neurocognitive disorders

Question 1

learning & memory deficits in NCD

Answer 1

amnesia is a common feature of many NCDs – including inability to learn new info and failure to recall past events
- anterograde amnesia = memory loss for info acquired after the onset of amnesia

in degenerative disorders: memory deficits slowly develop from normal forgetfulness to a more full-blown inability to recall events

Question 2

attentional & arousal deficits in NCD

Answer 2

lack of attention, being easily distracted & performing well-learnt activities more slowly than before

difficulty focusing on or keeping up w a convo + needing more time to make simple decisions

Question 3

language deficits in NCD

Answer 3

• may appear to be rambling during convos + have difficulty conveying what they have to say in a coherent manner
• may have difficulty reading & understanding speech of others

are one of the most common features – collectively known as aphasias:
fluent, non-fluent, Broca’s & Wernicke’s

Question 4

fluent vs non-fluent aphasia

Answer 4

fluent = the production of incoherent, jumbled speech
- speak in sentences that sound like normal speech, but some of the words are made-up words or have some sounds that are not correct

non-fluent = an inability to initiate speech - struggle to get words out, omit words, and speak in very short sentences.

Question 5

Broca’s vs Wernicke’s aphasia

Answer 5

Broca’s = difficulties with speaking – word ordering, finding right word & articulation (associated w damage to left frontal lobe)

Wernicke’s = difficulties in comprehension of speech – recognizing spoken words & converting thoughts into words (associated w damage to regions behind frontal lobes)

Question 6

Agnosia

Answer 6

the loss of the ability to recognize objects, persons, sounds, shapes or smells while the specific sense is not defective (no sig memory loss)

Question 7

apraxia

Answer 7

the loss of the ability to execute or carry out learnt movements, despite having the desire & physical ability to do so

• in more complex cases: can emit a behavior when it is under routine conditions but not on command

Question 8

executive function deficits in NCD

Answer 8

reflects the inability to effectively problem-solve, plan, initiate, organize, monitor & inhibit complex behaviors
- normally associated w the prefrontal cortex: damage to this area is frequently involved in these deficits
- can be tested by Wisconsin card sorting task

Question 9

diagnosis of NCD

Answer 9

is difficult bcuz symptoms & deficits often closely resemble those of other psychopathologies

DSM-5 identifies 2 broader syndromes into which many NCDs fall: delirium & major/mild NCDs (dementias)

Question 10

delirium NCD

Answer 10

a disturbance of consciousness that develops over a short period of time – reflected in a reduced ability to direct, focus, sustain & shift attention
- may not understand simple questions or shift attention from answering one question to another
- often occurs in context of other NCDs + accompanied by memory & learning deficits, disorientation & perceptual disturbances
- may be result of widespread disruption of brain metabolism & NT activity
- may also exhibit emotional disturbances

Question 11

prevalence of delirium NCD

Answer 11

community prevalence = 1-2%
increases with age, rising to 14% over 85

Question 12

major/mild NCDs (dementias)

Answer 12

conditions where there is evidence of a significant decline in performance across 1 or more cog domains

cog deficits in: complex attention, executive functioning, learning/memory, language, perceptual-motor, or social cognition

Question 13

major vs mild levels of NCDs

Answer 13

mild = modest impairment that doesn’t interfere

major = substantial impairment that interferes w daily life
- language function may deteriorate: convo may become vague or empty + unable to name individual everyday objects
- may also be associated with apraxia & agnosia
- disturbances in exec functioning also common

Question 14

NCD due to HIV infection

Answer 14

HIV enters the CNS early in the illness & neurological difficulties can develop in up to 60% of those infected
- impairments are usually minor but may induce multiple symptoms of motor & cog dysfunction
- impaired exec functioning, slowed processing speed, problems w attentional tasks & difficulty learning new info
- fewer than 5% meet the criteria for major NCD

associated with progressive cortical atrophy in grey & white matter
- but deficits often caused by body’s weakened immune system allowing other infections to attack the brain

Question 15

NCD due to prion disease

Answer 15

variant Creutzfeldt-Jakob disease (vCJD) = a fatal infectious disease that attacks the CNS
- early signs: changes in mood, temperament & behavior + memory & concentration + confused thinking
- verbal fluency, numeracy ability, face recognition, memory & exec functioning

prion (infectious agent) = an abnormal, transmissible agent that is able to induce abnormal folding of normal cellular proteins in the brain
- rapid dementia in vCJD appear to result from prions/protein deposits encrusting or replacing neurons

Question 16

vascular NCDs

Answer 16

damage to brain tissue can also occur as a result of a cardiovascular accident (CVA) = a stroke
- can be defined in 2 broad ways: an infarction or a hemorrhage
- symptoms of stroke: numbness, weakness or paralysis on one side of the body, slurred speech, blurred vision
- LT symptoms: aphasia, agnosia, apraxia & paralysis
- emotional disturbance – often depressed mood or emotional lability

Question 17

what is an infarction

Answer 17

the injury caused when the blood flow to the brain is impeded in some way – results in damage to brain tissue fed by that blood flow

most common cause are an embolism or thrombosis

Question 18

cerebral embolism

Answer 18

a blood clot that forms somewhere in the body before traveling through the blood vessels and lodging in the brain
– causes brain cells to become damaged bcuz of O2 starvation

Question 19

cerebral thrombosis

Answer 19

an injury caused when a blood clot (thrombus) forms in an artery supplying blood to brain
– clot interrupts blood supply & brain cells are starved of O2

Question 20

what is a hemorrhage

Answer 20

when a blood vessel in the brain ruptures and affects local brain tissue
- often the result of hypertension or high BP & often due to an aneurysm

aneurysm = a localized bulging in a blood vessel caused by disease or weakening of the vessel wall

Question 21

degenerative disorders

Answer 21

NCDs that are characterized by a slow, general deterioration in cog, physical & emotional functioning as a result of progressive physical changes in the brain
- occurs gradually over a number of years + more frequent in old age
- prevalence: 7% over 65, 30% over 85

represent an active pathological organic deterioration of the brain
- many manifest with very similar cog impairments

Question 22

alzheimer’s disease

Answer 22

most common form of dementia
involves progressive impairments in STM + symptoms of aphasia, apraxia & agnosia + impaired judgement, decision-making & orientation
- personality changes

known risk factors: age, sex (higher in women), genetics, family history of dementia, history of head injury & low educational status

Question 23

causes of alzheimer’s

Answer 23

brain changes: are structural & involve develop of beta amyloid plaques & neurofibrillary tangles
- result is gradual shrinkage of healthy brain tissue + enlarged ventricles

Faulty production of ACH: alz affects structures involved in production of ACH
- ACH levels fall too low and memory & other brain functions are impaired

appears to be a significant inherited component: 50% of 1* relatives also develop the disorder
- several genes have been identified – APOE4 & GAB2

Question 24

beta amyloid plaques & neurofibrillary tangle

Answer 24

beta amyloid plaques = abnormal cell development

neurofibrillary tangles = abnormal collections of twisted nerve cell threads

Question 25

amnestic disorder

Answer 25

amnestic = amnesia – causes strikingly disturbed memory
- immediate recall + memory for remote past event are not usually affected but STM is typically impaired
- overall cog functioning is quite good & person may be able to execute a complex task

e.g. Korsakoff’s syndrome

Question 26

Korsakoff’s syndrome

Answer 26

an amnestic disorder caused by deficiency in vitamin B1 (thiamine)
- problems associated can sometimes be reversed if it is detected early enough & B1 is given
- often found in chronic alcoholic or people who do not eat healthy

Question 27

frontotemporal NCD

Answer 27

associated w a loss of neurons from the frontal & temporal regions – leads to progressive behavioral and personality changes and language impairment
- doesn’t usually affect memory – mainly impacts emotional processes (e.g. apathy & empathy)
- accounts for only 5% of all dementia

Question 28

NCD due to parkinson’s disease

Answer 28

parkinson’s disease = a progressive neurological condition affecting movements such as walking, talking and writing, and causes psychological disturbance in 40 to 60% sufferers
main symptoms:
1. tremor, including jerky movements of the arms, hands and head that are also present during resting periods
2. slowness of movement (bradykinesia)
3. stiffness or rigidity of muscles

occurs as a result of damage in the basal ganglia, specifically the substantia nigra - responsible for producing dop: allows messages to be sent to parts of the brain that coordinate movement

more common in men + over 50

memory, learning, judgement, concentration + hallucinations & depression

Question 29

NCD with lewy bodies

Answer 29

lewy bodies = abnormal protein deposits that disrupt the brain’s normal functioning
- are found in area of brain stem where they deplete dop = Parkinson’s symptoms
- can also diffuse throughout other areas of the brain
- may account for up to 30% of all dementia

varying cognition w obvious changes in attention & alertness + hallucinations + features of Parkinsonism prior to develop of cog decline

Question 30

NCD due to Huntington’s disease

Answer 30

huntington’s = an inherited, degenerative disorder of the CNS, caused by a dominant gene
- principally a movement disorder + changes in temperament + decline in cog functioning
- prevalence: 8 in 100,000 people in the UK

Question 31

cholinesterase inhibitors (alzheimer’s)

Answer 31

a group of drugs that prevent ACH breakdown in synapse by acetylcholinesterase + increases its uptake in the postsynaptic receptor
- produces moderate improvements in cog function in alz
- slows memory decline - best when treatment begins early in the disease
- alleviates behavioural symptoms, mood disturbances and delusions associated w alz

Question 32

levodopa (parkinson’s)

Answer 32

a natural amino acid that is converted by the brain into dop - used in the treatment of Parkinson’s
- successful in controlling tremor and other motor symptoms
- little evidence that it alleviates any cognitive impairments
- side effects: hypertension, delusions, hallucinations

Question 33

thrombolytic therapy

Answer 33

the use of drugs to break up or dissolve blood clots
- if it is administered within the first 3 hours of a stroke disability is significantly reduced
- success is dependent on the individual being able to identify early sings of stroke & seeking rapid treatment
- little evidence that this helps alleviate the cognitive deficits that come with stroke

Question 34

antiretroviral drugs (NCD HIV)

Answer 34

chemicals that inhibit the replication of retroviruses, such as HIV
- reduce the severity of HIV dementia
- reduce the prevalence of diagnoses of NCDs
- act on different stages of the virus life-cycle
- produces a dramatic reduction in viral load + prevents further immune damage

Question 35

deep brain stimulation (for parkinson’s)

Answer 35

uses a surgically implanted battery-operated device to deliver electrical stimulation the thalamus or the basal ganglia
- blocks the abnormal nerve signals that cause tremor and Parkinson’s symptoms
- results in improvements in physical abilities & quality of life

Question 36

attention process training

Answer 36

a form of rehabilitation training for attention deficits that uses a number of different strategies to promote and encourage attentional abilities
- e.g. listening to an audio that contains target words that must be responded to by pressing a buzzer

provides gains in other everyday skills such as independent living and driving ability

Question 37

time pressure management

Answer 37

an approach to dealing with attention deficits which aims to provide clients with some compensatory skills that will allow them to effectively manage their slowed information processing

Question 38

computer-assisted training program aiding visual scanning

Answer 38

consists of a series of tasks where the patient practices various skills, e.g.:
- scanning full frontal environment
- coordination of scanning and physical movement
- detection of stimuli space

Question 39

gestural training

Answer 39

a form of rehabilitation training for limb apraxia
- client is taught to recognise gestures and postures that are appropriate and in context

Question 40

computer-based virtual reality environments

Answer 40

have been developed to enable individuals with brain injury to learn to improve basic daily living skills in a safe and controlled environment

Question 41

constraint-induced movement therapy

Answer 41

used with aphasic patients - involves the mass practice of verbal responses
- patient may be required to communicate without gesturing or pointing to describe various objects of varying complexity

Question 42

group communication treatment

Answer 42

used in the production and comprehension of speech
- focuses on increasing initiation of conversation and exchanging information using whatever communication means possible

Question 43

goal management training

Answer 43

involves training in problem solving to help evaluate a current problem, followed by specification of the relevant goals + dividing the problem-solving process into subgoals or steps

Question 44

self-instructional training

Answer 44

used in the intervention for executive functioning deficits where individuals learn a set of instructions for talking themselves through particular problems