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Neurocognitive Disorders Flashcards

1
Q

Delirium criteria

A
  1. Disturbance in attention and awareness over short time
  2. 1+ other cognitive disturbance (language, memory, etc.)
  3. Symptoms connected to medical cause
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2
Q

Delirium course

A
  1. Develops in hours to a few days
  2. Change from baseline
  3. Fluctuates in severity throughout day
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3
Q

Risk factors for delirium

A
  1. Hospitalized older adults
  2. High fever
  3. Nutritional deficiency
  4. Electrolyte disturbance
  5. Renal or hepatitic failure
  6. Head injury
  7. Drugs/medications
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4
Q

Common substance/medication sources of Delirium

A
  1. Alcohol
  2. Lithium
  3. Sedatives
  4. Anticholinergic drugs
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5
Q

Delirium treatment

A
  1. Addressing medical problem
  2. Environmental changes (reduce disorientation)
  3. Antipsychotics (agitation, psychotic symptoms)
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6
Q

NCDs

A
  1. Acquired (NOT developmental) cognitive dysfunction
  2. Mild or major
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7
Q

Mild NCD criteria

A
  1. Modest decline from baseline in 1+ cognitive areas
  2. Not just part of Delirium
  3. Independence w/ skills
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8
Q

Major NCD criteria

A
  1. Significant decline from baseline in 1+ cognitive areas
  2. Not just part of Delirium
  3. No independence
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9
Q

Types of NCDs

A
  1. NCD due to Alzheimer’s
  2. NCD with Lewy Bodies
  3. Vascular NCD
  4. NCD due to HIV Infection
  5. NCD due to Prion Disease
  6. Frontotemporal NCD
  7. NCD due to Another Medical Condition
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10
Q

NCD due to Alzheimer’s Disease criteria

A
  1. Meet criteria for mild or major NCD
  2. 1+ areas for mild, 2+ areas for major
  3. Subtle onset, slow progression
  4. Probable for Alzheimer’s
  5. Not better explained
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11
Q

Mild NCD + possible Alzheimer’s

A
  1. No genetic mutation
  2. Decline in memory and learning
  3. Gradual
  4. No mixed etiology
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12
Q

Mild NCD + probable Alzheimer’s

A
  1. Genetic mutation
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13
Q

Major NCD + possible Alzheimer’s

A
  1. Criteria for Major NCD + probable Alzheimer’s not fully met
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14
Q

Major NCD + probable Alzheimer’s

A
  1. Genetic mutation
  2. Decline in memory and one other area
  3. Gradual
  4. No mixed etiology
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15
Q

NCD due to Alzheimer’s prevalence

A
  1. Women > men (may be due to life expectancy)
  2. 65+ yo
  3. Black Americans
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16
Q

NCD due to Alzheimer’s course

A
  1. Onset 70-89 yo
  2. When onset 49-59 yo = genetic mutation
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17
Q

Diagnosing NCD due to Alzheimer’s

A
  1. ONLY confirmed by brain biopsy (high risk) or autopsy
  2. Symptoms + ruling out other causes
  3. Family history
  4. Exams (physical, neuro, neuropsych, status)
  5. Labs, scans (MRI, CT)
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18
Q

NCD due to Alzheimer’s genetic mutation

A

ApoE4 chromosomal variant

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19
Q

NCD due to Alzheimer’s and brain structure

A
  1. General = buildup of proteins
  2. Amyloid plaques (beta-amyloid clumps)
  3. Neurofibrillary tangles
  4. Mild = rapid loss of smell

Locus coeruleus (in brain stem)? >
Medial temporal lobe >
Frontal and parietal lobes >
Entire cortex

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20
Q

Amyloid plaques

A
  1. Linked to NCD due to Alzheimer’s
  2. Beta-amyloid protein clumps
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21
Q

Neurofibrillary tangles

A
  1. Linked to NCD due to Alzheimer’s
  2. Disrupt between-cell communication
  3. Tau protein
  4. Threads > tangles
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22
Q

NCD due to Alzheimer’s risk factors

A
  1. Low educational status
  2. Obesity
  3. Hearing loss
  4. Down’s syndrome
  5. High neuroticism, low conscientiousness
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23
Q

NCD due to Alzheimer’s and Down’s syndrome

A
  1. Extra chromosome for amyloid protein
  2. Early onset in 20s
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24
Q

MCD due to Alzheimer’s and Big Five

A
  1. High neuroticism AND low conscientiousness
  2. More amyloid and tau proteins
25
Q

Alzheimer’s course

A
  1. Duration = 8-10 years
  2. Early, middle, and late stages
26
Q

Early stage of Alzheimer’s

A

2-4 years

  1. ST memory loss
  2. Anomia
  3. Personality changes
  4. Anxiety, depression
  5. Impaired attention and concentration
  6. Poor judgement
  7. Disorientation
27
Q

Middle stage of Alzheimer’s

A

2-10 years

Worsens:
1. Memory (ST worse and new LT loss)
2. Disorientation
3. Mood (anxiety, depression > labile, irritable)

New:
1. Psychotic symptoms
2. Behavior (wandering, pacing, repetitive, impulsive)
3. Speech (poor, repetitive)
4. Basic needs (sleep, adaptive skills)
5. “Sundowning”

28
Q

Late stage of Alzheimer’s

A

1-3 years

Worsens:
1. Cognitive functioning
2. Disorientation
3. Mood (labile, irritable > apathy, agitation, aggression)
4. Speech
4. Basic needs (appetite, incontinence, motor skills, self-care)

New:
5. Health (abnormal reflexes, infections, seizures)

29
Q

Pseudodementia

A
  1. Depression w/ cognitive symptoms that mask as Alzheimer’s symptoms due to denial of depressive symptoms
  2. Responds well to treatment
30
Q

Pseudodementia v. Alzheimer’s

A
  1. Abrupt onset of cognitive symptoms (Alzheimer’s = gradual)
  2. Exaggerated cognitive problems
    (Alzheimer’s = deny cognitive problems)
  3. Moderate memory loss
    (Alzheimer’s = severe memory loss)
  4. Melancholia and anxiety
    (Alzheimer’s = apathy and avolition)
  5. Often says “I don’t know” to questions
    (Alzheimer’s = often answers incorrectly)
31
Q

Alzheimer’s treatment

A

No cure (focused on symptom reduction)
Better outcomes at home v. facility

  1. Medications
  2. Cognitive-behavioral interventions
  3. Support, caregivers, etc.
  4. Skills training
32
Q

Medications for Alzheimer’s

A
  1. Cholinesterase inhibitors = reduce cognitive symptoms
  2. NMDA receptor antagonist = regulate glutamate (memantine)
  3. Antidepressants = depression, irritability
  4. Anxiolyics = anxiety, restlessness
  5. Antipsychotics = mania, psychosis, risky behavior
33
Q

Cholinesterase inhibitors for Alzheimer’s

A
  1. Donepezil
  2. Rivastigmine
34
Q

NCD with Lewy Bodies criteria

A
  1. Meet criteria for mild or major NCD
  2. Meet criteria for possible or probable NCD
35
Q

Possible NCD with Lewy Bodies

A

1 core feature
OR
2 suggestive features

36
Q

Probable NCD with Lewy Bodies

A

2 core features
OR
1 core + 1 suggestive feature

37
Q

NCD with Lewy Bodies CORE symptoms

A
  1. Fluctuating cognition (attention, alertness)
  2. Recurrent visual hallucinations
  3. Parkinson’s symptoms (WITH or AFTER cognitive symptoms)
38
Q

NCD with Lewy Bodies SUGGESTIVE symptoms

A
  1. REM sleep behavior disorder
  2. Severe neuroleptic sensitivity
39
Q

Alzheimer’s v. Lewy Bodies

A

Early cognitive deficits:
1. Alzheimer’s = learning, memory
2. Lewy Bodies = complex attention, visuospatial ability, executive function

40
Q

Vascular NCD criteria

A
  1. Meet criteria for mild or major NCD
  2. Vascular etiology (stroke, cerebrovascular event) or decline in attention and executive function
  3. Evidence of cerebrovascular disease
41
Q

Vascular NCD course

A

Depends on etiology

  1. Acute w/ partial recovery
  2. Stepwise decline
  3. Progressive w/ fluctuations and plateaus
42
Q

Vascular NCD treatment

A
  1. Prevention and intervention of causes/risk factors
43
Q

Vascular NCD risk factors

A
  1. Hypertension
  2. Heart disease
  3. Diabetes
  4. Obesity
  5. High cholesterol
  6. Smoking
44
Q

NCD due to HIV Infection criteria

A
  1. Meets criteria for mild or major NCD
  2. Infection with HIV
45
Q

NCD due to HIV Infection symptoms

A
  1. Forgetfulness
  2. Impaired attention
  3. Cognitive slowing
  4. Psychomotor retardation
  5. Clumsiness/tremors
  6. Apathy
  7. Social withdrawal
46
Q

NCD due to Prion Disease criteria

A
  1. Meet criteria for mild or major NCD
  2. Insidious onset, rapid progression (mild to major NCD in < 6 months)
  3. Motor or biomarker (lesions) features of prion disease
47
Q

Prion Disease v. Alzheimer’s

A
  1. Rapid progression
    (Alzheimer’s = gradual progression)
48
Q

Creutzfeldt-Jakob Disease (CJD)

A
  1. Most common prion disease
  2. Four types
49
Q

Four types of CJD (and etiology)

A
  1. Sporadic CJD* (unknown)
  2. Familial CJD (inherited)
  3. Acquired CJD (infected meat, transmission via blood transfusion)
  4. Iatrogenic CJD (transmission via medical procedures)
50
Q

CJD symptoms

A
  1. Confusion, disorientation
  2. Impaired memory and judgment
  3. Motor (ataxia, myoclonus, chorea)
  4. Psychiatric (apathy, anxiety, mood swings)
51
Q

Most common NCDs

A
  1. Overall = Alzheimer’s (60-80%)
  2. Early-onset < 65 yo = Frontotemporal NCD
52
Q

Frontotemporal NCD criteria

A
  1. Meet criteria for mild or major NCD
  2. Insidious onset, gradual progression
  3. No significant impact on learning, memory, motor skills in early stages
  4. Meet criteria for behavioral (common) or language variant
53
Q

Behavioral Frontotemporal NCD criteria

A
  1. Decline in social cognition and/or executive function
  2. 3+ other symptoms
54
Q

Behavioral Frontotemporal NCD symptoms

A
  1. Behavioral disinhibition
  2. Apathy and inertia
  3. Loss of sympathy or empathy
  4. Stereotypy or compulsions
  5. Dietary changes
55
Q

Language Frontotemporal NCD

A
  1. AKA Primary Progressive Aphasia (PPA)
  2. Three types
56
Q

Three types of Language Frontotemporal NCD

A
  1. Semantic PPA = impaired comprehension of written and spoken language
  2. Agrammatic/nonfluent PPA = incorrect grammar and effortful speech
  3. Logopenic PPA = repetition of phrases, word-finding difficulty
57
Q

NCD due to Another Medical Condition

A
  1. Meet criteria for mild or major NCD and evidence that symptoms related to medical condition
  2. Depends on underlying condition = onset, progression, treatment, prognosis
58
Q

Potentially reversible NCD medical conditions

A
  1. Hypoxia
  2. Infections
  3. Endocrine disorders
  4. Poisoning
  5. Nutritional deficiences

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