Neurocognitive Disorders Flashcards
What are two types of causes of neurocognitive disorders?
Acquired and degenerative causes
What are acquired causes?
Causes of neurocognitive disorders that are related to illness, diseases, traumatic brain injury, drugs/alcohol, and chronic stress.
What are degenerative causes?
Causes of neurocognitive disorders that have no cure such as HIV+, Alzheimer’s disease, and Parkinson’s
Define neurocognitive disorder
A disorder marked by a significant decline in at least one area of cognitive functioning such as memory, attention, or visual perception. It can worsen steadily over time.
Define delirium
A rapidly developing disturbance in attention or awareness
What are characteristics of delirium?
- Develops over hours or days
- Most common in elderly people
What is delirium caused by?
- Infections
- Poor nutrition
- Head injuries
- Stress
- Underlying condition
How is delirium treated?
- Underlying condition
- Antipsychotic medication
What are symptoms of delirium?
- Misinterpretations
- Hallucinations
- Illusions
- Extreme trouble focusing attention
- Disturbances in sleep/wake schedule
- Speech is rambling and incoherent
- Disorientation
- Memory impairments
- Mood swings
What is a common issue in diagnosing delirium?
Detection of delirium is important but is often missed and if it untreated further cognitive decline and mortality can occur
What is the prevalence of delirium in the community?
Only 1-2% of people in the community overall have it but it increases with age as 83% of all individuals have it at the end of their life
What are characteristics of normal aging and when do they occur?
- Intelligence remains intact
- Normal performance on Mental Status Exam
- Occasional complaints of memory loss
- Occurs at age 60 or 70
What is major neurocognitive cognitive disorder (dementia)?
Individual displays substantial decline in at least one cognitive area which interferes with that individual’s ability to be independent
How is mild cognitive impairment and dementia detected?
SLUMS (Saint Louis University Mental Status)
What is mild neurocognitive disorder?
Individual displays modest decline in at least one cognitive area which does not interfere with that individual’s ability to be independent or activities of daily living (they might need strategies to maintain these). These cognitive deficits are not due to another psychological disorder.
What are the differences between dementia and depression?
Dementia: 1. Even progression over the years 2. Attempts to hide memory loss 3. Worse later in the day 4. Unaware or minimizes disability 5. Rarely abuses drugs Depression: 1. Uneven progression over the years 2. Complains of memory loss 3. Often worse in the morning and lessens as the day goes on 4. Aware of, exaggerates disability 5. May abuse alcohol
What are differences between dementia and delirium?
Dementia:
1. Gradual deterioration of abilities
2. Deficits in memory of recent events
3. Caused by disease processes that are influencing the brain
4. Irreversible
5. Treatment offers minimal benefit
6. Prevalence increases with age
Delirium:
1. Rapid onset
2. Trouble concentrating
3. Secondary to a medical condition
4. Fluctuations over the course of the day
5. Reversible if underlying condition is treated
6. Prevalent in both young and old people
What is differential diagnosis?
The process of making a diagnostic decision in which a clinician rules out the other diagnoses in favor of one diagnosis
What are complex attentional impairments in major neurocognitive disorder?
A patient has increased difficulty with …
- multiple stimuli (TV, radio, and people talking)
- holding new information in mind (remembering phone numbers and reporting what was just said)
- thinking (takes longer than usual and has to be simplified)
What are complex attentional impairments in mild neurocognitive disorder?
- Normal tasks take longer than before with errors
- Thinking is easier when not doing other things such as listening to the radio or TV
What are learning and memory impairments in major neurocognitive disorder?
The patient …
- Repeats themselves in conversation
- Cannot keep track of short list of items while shopping
- Requires frequent reminders to complete the task at hand
What are learning and memory impairments in mild neurocognitive disorder?
The person …
- Has difficulty recalling recent events
- Needs occasional reminders or re-reading to keep track of characters in a movie
- Occasionally say the same things to the same person
- Loses track of whether bills have been paid
What are perceptual-motor impairments in major neurocognitive disorder?
Patient …
- Significant difficulty with previously familiar activities (using tools)
- More confused at dusk when shadows start to appear
What are perceptual-motor impairments in mild neurocognitive disorder?
The person …
- Relies more on maps for directions
- Uses notes and follows other to get to a new place
- Finds themselves lost when not on task
- Less precise in parking
- Spends greater effort on spatial tasks
What are language impairments in major neurocognitive disorder?
Patients…
- Significant difficulties with either expressive or receptive language
- May not recall names of closer friends
- Grammar errors
Automatic speech precede mutism
What are language impairments in mild neurocognitive disorder?
Person…
- Has word-finding difficulty
- Substitute general for specific terms (names of people)
- Smaller grammatical errors
What are examples of mild and major neurocognitive disorder?
- Alzheimer’s disease
- Frontotemporal lobar degeneration
- Lewy body disease
- Vascular disease
- Traumatic brain injury
- Substance/medication use
- HIV infection
- Prion disease
- Parkinson’s disease
- Huntington’s disease
- Multiple etiologies
What are the top two causes of major neurocognitive disorder?
- Alzheimer’s diease
2. Stroke
Who was Alzheimer’s disease described by?
Alois Alzheimer
What is Alzheimer’s disease?
- irreversible brain tissue deterioration
- death usually occurs within 12 years
What are characteristics/symptoms of Alzheimer’s disease that are noticeable at the beginning?
- Difficulty remembering certain events
- Short term memory impairment
- Hard time learning new information
- Irritability
What are characteristics/symptoms of Alzheimer’s disease in general?
- Language problems
- Disorientation (time, place, identity confusion)
- Irritability
- Depression
What are neuritic plaques (a brain change associated with Alzheimer’s disease)?
- Beta amyloid deposits
- Primarily found and most dense in frontal cortex
What are neurofibrillary tangles (brain change associated with Alzheimer’s disease)?
- Protein filaments composed of tau in axons of neurons
- Primarily found and most dense in hippocampus
How are brain changes measured?
Using PET scans
What lowers your risk for getting Alzheimer’s disease?
Lowering amyloid levels
What are the three signature characteristics in the brain of someone with Alzheimer’s disease?
- As neurons die there is a deterioration of the cerebral corticies and hippocampus and the glutamtate is released
- Enlargement of ventricles
- You want acetylcholine and to prevent the toxic breakdown of excess glutamate (the toxic effects of it)
TEST QUESTION
Beta-amyloid: plaques: tau: microtubules
How are beta-amyloid plaques formed?
From a amyloid precursor protein (APP) that form fragments which clump together from debris from dying neurons
What are tau proteins?
Structural component that forms microtubules and transports molecules from one part of a cell to another
What happens when tau proteins are abnormal?
Leads to collapse of the microtubules, which twist; these are the neurofibrillary tangles
What genes cause early onset genetic mutations?
APP, PS1, and PS2 genes
What genes cause late onset genetic mutations?
APOE genes
What gene is associated with late onset Alzheimer’s dementia and responsible for 95% of cases?
APOE genetic mutations
What are later symptoms of Alzheimer’s dementia?
- Long term memory becomes fragmented
- Need for supervision
- Motor skills dysfunction
What is the heritability of genetic factors for Alzheimer’s dementia? (percentage)
79%
What allele increases the risk for being diagnosed with Alzheimer’s dementia and by how much?
The ApoE4 allele which is a gene on chromosome 19 and increases risk by 20%
What does having an ApoE4 (or two) mean for the individual?
- Over production of beta-amyloid plaques
- Loss of neurons in the hippocampus
- Low glucose metabolism in cerebral cortex
- If you have Alzheimer’s you have at least 1 ApoE4 gene
What are the causes of Alzheimer’s disease based on risk? GREATER RISK
- Smoking
- Being single
- Low social support
- Depression related to greater risk of developing Alzheimer’s
- Social isolation
- Insomnia
What activities lower the risk of Alzheimer’s disease?
- Engagement in cognitive activities/eating: solving crossword puzzles, reading the newspaper daily, fish consumption (omega 3 oils), mediterranean diet
- Exercise: predicts less decline in cognitive functioning and decreased risk of developing Alzheimer’s
What is the connection between Alzheimer’s disease and head injury?
If someone has a severe traumatic brain injury, it increases the risk by 4.5% of developing AD
How is dementia treated and prevented?
- Drugs
- Creation of amyloid from its precursor protein
- Antidepressants for depression
- Antipsychotic drug for agitation
What drugs produce slightly less decline in AD?
- Cholinesterase inhibitors
- Donepezil
- Galantamine
What do cholinesterase inhibitors do to prevent AD?
- They prevent the breakdown of acetylcholine
- Stimulate the nicotinic receptors to release more acetylcholine in the brain
- The two drugs are called EXELON (used to treat mild to moderate AD) and RAZADYNE (used to treat mild to moderate AD)
What do NMDA antagonists do to prevent AD?
- They block the toxic effects associated with excess glutamate
- Treats moderate to severe AD
What is the new drug to treat AD and its release date?
Aduhelm was released on June 7th, 2021
How does Aduhelm treat AD biologically? and who in the AD population
It is an antibody that binds to clumped beta amyloids to reduce the amount of amyloid plaques
Is Aduhelm the first drug to prevent disease progression?
Yes
What are some of the controversies over Aduhelm?
It is tested on very few POC, causes brain bleeds, is very expensive
What causes vascular dementia?
It results from stroke due to clot formation and the death of cells
What are risk factors of vascular dementia?
Smoking and high LDL cholesterol
What causes frontotemporal dementia?
- Loss of neurons in frontal and temporal lobes
- High concentration of tau proteins (Pick’s disease)
What are symptoms of frontotemporal dementia?
- Memory is not severely impaired
- Impairment in planning and motor control
- Difficulty recognizing and regulating emotion
What is the behavioral variant FTD of Pick’s disease and when is it diagnosed? (name 3)
- Diagnosed when 3 or more symptoms are present Symptoms: - Lack of sympathy and empathy - Problems with planning - Inappropriate social behavior
What are the two subtypes of Dementia with Lewy Bodies? (DLB)
With Parkinson’s and without Parkinson’s diseae
What are symptoms of DLB that are similar to Alzheimer’s and Parkinson’s disease?
- Loss of memory
- Shuffling gait
What are symptoms of DLB that are different than Alzheimer’s and Parkinson’s?
- Fluctuating cognitive symptoms
- Prominent visual hallucinations
- Intense dreams involving movement and vocalizing
- Hard time sleeping
Is DLB often misdiagnosed? and what is it diagnosed as?
Yes
- Bipolar disorder
What is Pick’s disease?
- An example of frontotemporal dementia
- Less common than Alzheimer’s
- Behavior and personality change
What is the third most common type of neurodegenerative disorder?
Parkinson’s disease
What is the one thing Parkinson’s disease is characterized by?
Tremors or rigid movements
What is Parkinson’s disease caused by?
Loss of dopamine neurons
What percent of people end up experiencing cognitive impairment?
25-40%
How is Huntington’s Disease characterized biologically?
- A rare degenerative disorder of the central nervous system
- Autosomal disease (inherit two mutated genes: one from each parent)
- Late onset
Is Huntington’s disease chronic?
Yes
Do patients with Huntington’s disease usually develop dementia?
Yes
When does death usually occur post symptom onset for Huntington’s disease?
10-20 years
What are dementias caused by injury and disease? (List 3)
- Meningitis
- HIV (AIDs related dementia)
- Head traumas
- Brain tumors
How many people in the United States are affected by head injury annually?
2 million people
What are the most common causes of head injury?
Falls and motor vehicle accidents
What is the associated risk with head injury?
Gender and age
What are specific symptoms related to head injuries?
- Impaired capacity for learning and remembering (retrograde and anterograde amnesia)
- Personality changes
What are treatments and outcomes of head injuries?
- Remove pressure on the brain
- Immediate and longterm rehabilitation and reeducation
- Treatment team involves many healthcare professionals
