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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
cognitive deficits in mild neurocognitive disorder
-do not interfere with independence in everyday activities -not only in delirium -not better explained by mental disorder
26
causes of dementia that begin at a specific time and remain static
TBI, stroke
27
what causes dementia to have insidious onset and gradual progression
neurodegenerative diseases
28
dementia that fluctuates over time
consider delirium superimposed on etiological disorder
29
difference in presentation between men and women
women tend to have more psych sx men tend to have more aggression, apathy, vegetative sx
30
differential dx for neurocognitive disorder
normal aging delirium MDD specific learning disorder neurodevelopmental disorders
31
diagnostic criteria for Alzheimer's
-criteria met for neurocognitive disorder -insidious onset w/ gradual progression -for major, at least 2 cognitive domains must be affected
32
criteria for Alzheimer's dx to be "probable"
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
33
neuropsych features associated with mild NCD
depression, irritability and/or apathy
34
neuropsych features of moderate NCD
delusions, agitation, combativeness, wandering,
35
neuropsych features of late stage NCD
gait disturbance, dysphagia, incontinence, myoclonus, seizures
36
hallmark diagnostic markers of Alzheimer's
amyloid plaques tau neurofibrillary tangles neuronal loss
37
diagnostic critera for frontotemporal NCD
-NCD criteria met -insidious onset w/ gradual decline -sparing of learning, memory, perceptual-motor function -not explained by other NCDs, substances, or medical disorders
38
behavioral variant of frontotemporal NCD
3+ of following: -behavioral disinhibition -apathy/inertia -loss of sympathy/empathy -perseverative, stereotyped, compulsive behavior -hyperorality and dietary changes
39
language variant of frontotemporal NCD
prominent decline in language ability in the form of: -speech production -word finding -object naming -grammar -word comprehension
40
specifiers for "probable" frontotemporal NCD
evidence of genetic mutation from family hx or testing AND/OR disproportionate frontal and/or temporal involvement on neuroimaging
41
criteria for major deficit in complex attention
-easily distracted by multiple stimuli -input must be restricted/simplified -hard to hold new info -cant do mental calculations -thinking takes longer
42
criteria for mild deficit in complex attention
-normal tasks take longer -begins to be errors in routine tasks -more double-checking -hard to think when competing stimuli
43
major deficit in executive function
-must focus on one thing at a time -others must plan ADLs/make decisions
44
mild deficit in executive function
-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
working memory
ability to hold/manipulate info for a brief period executive function
46
feedback/error utilization
ability to use feedback to infer rules for solving a problem executive function
47
overriding habits/inhibitions
executive function: can chose more complex solution *name the color of the words instead of the words
48
mental/cognitive flexibility
executive function: ability to shift between 2 concepts/tasks
49
major deficit in learning/memory
-repeats self in same conversation -cant keep track of short list when shopping/planning -frequent reminders to orient to task at hand
50
mild deficits in learning/memory
-hard to recall recent events -needs lists/calendars -reminders to keep track of characters on a TV show -have bills been paid?
51
aspects of recent memory
free recall cued recall recognition memory
52
major deficit in language
-difficulty w/ expressive/receptive language -general phrases/pronouns rather than specifics
53
severe deficits in language
-doesn't know loved ones names -grammatical errors -stereotypy of speech -echolalia and automatic speech that precedes mutism
54
mild deficits in language
-difficulty word-finding -substitutes general for specific terms -may avoid names -subtle grammatical errors
55
major deficits in perceptual-motor behavior
-difficulty in previously familiar activities/environments -sundowning
56
mild deficits in perceptual-motor behavior
-more reliance on maps -getting glost when not focused -less precise in parking
57
perceptual-motor
integrating perception with purposeful movement *rapidly inserting pegs in a board*
58
visuoconstructional behavior
assembly of items using hand/eye coordination *drawing/copying*
59
major deficits in social cognition
-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
mild deficits in social cognition
subtle changes in behavior/mood
61
executive function in frontotemporal NCD
deficits are present but learning/memory are relatively spared
62
when does frontotemporal NCD typically manifest
50s (early onset)
63
survival and decline in frontotemporal v. Alzheimer's
survival shorter and decline faster in frontotemporal
64
treatable causes of dementia
metabolic disturbances, nutritional deficiencies, and infections
65
diagnostic criteria for NCD w/ Lewy bodies
-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
core diagnostic features for Lewy body
-fluctuating cognition -recurrent well-formed, detailed visual hallucinations -spontaneous parkinson features AFTER cognitive decline
67
suggestive diagnostic features for Lewy body
-meets criteria for REM sleep behavior disorder -severe neuroleptic sensitivity
68
specifiers for "probable" Lewy body
2 core features OR 1 suggestive w/ 1 core feature
69
specifiers for "possible" Lewy body
1 core or suggestive feature
70
diagnostic criteria for vascular NCD
-criteria met for NCD -evidence of cerebrovascular disease -not better explained by another NCD, medical, mental disorder or substance
71
specifiers for "probable" vascular NCD
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
"possible" vascular NCD
-clinical criteria not met -neuroimaging not available --temporal relationship to cerebrovascular incident not well established
73
subtypes of vascular NCD
-poststroke manifesting immediately -subcortical ischemic vascular -multi-infarct -cortical-subcortical vascular
74
varying course of vascular NCD
-acute onset w/ partial improvement -stepwise decline -progressive decline
75
diagnostic criteria for NCD from TBI
criteria met for NCD evidence of TBI
76
evidence of TBI is 1+ of following
-loss of consiousness -posttraumatic amnesia -disorientation/confusion -neurological s/s
77
severity classifications for TBI
mild complicated mild moderate severe
78
how do you code NCD d/t a substance
first substance use disorder "with" substance-induced NCD, followed by duration
79
80
types of alcohol-induced NCD
nonamnestic-confabulatory amnestic-confabulatory
81
amnestic-confabulatory type
characterized by impairment in recent memory out of proportion to additional NCD sx
82
wernickes encephalopathy
thiamine encephalopathy nystagmus, ataxia, lateral gaze paralysis
83
associated feature of inhalant-induced NCD
smell of inhalant on breath rash around nose/mouth
84
associated features of NCD d/t CNS depressant drugs
increased irritability, anxiety, sleep disturbance, and dysphoria
85
associated features of NCD d/t stimulants
rebound depression, hypersomnia, and apathy
86
diagnostic critera for NCD d/t HIV
criteria met for NCD evidence of HIV infection
87
diagnostic criteria for NCD d/t Prion disease
-criteria met for NCD -insidious onset w/ rapid progression
88
types of Prion disease
-Creutzfeldt-Jakob disease -protease-sensitive prionopathy -Kuru -Gerstmann-Straussler-Scheineker syndrome -fatal insomnia -mad cow disease
89
common sx of Creutzfeldt-Jakob disease
-presents with neurocognitive deficits, ataxia, myoclonus, chorea, dystonia -startle reflex is common
90
diagnostic criteria for NCD d/t Parkinson's
-criteria for NCD met -established Parkinson's dx
91
course of NCD d/t Parkinson's
insidious onset w/ gradual progression
92
"probable" NCD d/t Parkinson's
both met: -no evidence of mixed etiology -Parkinson's clearly precedes onset of NCD
93
diagnostic criteria for NCD d/t Huntington's
criteria met for NCD established Huntington's dx
94
course of NCD d/t Huntington's
insidious onset w/ gradual progression
95
associated features of NCD d/t Huntington's
-changes in executive function more prominent than decline in learning/memory -cognitive/behavioral changes precede motor sx
96
other disorders associated with chorea that must be differentiated from NCD from Huntington's
-Wilson's disease -drug0induced TD -Sydenham's chorea -senile chorea
97
how do you code for major NCD d/t medical condition
medical disorder first followed by NCD dx and specify if behavioral disturbance
98
how do you code for mild NCD d/t medical condition
do not use additional code for medical disorder
99
how do you code for major NCD d/t multiple etiologies
code all medical disorders followed by NCD d/t multiple etiologies
100
how do you code for mild NCD d/t multiple etiologies
no extra etiological codes. Just NCD d/t multiple etiologies

DSM5 (18 decks)

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