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
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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)
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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
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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
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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
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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