Neurocognitive Disorders Flashcards
Delirium Diagnostic Criteria
A. A disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) accompanied by reduced awareness of the environment).
B. The disturbance develops over a short period of time (hours to a few days), is a change from baseline, and tends to fluctuate in severity throughout the day.
C. An additional disturbance in cognition (e.g., memory deficit, disorientation, language, visuospatial ability, or perception)
D. A and C are not better explained by another neurocognitive disorder and do not occur in the context of severely reduced arousal, such as coma.
E. Evidence from history, physical examination, or lab findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal, or exposure to a toxin, or is due to multiple etiologies.
Delirium Specifiers
Specify if:
* Acute: Lasting a few hours or days
* Persistent: Lasting weeks or months
Specify if:
* Hyperactive: Hyperactive level of psychomotor activity which may be accompanied by mood lability, agitation, and/or refusal to cooperate with medical care.
* Hypoactive: Hypoactive level of psychomotor activity which may be accompanied by sluggishness and lethargy that approaches stupour.
* Mixed level of activity: Normal level of psychomotor activity. Also includes individuals whose activity level rapidly fluctuates
Specify whether:
* Substance intoxication delirium
* Medication-induced delirium
* Delirium due to another medical condition
* Delirium due to multiple etiologies
Major Neurocognitive Disorder Diagnostic Criteria
A. Evidence of significant cognitive decline from a previous level in ≥1 domains (complex attention, EF, learning and memory, language, perceptual-motor, or social cognition) based on:
1. Concern of the individual, a knowledgeable informant, or the clinican that there has been significant decline
2. A substantial impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment.
B. The cognitive deficits interfere with independence in everyday activities (i.e., requiring, at minimum, assistance with complex iADLs)
C. Does not occur exclusively in the context of delirium
D. Not better explained by another mental disorder.
Major or Mild Neurocognitive Disorder Specifiers
Specify whether due to:
* Alzheimer’s disease
* Frontotemporal degeneration
* Lewy body disease
* Vascular disease
* TBI
* Substance/medication use
* HIV infection
* Prion disease
* Parkinson’s disease
* Huntington’s disease
* Another medical condition
* Multiple etiologies
* Unspecified etiology
Specify:
* Without behavioural disturbance
* With behavioural disturbance (e.g., psychotic sx, mood disturbance, agitation, apathy, other behavioural sx)
(For Major only) Specify current severity:
* Mild: Difficulties with iADLs
* Moderate: Difficulties with basic ADLs (e.g., feeding, dressing)
* Severe: Fully dependent
Logic of Probable vs. Possible etiology for Major/Mild Neurocognitive Disorder due to AD
If Major, it is probable if either of the following is present (otherwise it is only possible):
* Evidence of a causative genetic mutation from family hx or genetic testing (or neuroimaging)
* All the hallmark features are present.
If Mild, it is probable only if there is evidence of a causative genetic mutation from family hx or genetic testing. It is possible if there is no such evidence, but all the hallmark features are present.
Alzheimer’s Disease hallmark features
All 3 must be present:
1. Clear evidence of decline in learning and memory (+1 other domain for major)
2. Steadily progressive, gradual decline, without extended plateaus
3. No evidence of mixed etiology.
Major or Mild Frontotemporal Neurocognitive Disorder Diagnostic Criteria
A. Criteria are met for major or mild neurocognitive disorder.
B. Disturbance has insidious onset and gradual progression.
C. Either 1 or 2:
1. Behaviorual variant:
a. ≥3 of the following behavioural sx:
* Behavioural disinhibition
* Apathy or inertia
* Loss of sympathy or empathy
* Perseverative, stereotyped, or compulsive/ritualistic behaviour
* Hyperorality/dietary changes
b. Prominent decline in social cogntion and/or executive abilities
2. Language variant:
* Prominent decline in language abilitiy, in the form of speech production, word finding, object naming, grammar, or word comprehension.
D. Relative sparing of learning and memory or perceptual-motor function.
E. Not better explained by other diseases/disorders
Probable if imaging has been performed, otherwise only possible
Major or Mild Neurocognitive Disorder with Lewy Bodies Diagnostic Criteria
A. Criteria are met for major/mild neurocognitive disorder.
B. Insidious onset and gradual progression.
C. Meets a combination of core diagnostic features and suggestive diagnostic features: Probable = 2 core features or 1 suggestive feature and ≥1 core features; Possible = 1 core feature and ≥1 suggestive features.
* Core diagnostic features:
* Fluctuating cognition with pronounced variations in attention and alertness
* Recurrent visual hallucinations that are well formed and detailed
* Spontaneous features of parkinsonism, with onset subsequent to development of cognitve decline
* Suggestive diagnostic features:
* Meets criteria for rapid eye movement sleep behaviour disorder
* Severe neuroleptic sensitivity
D. Not better explained by otehr diseases/disorders
Major or Mild Vascular Neurocognitive Disorder
A. All the criteria are met for major neurocognitive disorder.
B. The clinical features are consistent with a vascular eitiology, as suggested by either of the following:
1. Onset of deficits soon after ≥1 cerebrovascular events
2. Evidence for decline is prominent in complex attention (including processing speed) and frontal EF
C. Evidence of cerebrovascular disease from hx, physical examination, and/or neuroimaging considered sufficient to account for the deficits.
D. Not better explained by another disease/disorder.
Probable if 1 of the following is present (otherwise only possible):
1. Support from neuroimaging evidence of significant parenchymal injury due to cerebrovascular disease
2. Syndrome is temporally related to ≥1 cerebrovascular events
3. Both clinical and genetic evidence of CV disease is present.
Major or Mild Neurocognitve Disorder Due to TBI Diagnostic Criteria
A. Criteria are met for neurocognitive disorder
B. Evidence of a TBI with ≥1 of the following:
1. LOC
2. Posttraumatic amnesia
3. Disorientation and confusion
4. Neurological signs
C. Neurocognitive disorder presents immediately after TBI or recovery of consciousness and persists past acute post-injury period.
Substance/Medication-Induced Major or Mild Neurocognitive Disorder Diagnostic Criteria
A. Criteria are met for NC disorder
B. The NC impairments do not occur exclusively in delirium and persist beyond intoxication and acute withdrawal.
C. The involved substance is capable of producing the impairment.
D. The timing of the NC deficits is consistent with that of substance use and/or abstinence
E. Not attributable to another condition or disorder.
Specify if:
* Persistent: NC impairment continues after extended abstinence.
Major or Mild Neurocognitve Disorder Due to HIV Infection Diagnostic Criteria
A. Criteria are met for NC disorder
B. There is a documented infection with HIV
C. The NC disorder is not better explained by non-HIV conditions, including secondary diseases.
D. The NC disorder is not attributable to another condition or disorder.
Major or Mild Neurocognitve Disorder Due to Prion Disease Diagnostic Criteria
A. Criteria are met for NC disorder
B. There is insidious onset, and rapid progression of impairment is common.
C. There are motor features of prion disease (e.g., myoclonus or ataxia) or biomarker evidence
D. Not attributable to another condition or disorder.
Major or Mild Neurocognitve Disorder Due to Parkinson’s Disease Diagnostic Criteria
A. Criteria are met for NC disease
B. Presence of Parkinson’s is established.
C. Insidious onset and gradual progression of impairment.
D. Not attributable to another medical condition or disorder.
“Probably due to” if 1 and 2 are met; “Possible due to” if 1 or 2 is met:
1. No evidence of mixed etiology
2. Parkinson’s clearly precedes onset of the NC disorder.
Major or Mild Neurocognitve Disorder Due to Huntington’s Disease Diagnostic Criteria
A. Criteria are met for NC disorder.
B. Insidious onset and gradual progression.
C. Established presence of Huntington’s, or risk for Huntington’s based on family hx or genetic testing.
D. Noe attributable to another condition or disorder.
