Neurocognitive Disorders Flashcards
what is the most common post surgery procedure that incites delirium?
hip surgery
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
D
Cognitive disorders are disruptions in the acts and processes involved in cognition and are associated with behavioral symptoms. Examples include delirium and dementia.
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
B
Conditions like dementia and delirium have specific etiologies to them and do not occur naturally.
The underlying disturbance among cognitive
disorders is:
A. Brain dysfunction
B. Mood dysfunction
C. Perceptual dysfunction
D. Endocrine dysfunction
A
Cognitive disorders are characterized by decline in brain functioning which reflects brain dysfunction and not dysfunction of the mood, perception or endocrine status.
The main disturbance in delirium is in:
A. Memory
B. Speech
C. Attention
D. Perception
C
Delirium is characterized by disturbance in attention and awareness, impairment of consciousness and fluctuating symptoms.
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
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.`
The cognitive disorder which develops gradually is
A. Delirium
B. Pseudodementia
C. Memory loss due to electroconvulsive therapy
D. Dementia
D
The group most likely to develop delirium is:
A. Children
B. Adults
C. Adolescents
D. Elderly
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.
Of the following the least likely to cause delirium
is:
A. Alcohol dependence
B. Encephalitis
C. Nicotine dependence
D. Hypoglycemia
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)
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
Those with delirium commonly experience visual hallucinations.
The most common etiology of dementia is:
A. Cardiac disease
B. Multiple infarcts
C. Alzheimer’s disease
D. Alcohol dependence
C
Common etiologies of dementia:
● Alzheimer’s disease
● Vascular disease (stroke)
● Frontotemporal lobar degeneration
● Lewy body disease/Parkinson’s Disease
● Traumatic brain injury (TBI)
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
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.
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
C
Delirium is a disturbance in attention and awareness. It usually has acute onset.
In an individual suffering from hyperactive delirium
the least likely behavior you will encounter is:
A. Agitation
B. Paranoia
C. Cooperation
D. Disorientation
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
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
B
In delirium, after the cause is removed, symptoms usually recede over 3 to 7 days
The most common reason that patients with
delirium are referred for psychiatric evaluation:
A. Memory loss
B. Restlessness and agitation
C. Insomnia
D. Depression
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
what is the major neutroransmitter involved in cognitive disorders?
acetylcholine
What is the major neuroanatomical area involved in cognitive disorders?
Reticular formation
What is the major neurological pathway
Dorsal tegmental pathway
What are the 5 DMS-5 diagnostic criteria for delirium?
- disturbance in ATTENTION & AWARENESS
- disturbance develops over a short period of time
- disturbance in cognition
- disturbances in 1&3 are not better explained by another preexisting & established condition.
- there is evidence from the hx, PE, or lab findings that the disturbance is a direct physiological consequence of another medical condition
what is aka major neurocognitive disorder?
dementia
what neurocognitive disorder presents w/ progressive impairment of cognitive functions in persons with clear consciousness?
dementia
what are the most common forms of dementia?
alzheimer’s disease
vascular dementia
How can you say that a px has pseudodementia?
px will not put effort to remembering details being asked
How can u say that a px has true dementia?
px gets frustrated when they cannot recall what is being asked of them
what are the 5 types of dementia?
Alzheimer’s dementia
Vascular dementia/Multi-infarct dementia
Frontotemporal dementia/Pick’s disease
Lewy-Body disease
Huntington’s disease
Parkinson’s disease
what is the hallmark of Alzheimer’s demetia?
Amyloid deposits with hypoactive Ach & Norepinephrine
What type of dementia has multiple areas of vascular disease with pre-existing HTN or other CV risk factors?
Multi-infarct dementia/Vascular dementia
What type of dementia predominance of atrophy in the FRONTOTEMPORAL area & presents with personality change?
Frontotemporal dementia/Pick’s disease
What type of dementia has hallucination, Parkisonian features, & extrapyramidal signs?
Lewy Body diseaess
What are the inclusion bodies found in Lewy body diseaes?
Lewy inclusion bodies or alpha syncnuclein inclusions
What type of dementia presents with the belief that loves one have dopplegangers/duplicates?
Lewy body disease
What type of dementia presents with motor abnormalities and fewer language abnormalities with HIGH incidence of depression & psychosis?
Huntington’s dis
What are the 6 psychiatric and neurologic changes of dementia?
- personality traits become accentuated
- hallucinations & delusions
- mood (depression & anxiety)
- cognitive changes
- catastrophic rxn
- Sundowner syndrome
what kind of rxn of a px with dementia experiences drowsiness, confusion, ataxia and accidentally falls overly sedated
Sundower syndrome
what are possible causes of Sundowner syndrome?
INC medication
Less interpersonal cues
what are manifestations of mild, moderate, & severe dementia?
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
What is the Mini-mental state exam scoring?
No cognitive impairment = 24-30
Mild cognitive impairment = 18-23
Severe cognitive impairment = 0-17
what is an assessment and management guide made by the WHO for mental, neurological and substance used disorder in non-specialized setting?
mhGAP intervention guide
what aer the 6 Qs u have to ask in order to properly assess different neurocognitive disorders?
- Does this person have dementia?
- Does this person have another priority mental disorder?
- does the person have behavioral and psychological symptoms of dementia?
- are cardiovascular disease & risk factors present?
- does this person suffer from other physical conditions?
- is the carer experiencing strain or in need or support?
what are the 2 things u need to do to identify dementia during intervention?
- assess memory & cognition
- interview key informant
what are diff psychosocial interventions of dementia?
- managing behavioral & cognitive symptoms
- psychosocial interventions for cognitive symptoms & functioning
- promote independence, functioning, and mobility
when should you do a follow-up for neurocognitive disorder cases?
every 3 mons
what are the 1st line of tx for neurocognitive disorders?
Antipsychotics
What is the typical or 1st generation antipsychotics?
Haloperidol
what drugs should be avoided in neurocognitive disorders?
all drugs with “-pam”
Diazepam, Benzodiazepines
