Neurocognitive Disorders

Question 1

What is the core feature in Neurocognitive Disorders?

Answer 1

Acquired Dysfunction in a cognitive domain that occurs after “early life”

Question 2

What are the Domains of Cognition?

Answer 2

1. Memory
2. Language
3. Executive function
4. Visuospatial functioning
5. Attention

Question 3

Diagnostic Criteria for Delirium (AKA: acute confusional state, acute brain syndrome)

Answer 3

1. Disturbance in awareness and attention
2. Additional disturbance in a cognitive domain
3. Sudden onset-symptoms typically fluctuate during the day
4. Evidence for a direct physiological cause (ETOH withdrawal etc)

Question 4

Risk Factors for Delirium
(modifiable, non modifiable)

Answer 4

Non-modifiable: poor health, old age, male
Modifiable: immobilization, sleep disturbance, ICU setting

Question 5

Course of Delirium

Answer 5

1. Symptoms persist until causal factors are treated
2. Resolution typically within 3-7 days
3. Amnesia common during delirium
4. Poor prognostic sign for long-term survival in long ICU stays

Question 6

Treatment for Delirium

Answer 6

1. Treat underlying condition
2. Antipsychotics-for associated symptomology
3. Environmental Support measures (bed rails, lights)

Benzos are a risk factor for delirium-USED TO TX ETOH WITHDRAWAL

Question 7

Dementia Diagnostic Criteria

Answer 7

Multiple and severe cognitive impairment without impaired consciousness
* progressive and irreversible
* more common in elderly (>65)

If no impairment in ADLs-Mild Cognitive Impairment

Question 8

Alzheimer’s Dementia (AD)

Answer 8

1. Significant memory impairment plus 1 other cognitive domain
2. Gradual onset and steadily progressive decline
3. Must exclude other symptoms (stroke)

Question 9

3 Types of Alzheimers Dementia

Answer 9

1. Early stage: memory deficits and word finding problems (anomia)-rapid forgetting
2. Middle Stage: Agnosias (inability to identify/comprehend meaning of stimuli-mood changes, personality changes, psychosis
3. End stage: Global cognitive impairment, motor deficits, and death from opportunistic infections

Middle Stage: ADL’s compromised. End Stage: round the clock asstance

Question 10

Neuropathology of Alzheimers Disease

Answer 10

1. Hippocampus atrophy
2. Enlarged ventricles
3. Cortical Atrophy

Question 11

Neurochemistry of Alzheimers Disease

Answer 11

1. Acetylcholine decreases (important for memory function
2. Drugs try to increase ACH and decrease glutamate

Question 12

Alzheimers Disease Neuropathology

Neurofunctional/Histopathological

Answer 12

1. Reduced metabolism in posterior parts of brain (parietal and temporal lobes)
2. Beta-Amyloid plaques and neurofibrillary tangles
3. Detection of amyloid in brain by: CSF, PET imaging

Definitive Dx can only be made post-mortem by brain tissue sample

Question 13

Genetics of Alzheimers Disease

Answer 13

1. Early-Onset ( less than 65 years) strong genetic component
   3 genes (chromosome 1,14, 21)
   * If 1 copy of the gene is inherited-the person WILL develop early onset AD
2. Late-Onset: Chromosome 19 -1 or 2 copies increase chance of developing

APOLIPOPROTEIN E (APOE) late-onset

Question 14

Drugs that treat Alzheimers Disease

Answer 14

1.Increase Acetylcholine (cholinesterase inhibitors): Donepezil, Galantamine, Rivastigmine
2. Decrease glutamate (NMDA-receptor blockers): Memantine
3. Decrease amyloids (prevent plaque formation) Aducanumab

NO NEUROLEPTICS (ANTIPSYCHOTICS) INCREASED MORTALITY

Question 15

Vascular Diagnosis

Alzheimer differential

Answer 15

Symptoms of vascular disease (HTN, elevated BMI)
Stepwise progression of dementia symptoms

Question 16

Frontotemporal (Pick’s) Diagnosis

Alzheimers differential

Answer 16

Frontal signs predominate early
Dishinhibition & personality change (starts cussing)

Question 17

Lewy Body Dementia Diagnosis

Alzheimers Differential

Answer 17

1. Fluctuating cognition
2. Visual hallucinations
3. Mild parkinsonism
   Severe neuroleptic sensitivity (extrapyramidal symptoms develop)

If dementia develops within 12 months then this is the diagnosis

Question 18

Huntington’s Disease Diagnosis

Alzheimers Differential

Answer 18

Motor disorder w/ choreiform and athetoid movements and often psychiatric disturbance

Question 19

Prion Disease (Creutzfedlt-Jakob)

Alzheimers Differential

Answer 19

Dementia progresses rapidly death under a year

Question 20

Neurocognitive Diagnoses

DSM-5-TR

Answer 20

1. Delirium
2. Major NCD: “Significant” decline in 1 or more cognitive domains-interferes w/ ADLs
3. Minor NCD: “Modest” decline in 1 or more cognitive domains-does not interfere w/ ADLs

Question 21

Amnesia

Answer 21

• Acquired significant memory impairment
  1. Retrograde: loss of memories for events prior to damage
  Information is forgotten in a temporal gradient
  2. Anterograde: loss of ability to store new memories of events after damage

Question 22

Paraphasias (3)

Answer 22

1. Phonemic: sound substitution “I wear my red dat to church”
2. Semantic: “Meet my son Mary”
3. Neologistic: made up words

Dysarthria: slurred or slow speech

Question 23

Broca’s Aphasia

Non fluent

Answer 23

1. Dysarthria, stuttering, effortful
2. Speech is off-missed syllables
3. Able to understand spoken language

Question 24

Wernicke’s Aphasia

Fluent Aphasia

Answer 24

1. Speech is normal
2. Word salad
3. Unable to understand spoken language

Question 25

Normal Memory Systems (3)

Answer 25

1. **Short-term Memory** (STM): brief duration (approx 30 seconds) small capacity 2. **Long-Term Memory** (LTM): divided into "recent" vs "remote" 3. **Encoding & consolidation**: process of turning STM into LTM (learning new info)

Question 26

What are the different types of Memory?

Answer 26

1. **Explicit** (conscious)/ Implicit (unconscious) 2. **Declarative** (facts, events) 3. **Procedural** (skills, tasks) 4. **Episodic** (experiences events) 5. **Semantic** (facts, concepts)

Question 27

Where is memory stored?

Answer 27

Recalling pictures: **R pre-frontal cortex** Recalling words: **L pre-frontal cortex** LTM: **storage occurs in the cortex** | Consolidation of memory occurs in hippocampus but not stored

Question 28

Confabulation definition

Answer 28

Patient filling in memory gaps by unconsciously making up information

Question 29

What are the common causes of Amnesia?

Answer 29

1. **Direct** damage to hippocampus 2. **Indirect** damage to hippocampus: **Korsakoff's Syndrome**- result of chronic alcoholism or thiamine deficiency

Question 30

Treatment of Amnesia

Answer 30

1. Treat underlying cause 2. **Cognitive rehabilitation**: * Restoration (memory exercises to strengthen memory systems * Training in use of mnemonic strategies as compensation

Question 31

2 Types of Mnemonics

Answer 31

External: lists, calendars, electronic schedulers **Internal**: 1. **Rhyme**: saying that **directly** contains info to be remembered without needing to decode 2. **Acrostic**: a phrase that contains the first letter of each word as a **cue** to the information 3. **Acronym**: single word (SIGECAPS) 4. **Clustering**: group of similar information 5. **Imagery**: picturing information in a meaningful way

Question 32

Development of Language in Children

Answer 32

1. **5-7 months**: like sounds 2. **7-8 months**: well-formed syllables 3. **1-2 years**: first word 'mama'-understands visual connection with acoustic appearance 4. **2 years**: speaking in rich phrase 5. **3 years**: most of the time correct use of words and grammar-but don't understand rules

Question 33

Left Hemisphere | For Language

Answer 33

1. **DOMINANT** 96% 2. language processing 3. Lexicon (dictionary of words) 4. Phonetic assembly 5. Phonetic procession

Question 34

Role of R hemisphere

Answer 34

1. Communicative and emotion prosody (stress, timing, intonation). **R Anterior damage**-wrong intonation, **R posterior damage**: difficulty in interpretation 2. Pragmatics of language: **damage of Rt hemisphere**-difficulty in construction of sentences into a story. Unable to understand jokes, sarcasm