Neurocognitive disorders Flashcards
what are the 6 neurocognitive domains
complex attention
executive function
learning and memory
language
perceptual-motor
social cognition
sustained attention
maintenance of attention over time
*pressing a button every time a sound is heard
selective attention
maintenance of attention despite competing stimuli
divided attention
multitasking successfully
praxis
integrity of learned movements
ability to imitate gestures/pantomime
gnosis
integrity of awareness/cognition
recognition of faces/colors
theory of mind
ability to consider another person’s mental state/experience
diagnostic criteria for delirium
-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
time frame for acute delirium
hours to days
time frame for persistent delirium
weeks or months
hyperactive delirium
motor activity accompanied by mood lability, agitation, refusal to cooperate
hypoactive delirium
psychomotor activity accompanied by lethargy/sluggishness
mixed delirium
-normal psychomotor activity w/ disturbed attention/awareness
AND/OR
-activity rapidly fluctuates
how do you code a substance intoxication delirium
start with substance use disorder, “with”, name of intoxication delirium, then acute/persistent, then level of psychomotor activity
how do you code substance withdrawal delirium
name of substance use disorder, “with” name of substance withdrawal delirium, then acute/persistent, then psychomotor activity
how do you code medication-induced delirium
begins with specific substance, then acute/persistent, then psychomotor activity
associated features of delirium
disturbed sleep/wake cycle
emotional disturbances
if not tx what does delirium progress to
stupor, coma, seizures, death
criteria for other specified delirium
sx characteristic of delirium and cause clinically significant distress but do not meet full criteria and clinician choses to specify why not
criteria for major neurocognitive disorder
-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
how do you judge if there is significant cognitive decline
concern of patient, clinician, informant
or
impairment in neuropsych cognitive testing
specifier for major neurocognitive disorders
w/ or w/o behavioral disturbance
severity specifiers for major neurocognitive disorder
mild - difficult instrumental ADLs
mod - difficult basic ADLs
severe - total dependence
criteria for mild neurocognitive disorder
modest decline in 1+ neurocognitive domains
cognitive deficits in mild neurocognitive disorder
-do not interfere with independence in everyday activities
-not only in delirium
-not better explained by mental disorder
causes of dementia that begin at a specific time and remain static
TBI, stroke
what causes dementia to have insidious onset and gradual progression
neurodegenerative diseases
dementia that fluctuates over time
consider delirium superimposed on etiological disorder
difference in presentation between men and women
women tend to have more psych sx
men tend to have more aggression, apathy, vegetative sx
differential dx for neurocognitive disorder
normal aging
delirium
MDD
specific learning disorder
neurodevelopmental disorders
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
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
neuropsych features associated with mild NCD
depression, irritability and/or apathy
neuropsych features of moderate NCD
delusions, agitation, combativeness, wandering,
neuropsych features of late stage NCD
gait disturbance, dysphagia, incontinence, myoclonus, seizures
hallmark diagnostic markers of Alzheimer’s
amyloid plaques
tau neurofibrillary tangles
neuronal loss
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
behavioral variant of frontotemporal NCD
3+ of following:
-behavioral disinhibition
-apathy/inertia
-loss of sympathy/empathy
-perseverative, stereotyped, compulsive behavior
-hyperorality and dietary changes
language variant of frontotemporal NCD
prominent decline in language ability in the form of:
-speech production
-word finding
-object naming
-grammar
-word comprehension
specifiers for “probable” frontotemporal NCD
evidence of genetic mutation from family hx or testing
AND/OR
disproportionate frontal and/or temporal involvement on neuroimaging
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
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
major deficit in executive function
-must focus on one thing at a time
-others must plan ADLs/make decisions
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
working memory
ability to hold/manipulate info for a brief period
executive function
feedback/error utilization
ability to use feedback to infer rules for solving a problem
executive function
overriding habits/inhibitions
executive function:
can chose more complex solution
*name the color of the words instead of the words
mental/cognitive flexibility
executive function:
ability to shift between 2 concepts/tasks
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
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?
aspects of recent memory
free recall
cued recall
recognition memory
major deficit in language
-difficulty w/ expressive/receptive language
-general phrases/pronouns rather than specifics
severe deficits in language
-doesn’t know loved ones names
-grammatical errors
-stereotypy of speech
-echolalia and automatic speech that precedes mutism
mild deficits in language
-difficulty word-finding
-substitutes general for specific terms
-may avoid names
-subtle grammatical errors
major deficits in perceptual-motor behavior
-difficulty in previously familiar activities/environments
-sundowning
mild deficits in perceptual-motor behavior
-more reliance on maps
-getting glost when not focused
-less precise in parking
perceptual-motor
integrating perception with purposeful movement
rapidly inserting pegs in a board
visuoconstructional behavior
assembly of items using hand/eye coordination
drawing/copying
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
mild deficits in social cognition
subtle changes in behavior/mood
executive function in frontotemporal NCD
deficits are present but learning/memory are relatively spared
when does frontotemporal NCD typically manifest
50s (early onset)
survival and decline in frontotemporal v. Alzheimer’s
survival shorter and decline faster in frontotemporal
treatable causes of dementia
metabolic disturbances, nutritional deficiencies, and infections
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
core diagnostic features for Lewy body
-fluctuating cognition
-recurrent well-formed, detailed visual hallucinations
-spontaneous parkinson features AFTER cognitive decline
suggestive diagnostic features for Lewy body
-meets criteria for REM sleep behavior disorder
-severe neuroleptic sensitivity
specifiers for “probable” Lewy body
2 core features
OR
1 suggestive w/ 1 core feature
specifiers for “possible” Lewy body
1 core or suggestive feature
diagnostic criteria for vascular NCD
-criteria met for NCD
-evidence of cerebrovascular disease
-not better explained by another NCD, medical, mental disorder or substance
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
“possible” vascular NCD
-clinical criteria not met
-neuroimaging not available
–temporal relationship to cerebrovascular incident not well established
subtypes of vascular NCD
-poststroke manifesting immediately
-subcortical ischemic vascular
-multi-infarct
-cortical-subcortical vascular
varying course of vascular NCD
-acute onset w/ partial improvement
-stepwise decline
-progressive decline
diagnostic criteria for NCD from TBI
criteria met for NCD
evidence of TBI
evidence of TBI is 1+ of following
-loss of consiousness
-posttraumatic amnesia
-disorientation/confusion
-neurological s/s
severity classifications for TBI
mild
complicated mild
moderate
severe
how do you code NCD d/t a substance
first substance use disorder “with” substance-induced NCD, followed by duration
types of alcohol-induced NCD
nonamnestic-confabulatory
amnestic-confabulatory
amnestic-confabulatory type
characterized by impairment in recent memory out of proportion to additional NCD sx
wernickes encephalopathy
thiamine encephalopathy
nystagmus, ataxia, lateral gaze paralysis
associated feature of inhalant-induced NCD
smell of inhalant on breath
rash around nose/mouth
associated features of NCD d/t CNS depressant drugs
increased irritability, anxiety, sleep disturbance, and dysphoria
associated features of NCD d/t stimulants
rebound depression, hypersomnia, and apathy
diagnostic critera for NCD d/t HIV
criteria met for NCD
evidence of HIV infection
diagnostic criteria for NCD d/t Prion disease
-criteria met for NCD
-insidious onset w/ rapid progression
types of Prion disease
-Creutzfeldt-Jakob disease
-protease-sensitive prionopathy
-Kuru
-Gerstmann-Straussler-Scheineker syndrome
-fatal insomnia
-mad cow disease
common sx of Creutzfeldt-Jakob disease
-presents with neurocognitive deficits, ataxia, myoclonus, chorea, dystonia
-startle reflex is common
diagnostic criteria for NCD d/t Parkinson’s
-criteria for NCD met
-established Parkinson’s dx
course of NCD d/t Parkinson’s
insidious onset w/ gradual progression
“probable” NCD d/t Parkinson’s
both met:
-no evidence of mixed etiology
-Parkinson’s clearly precedes onset of NCD
diagnostic criteria for NCD d/t Huntington’s
criteria met for NCD
established Huntington’s dx
course of NCD d/t Huntington’s
insidious onset w/ gradual progression
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
other disorders associated with chorea that must be differentiated from NCD from Huntington’s
-Wilson’s disease
-drug0induced TD
-Sydenham’s chorea
-senile chorea
how do you code for major NCD d/t medical condition
medical disorder first followed by NCD dx and specify if behavioral disturbance
how do you code for mild NCD d/t medical condition
do not use additional code for medical disorder
how do you code for major NCD d/t multiple etiologies
code all medical disorders followed by NCD d/t multiple etiologies
how do you code for mild NCD d/t multiple etiologies
no extra etiological codes. Just NCD d/t multiple etiologies
