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DSM5 > Neurocognitive disorders > Flashcards

Neurocognitive disorders Flashcards

1
Q

what are the 6 neurocognitive domains

A

complex attention
executive function
learning and memory
language
perceptual-motor
social cognition

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2
Q

sustained attention

A

maintenance of attention over time
*pressing a button every time a sound is heard

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3
Q

selective attention

A

maintenance of attention despite competing stimuli

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4
Q

divided attention

A

multitasking successfully

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5
Q

praxis

A

integrity of learned movements
ability to imitate gestures/pantomime

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6
Q

gnosis

A

integrity of awareness/cognition
recognition of faces/colors

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7
Q

theory of mind

A

ability to consider another person’s mental state/experience

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8
Q

diagnostic criteria for delirium

A

-attention disturbance/reduced environmental awareness with an additional disturbance in cognition (memory, disorientation, language, visuospatial ability, perception)
-disturbance IS d/t medical condition/substance use

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9
Q

time frame for acute delirium

A

hours to days

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10
Q

time frame for persistent delirium

A

weeks or months

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11
Q

hyperactive delirium

A

motor activity accompanied by mood lability, agitation, refusal to cooperate

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12
Q

hypoactive delirium

A

psychomotor activity accompanied by lethargy/sluggishness

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13
Q

mixed delirium

A

-normal psychomotor activity w/ disturbed attention/awareness
AND/OR
-activity rapidly fluctuates

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14
Q

how do you code a substance intoxication delirium

A

start with substance use disorder, “with”, name of intoxication delirium, then acute/persistent, then level of psychomotor activity

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15
Q

how do you code substance withdrawal delirium

A

name of substance use disorder, “with” name of substance withdrawal delirium, then acute/persistent, then psychomotor activity

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16
Q

how do you code medication-induced delirium

A

begins with specific substance, then acute/persistent, then psychomotor activity

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17
Q

associated features of delirium

A

disturbed sleep/wake cycle
emotional disturbances

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18
Q

if not tx what does delirium progress to

A

stupor, coma, seizures, death

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19
Q

criteria for other specified delirium

A

sx characteristic of delirium and cause clinically significant distress but do not meet full criteria and clinician choses to specify why not

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20
Q

criteria for major neurocognitive disorder

A

-cognitive decline in 1+ neurocognitive domains
-deficits interfere with independence in daily activities
-deficits do not occur only in delirium
-not better explained by another mental disorder

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21
Q

how do you judge if there is significant cognitive decline

A

concern of patient, clinician, informant
or
impairment in neuropsych cognitive testing

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22
Q

specifier for major neurocognitive disorders

A

w/ or w/o behavioral disturbance

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23
Q

severity specifiers for major neurocognitive disorder

A

mild - difficult instrumental ADLs
mod - difficult basic ADLs
severe - total dependence

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24
Q

criteria for mild neurocognitive disorder

A

modest decline in 1+ neurocognitive domains

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25
Q

cognitive deficits in mild neurocognitive disorder

A

-do not interfere with independence in everyday activities
-not only in delirium
-not better explained by mental disorder

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26
Q

causes of dementia that begin at a specific time and remain static

A

TBI, stroke

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27
Q

what causes dementia to have insidious onset and gradual progression

A

neurodegenerative diseases

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28
Q

dementia that fluctuates over time

A

consider delirium superimposed on etiological disorder

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29
Q

difference in presentation between men and women

A

women tend to have more psych sx
men tend to have more aggression, apathy, vegetative sx

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30
Q

differential dx for neurocognitive disorder

A

normal aging
delirium
MDD
specific learning disorder
neurodevelopmental disorders

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31
Q

diagnostic criteria for Alzheimer’s

A

-criteria met for neurocognitive disorder
-insidious onset w/ gradual progression
-for major, at least 2 cognitive domains must be affected

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32
Q

criteria for Alzheimer’s dx to be “probable”

A

EITHER
evidence of genetic gene mutations (family hx or testing)
AND/OR
all 3:
-decline in memory/learning and at least 1 other domain
-steady progression with no significant plateaus
-no mixed etiologies

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33
Q

neuropsych features associated with mild NCD

A

depression, irritability and/or apathy

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34
Q

neuropsych features of moderate NCD

A

delusions, agitation, combativeness, wandering,

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35
Q

neuropsych features of late stage NCD

A

gait disturbance, dysphagia, incontinence, myoclonus, seizures

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36
Q

hallmark diagnostic markers of Alzheimer’s

A

amyloid plaques
tau neurofibrillary tangles
neuronal loss

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37
Q

diagnostic critera for frontotemporal NCD

A

-NCD criteria met
-insidious onset w/ gradual decline
-sparing of learning, memory, perceptual-motor function
-not explained by other NCDs, substances, or medical disorders

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38
Q

behavioral variant of frontotemporal NCD

A

3+ of following:
-behavioral disinhibition
-apathy/inertia
-loss of sympathy/empathy
-perseverative, stereotyped, compulsive behavior
-hyperorality and dietary changes

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39
Q

language variant of frontotemporal NCD

A

prominent decline in language ability in the form of:
-speech production
-word finding
-object naming
-grammar
-word comprehension

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40
Q

specifiers for “probable” frontotemporal NCD

A

evidence of genetic mutation from family hx or testing

AND/OR

disproportionate frontal and/or temporal involvement on neuroimaging

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41
Q

criteria for major deficit in complex attention

A

-easily distracted by multiple stimuli
-input must be restricted/simplified
-hard to hold new info
-cant do mental calculations
-thinking takes longer

42
Q

criteria for mild deficit in complex attention

A

-normal tasks take longer
-begins to be errors in routine tasks
-more double-checking
-hard to think when competing stimuli

43
Q

major deficit in executive function

A

-must focus on one thing at a time
-others must plan ADLs/make decisions

44
Q

mild deficit in executive function

A

-hard to do multi-step projects
-difficulty multitasking/restarting
-fatigue from extra effort to plan/organize
-social gathering taxing/less enjoyable d/t difficulty following conversations

45
Q

working memory

A

ability to hold/manipulate info for a brief period
executive function

46
Q

feedback/error utilization

A

ability to use feedback to infer rules for solving a problem
executive function

47
Q

overriding habits/inhibitions

A

executive function:
can chose more complex solution
*name the color of the words instead of the words

48
Q

mental/cognitive flexibility

A

executive function:
ability to shift between 2 concepts/tasks

49
Q

major deficit in learning/memory

A

-repeats self in same conversation
-cant keep track of short list when shopping/planning
-frequent reminders to orient to task at hand

50
Q

mild deficits in learning/memory

A

-hard to recall recent events
-needs lists/calendars
-reminders to keep track of characters on a TV show
-have bills been paid?

51
Q

aspects of recent memory

A

free recall
cued recall
recognition memory

52
Q

major deficit in language

A

-difficulty w/ expressive/receptive language
-general phrases/pronouns rather than specifics

53
Q

severe deficits in language

A

-doesn’t know loved ones names
-grammatical errors
-stereotypy of speech
-echolalia and automatic speech that precedes mutism

54
Q

mild deficits in language

A

-difficulty word-finding
-substitutes general for specific terms
-may avoid names
-subtle grammatical errors

55
Q

major deficits in perceptual-motor behavior

A

-difficulty in previously familiar activities/environments
-sundowning

56
Q

mild deficits in perceptual-motor behavior

A

-more reliance on maps
-getting glost when not focused
-less precise in parking

57
Q

perceptual-motor

A

integrating perception with purposeful movement
rapidly inserting pegs in a board

58
Q

visuoconstructional behavior

A

assembly of items using hand/eye coordination
drawing/copying

59
Q

major deficits in social cognition

A

-behavior clearly unacceptable
-insensitivity to social standards regarding modesty or topics of conversation
-excessive focus on topic despite group disinterest
-little regard to safety
-little insight

60
Q

mild deficits in social cognition

A

subtle changes in behavior/mood

61
Q

executive function in frontotemporal NCD

A

deficits are present but learning/memory are relatively spared

62
Q

when does frontotemporal NCD typically manifest

A

50s (early onset)

63
Q

survival and decline in frontotemporal v. Alzheimer’s

A

survival shorter and decline faster in frontotemporal

64
Q

treatable causes of dementia

A

metabolic disturbances, nutritional deficiencies, and infections

65
Q

diagnostic criteria for NCD w/ Lewy bodies

A

-met criteria for NCD
-insidious onset w/ gradual progression
-appropriate amount of core/suggestive features present
-not explained by other NCD, medical, mental disorder or substance

66
Q

core diagnostic features for Lewy body

A

-fluctuating cognition
-recurrent well-formed, detailed visual hallucinations
-spontaneous parkinson features AFTER cognitive decline

67
Q

suggestive diagnostic features for Lewy body

A

-meets criteria for REM sleep behavior disorder
-severe neuroleptic sensitivity

68
Q

specifiers for “probable” Lewy body

A

2 core features

OR

1 suggestive w/ 1 core feature

69
Q

specifiers for “possible” Lewy body

A

1 core or suggestive feature

70
Q

diagnostic criteria for vascular NCD

A

-criteria met for NCD
-evidence of cerebrovascular disease
-not better explained by another NCD, medical, mental disorder or substance

71
Q

specifiers for “probable” vascular NCD

A

1+ of the following:
-criteria supported by neuroimaging evidence
-cognitive decline temporally r/t cerebrovascular event
-clinical AND genetic evidence of cerebrovascular disease present

72
Q

“possible” vascular NCD

A

-clinical criteria not met
-neuroimaging not available
–temporal relationship to cerebrovascular incident not well established

73
Q

subtypes of vascular NCD

A

-poststroke manifesting immediately
-subcortical ischemic vascular
-multi-infarct
-cortical-subcortical vascular

74
Q

varying course of vascular NCD

A

-acute onset w/ partial improvement
-stepwise decline
-progressive decline

75
Q

diagnostic criteria for NCD from TBI

A

criteria met for NCD
evidence of TBI

76
Q

evidence of TBI is 1+ of following

A

-loss of consiousness
-posttraumatic amnesia
-disorientation/confusion
-neurological s/s

77
Q

severity classifications for TBI

A

mild
complicated mild
moderate
severe

78
Q

how do you code NCD d/t a substance

A

first substance use disorder “with” substance-induced NCD, followed by duration

79
Q
A
80
Q

types of alcohol-induced NCD

A

nonamnestic-confabulatory
amnestic-confabulatory

81
Q

amnestic-confabulatory type

A

characterized by impairment in recent memory out of proportion to additional NCD sx

82
Q

wernickes encephalopathy

A

thiamine encephalopathy
nystagmus, ataxia, lateral gaze paralysis

83
Q

associated feature of inhalant-induced NCD

A

smell of inhalant on breath
rash around nose/mouth

84
Q

associated features of NCD d/t CNS depressant drugs

A

increased irritability, anxiety, sleep disturbance, and dysphoria

85
Q

associated features of NCD d/t stimulants

A

rebound depression, hypersomnia, and apathy

86
Q

diagnostic critera for NCD d/t HIV

A

criteria met for NCD
evidence of HIV infection

87
Q

diagnostic criteria for NCD d/t Prion disease

A

-criteria met for NCD
-insidious onset w/ rapid progression

88
Q

types of Prion disease

A

-Creutzfeldt-Jakob disease
-protease-sensitive prionopathy
-Kuru
-Gerstmann-Straussler-Scheineker syndrome
-fatal insomnia
-mad cow disease

89
Q

common sx of Creutzfeldt-Jakob disease

A

-presents with neurocognitive deficits, ataxia, myoclonus, chorea, dystonia
-startle reflex is common

90
Q

diagnostic criteria for NCD d/t Parkinson’s

A

-criteria for NCD met
-established Parkinson’s dx

91
Q

course of NCD d/t Parkinson’s

A

insidious onset w/ gradual progression

92
Q

“probable” NCD d/t Parkinson’s

A

both met:
-no evidence of mixed etiology
-Parkinson’s clearly precedes onset of NCD

93
Q

diagnostic criteria for NCD d/t Huntington’s

A

criteria met for NCD
established Huntington’s dx

94
Q

course of NCD d/t Huntington’s

A

insidious onset w/ gradual progression

95
Q

associated features of NCD d/t Huntington’s

A

-changes in executive function more prominent than decline in learning/memory
-cognitive/behavioral changes precede motor sx

96
Q

other disorders associated with chorea that must be differentiated from NCD from Huntington’s

A

-Wilson’s disease
-drug0induced TD
-Sydenham’s chorea
-senile chorea

97
Q

how do you code for major NCD d/t medical condition

A

medical disorder first followed by NCD dx and specify if behavioral disturbance

98
Q

how do you code for mild NCD d/t medical condition

A

do not use additional code for medical disorder

99
Q

how do you code for major NCD d/t multiple etiologies

A

code all medical disorders followed by NCD d/t multiple etiologies

100
Q

how do you code for mild NCD d/t multiple etiologies

A

no extra etiological codes. Just NCD d/t multiple etiologies

DSM5 (18 decks)

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