembly)
Perceptual-motor describes the ability to ______.
(perceptual/motor cognitive domain)
integrate perception with purpose (insert blocks into a form board).
Gnosis
(perceptual/motor cognitive domain)
inability to know or recognize
Praxis
(perceptual/motor cognitive domain)
planning of a motor act
angosia
(perceptual/motor cognitive domain)
the ability to recognize & identify stimuli
(visual, auditory or tactile)
Prosopagnosia
inability to recognize familiar faces
(including their own)
How is agnosia assessed?
identify people in pictures in a room, picture of animal, sound of dog barking or bird chirping
Apraxia
deficit in motor planning and execution of skilled, sequential motor movements
(they will complain of difficulty w/ADL’s)
How do you assess apraxia (2)?
- give 3-step command (fold paper, put it in envelope and seal it)
- ask them to pantomime blowing out a match
Major NCD in perceptual/motor cognitive domain
difficulties w/previously familiar activities
(i.e. driving. Usually parkinson or lewy body)
Mild NCD in perceptual motor cognitive domain (3)
- needs maps/gets lost if not paying attention
- less precise parking
- difficulty sewing, knitting, carpentry
(usually parkinson or lewy body)
Functions of the executive function domain (4)
- self-initiate action
- response suppression
- information generation (verbal fluency)
- rule generation or deduction
2 Deficits in the planning (executive function)
- can’t find exit in maze
- can’t interpret sequential picture or object arrangement
How do you test decision-making (executive function)
Iowa Gambling Task
How do you test working memory (executive function cognitive domain)
spell “world” backward or repeat series of numbers backward
(ability to hold info & manipulate it)
Feedback/error utilization is the ability to _______.
benefit from feedback to infer the rules for solving a problem
(executive function domain)
Overriding habits/inhibition is the ability to _______.
(executive function domain)
choose more complex and effortful solution as correct
(ex: can choose the color of the word’s font rather than naming the word; can look away from the direction of an arrow)
Mental/cognitive flexibility is the ability to ______ (2).
- shift between 2 concepts, tasks or rules
- trail-making test
Signs of Major NCD in the executive function domain (2).
- relies on others for planning
- abandons complex projects
Signs of Mild NCD in the executive function domain (3)
- more effort to complete multistage projects
- difficulty resuming task after interruption
- fatigued by organizing or planning
Cognitive domain social cognition is controlled by the ______ lobes.
frontal
Personal perception is used to ______.
(social cognition)
perceive other people
(i.e. empathy; inferring thoughts and beliefs about others in order to make inferences about their reactions)
Interpersonal knowledge is enables people to _______.
(social cognition domain)
successfully navigate life tasks
The ability to recognize emotions of others is part of the _______ cognition
social
theory of mind
ability to consider another person’s mental state
how do you test theory of mind
story cards w/questions to elicit information about the mental state of the individuals in the story
(“why is the boy sad?”)
Signs of Major NCD in the Social Cognition domain (3)?
- focusing on topic despite groups disinterest
- making decisions w/out regard for safety
- insensitive to standards of dress or topics of conversation
Signs of mild NCD in the social cognition domain
- less ability to recognize facial expressions or social cues
- episodic apathy
- ⇣ empathy
- ⇡ introversion or extroversion
