Neurocognitive Disorders Flashcards

1
Q

what is the most common post surgery procedure that incites delirium?

A

hip surgery

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2
Q

Which of the following is considered a cognitive
disorder?
A. Panic attacks and Alzheimer’s disease
B. Alzheimer’s disease and substance abuse
C. Depression and schizophrenia
D. Delirium and dementia

A

D
Cognitive disorders are disruptions in the acts and processes involved in cognition and are associated with behavioral symptoms. Examples include delirium and dementia.

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3
Q

Cognitive disorders are no longer classified as
organic mental disorders in DSM-IV and DSM-V because:
A. They are mainly mood disturbances
B. There are biological reasons for
behavioral/psychological disorders
C. Organic disorders have accompanying behavioral
changes
D. Anxiety is common for these conditions

A

B
Conditions like dementia and delirium have specific etiologies to them and do not occur naturally.

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4
Q

The underlying disturbance among cognitive
disorders is:
A. Brain dysfunction
B. Mood dysfunction
C. Perceptual dysfunction
D. Endocrine dysfunction

A

A
Cognitive disorders are characterized by decline in brain functioning which reflects brain dysfunction and not dysfunction of the mood, perception or endocrine status.

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5
Q

The main disturbance in delirium is in:
A. Memory
B. Speech
C. Attention
D. Perception

A

C
Delirium is characterized by disturbance in attention and awareness, impairment of consciousness and fluctuating symptoms.

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6
Q

In DSM-V amnestic disorders are now under what
etiologic subtype of Major/Minor Neurocognitive Disorder
A. Due to another medical condition
B. Vascular disease
C. Alzheimer’s disease
D. Frontotemporal lobar degeneration

A

A
Amnestic disorders are characterized by loss of memories, loss of ability to create new memories or the loss of ability to learn new information. A distinction was made between amnestic order due to another medical condition and those otherwise not specified. In the DSM-V, it is now subsumed into the category of major neurocognitive
disorder and is not a distinct entity in itself.`

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7
Q

The cognitive disorder which develops gradually is
A. Delirium
B. Pseudodementia
C. Memory loss due to electroconvulsive therapy
D. Dementia

A

D

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8
Q

The group most likely to develop delirium is:
A. Children
B. Adults
C. Adolescents
D. Elderly

A

D
Delirium is commonly seen in the elderly, especially those institutionalized or living in a home for the aged facility. They have the highest risk to develop delirium.

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9
Q

Of the following the least likely to cause delirium
is:
A. Alcohol dependence
B. Encephalitis
C. Nicotine dependence
D. Hypoglycemia

A

C
Etiologies of delirium:
● Those with general medical condition (ex. infection)
● Intoxication withdrawal from drugs, alcohol or medications (anticholinergics, GABA antagonists, narcotic analgesics)
● Combination of multiples causes (head trauma, kidney disease)
● Due to other multiple etiologies (ex. sleep deprivation)

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10
Q

The perceptual disturbance most commonly seen
among those who have delirium is:
A. Visual hallucinations
B. Gustatory hallucinations
C. Tactile hallucinations
D. Auditory hallucinations

A

A
Those with delirium commonly experience visual hallucinations.

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11
Q

The most common etiology of dementia is:
A. Cardiac disease
B. Multiple infarcts
C. Alzheimer’s disease
D. Alcohol dependence

A

C
Common etiologies of dementia:
● Alzheimer’s disease
● Vascular disease (stroke)
● Frontotemporal lobar degeneration
● Lewy body disease/Parkinson’s Disease
● Traumatic brain injury (TBI)

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12
Q

In the early stages of dementia, the memory loss is
usually for
A. Remote memory
B. Recent memory
C. Immediate recall
D. Variable memory deficits

A

B
In the early stages of dementia, memory loss is for recent memory whereas in the advanced stage, there is obvious impairment of remote memory.

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13
Q

You are called to see a patient whom the
Emergency Room physician suspects have a
neurocognitive disorder. You are informed by the nurse that she has taken the patient’s vital signs and reports them as HR: 125, RR: 28, temp of 39.5 Blood Pressure: 180/95, the cognitive disorder the patient most likely is suffering from is:
A. Amnestic disorder
B. Dementia
C. Delirium
D. Pseudodementia

A

C
Delirium is a disturbance in attention and awareness. It usually has acute onset.

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14
Q

In an individual suffering from hyperactive delirium
the least likely behavior you will encounter is:
A. Agitation
B. Paranoia
C. Cooperation
D. Disorientation

A

C
Patients with delirium have an impairment in attention and awareness of environment, level of consciousness, memory, judgment, orientation, and behavior. They will most likely be
uncooperative during an examination

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15
Q

If the cause of delirium is removed the syndrome
usually subsides
A. Over several months
B. In a few days or days
C. Very slowly over several years
D. Remain unchanged

A

B
In delirium, after the cause is removed, symptoms usually recede over 3 to 7 days

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16
Q

The most common reason that patients with
delirium are referred for psychiatric evaluation:
A. Memory loss
B. Restlessness and agitation
C. Insomnia
D. Depression

A

B
To manage this, supportive therapy and environmental control may be used.
- Minimize disturbances which may provoke anxiety reaction and/or agitations on the part of the patient
- Help the patient be oriented to time, place, and person
- Put a clock which is easily accessible
- If you are the caregiver, either a family member, or a nurse can give subtle cues to orient the patient

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17
Q

what is the major neutroransmitter involved in cognitive disorders?

A

acetylcholine

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18
Q

What is the major neuroanatomical area involved in cognitive disorders?

A

Reticular formation

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19
Q

What is the major neurological pathway

A

Dorsal tegmental pathway

20
Q

What are the 5 DMS-5 diagnostic criteria for delirium?

A
  1. disturbance in ATTENTION & AWARENESS
  2. disturbance develops over a short period of time
  3. disturbance in cognition
  4. disturbances in 1&3 are not better explained by another preexisting & established condition.
  5. there is evidence from the hx, PE, or lab findings that the disturbance is a direct physiological consequence of another medical condition
21
Q

what is aka major neurocognitive disorder?

A

dementia

22
Q

what neurocognitive disorder presents w/ progressive impairment of cognitive functions in persons with clear consciousness?

A

dementia

23
Q

what are the most common forms of dementia?

A

alzheimer’s disease
vascular dementia

24
Q

How can you say that a px has pseudodementia?

A

px will not put effort to remembering details being asked

25
Q

How can u say that a px has true dementia?

A

px gets frustrated when they cannot recall what is being asked of them

26
Q

what are the 5 types of dementia?

A

Alzheimer’s dementia
Vascular dementia/Multi-infarct dementia
Frontotemporal dementia/Pick’s disease
Lewy-Body disease
Huntington’s disease
Parkinson’s disease

27
Q

what is the hallmark of Alzheimer’s demetia?

A

Amyloid deposits with hypoactive Ach & Norepinephrine

28
Q

What type of dementia has multiple areas of vascular disease with pre-existing HTN or other CV risk factors?

A

Multi-infarct dementia/Vascular dementia

29
Q

What type of dementia predominance of atrophy in the FRONTOTEMPORAL area & presents with personality change?

A

Frontotemporal dementia/Pick’s disease

30
Q

What type of dementia has hallucination, Parkisonian features, & extrapyramidal signs?

A

Lewy Body diseaess

31
Q

What are the inclusion bodies found in Lewy body diseaes?

A

Lewy inclusion bodies or alpha syncnuclein inclusions

32
Q

What type of dementia presents with the belief that loves one have dopplegangers/duplicates?

A

Lewy body disease

33
Q

What type of dementia presents with motor abnormalities and fewer language abnormalities with HIGH incidence of depression & psychosis?

A

Huntington’s dis

34
Q

What are the 6 psychiatric and neurologic changes of dementia?

A
  1. personality traits become accentuated
  2. hallucinations & delusions
  3. mood (depression & anxiety)
  4. cognitive changes
  5. catastrophic rxn
  6. Sundowner syndrome
35
Q

what kind of rxn of a px with dementia experiences drowsiness, confusion, ataxia and accidentally falls overly sedated

A

Sundower syndrome

36
Q

what are possible causes of Sundowner syndrome?

A

INC medication
Less interpersonal cues

37
Q

what are manifestations of mild, moderate, & severe dementia?

A

mild dementia: difficulties w/ instrumental activities of daily living

moderate dementia: difficulties with basic activities of daily living

severe dementia - fully dependent on their caregiver

38
Q

What is the Mini-mental state exam scoring?

A

No cognitive impairment = 24-30
Mild cognitive impairment = 18-23
Severe cognitive impairment = 0-17

39
Q

what is an assessment and management guide made by the WHO for mental, neurological and substance used disorder in non-specialized setting?

A

mhGAP intervention guide

40
Q

what aer the 6 Qs u have to ask in order to properly assess different neurocognitive disorders?

A
  1. Does this person have dementia?
  2. Does this person have another priority mental disorder?
  3. does the person have behavioral and psychological symptoms of dementia?
  4. are cardiovascular disease & risk factors present?
  5. does this person suffer from other physical conditions?
  6. is the carer experiencing strain or in need or support?
41
Q

what are the 2 things u need to do to identify dementia during intervention?

A
  1. assess memory & cognition
  2. interview key informant
42
Q

what are diff psychosocial interventions of dementia?

A
  1. managing behavioral & cognitive symptoms
  2. psychosocial interventions for cognitive symptoms & functioning
  3. promote independence, functioning, and mobility
43
Q

when should you do a follow-up for neurocognitive disorder cases?

A

every 3 mons

44
Q

what are the 1st line of tx for neurocognitive disorders?

A

Antipsychotics

45
Q

What is the typical or 1st generation antipsychotics?

A

Haloperidol

46
Q

what drugs should be avoided in neurocognitive disorders?

A

all drugs with “-pam”
Diazepam, Benzodiazepines