Neurocognitive Disorders Flashcards
What are the 3 defining features of neurocognitive disorders?
- cognitive deficit - primary manifestation . Can also have behavioural and functional.
- Decline from previous level of cognitive fx
- Acquired, not developmental.
Name 10 differences between delirium and neurocognitive disorder.
- Acute vs chronic
- Disturbance of brain physiology vs anatomy
- Short term (weeks) vs long (years)
- Secondary cause vs primary or secondary
- Fluctuating course vs progressive
- Impaired awareness + attention vs intact until late stage
- Working memory + immediate recall affected vs initial short term memory affected then later long term
- Psychomotor disturbances vs late stage
9 sleep-wake disturbance vs some worsening of symptoms at night - Language impairment incoherent/slow vs aphasia/word finding difficulty
- Reversible vs irreversible
Name 8 “correctible” (secondary) causes of dementia
DEMENTIA
Drugs: alcohol, stimulants, benzos! Carbon monoxide, heavy metals
Endocrine: Cushing, Addison’s, Wilson’s disease, hypothyroid
Metabolic: hypoglycemia, hypo/hyper calcaemia,
Eye and ear impairments
Nutritional: b12, B 1, b6, niacin (pellagra) ; normal pressure hydrocephalus
Tumours, trauma to head
Infections: HIV, neurosyphilis, neurocysticercosis, Tb meningitis
Arteriosclerosis, auto immune (sle, neurosarcoidosis, giant cell arteritis)
What is the most common cause of dementia?
Alzheimer’s
What is the second most common cause of dementia?
Vascular disease: multi-infarct (step-wise deterioration) or single infarct (acute) or small vessel disease (gradual deterioration eg atherosclerosis)
Which bedside test is useful for screening cortical dementia? (Eg Alzheimercognitive impairment )
Mini mental state exam
Name the scores and degree of impairment of the MMSE. (4)
- 20-24: mild: meds, driving, finances, cooking.
- 19-15: moderate: dressing, grooming, bathing.
- 10-14: moderately severe: incontinence, lost at home.
- <10: severe - poor speech, mobility , eating.
Which bedside screening test for cognitive impairment is more sensitive and inclusive?
Montreal cognitive assessment
What are the pharmacological treatment options for severe dementia? (4)
Acetylcholinesterase inhibitors (CHEIs) • donepezil • Galantamine • rivistigmine Partial glutamate receptor antagonist • memantine
Treatment neurocognitive disorders
Cholinesterase inhibitors eg rivastigmine, neostigmine, donepezil
Avoid anticholinergics
Name specifiers in category “specify whether due to” for neurocognitive disorders (13)
Due to:
- Alzheimer’s disease
- another medical condition
- frontOtemporal lobar degeneration
- HIV infection
- Huntington disease
- Lewy body disease
- multiple etiologies
- prion disease
- Parkinson’s disease
- substance /medication use
- traumatic brain injury
- unspecified
- vascular disease
Name 2 behavioural specifiers in neurocognitive disorders
- With behavioural disturbance (also specify disturbance here in brackets eg psychotic symptoms, mood disturbance, agitation, apathy)
- without behavioural disturbance
Name 3 severity specifiers in major neurocognitive disorders
- Mild : difficulty with instrumental activities of daily living eg housework, managing money
- moderate: basic activities eg feeding, dressing
- severe: fully dependent
Not used in minor!
Name the 6 domains that neurocognitive disorders affect
CELLPS
- complex attention
- executive functioning
- learning + memory
- Language
- perceptual motor skills eg driving, using tools
- social cognition: lack insight, personality change
Need impairment in at least 1 domain based on clinical test or someone else recognise change
Most common cause neurocognitive disorder?
Alzheimer’s
Then vascular disease
