Neurocognitive Disorders

Question 1

Delirium

Answer 1

-↓ ability to focus,
-Change in cognition of perceptual
-Disturbance caused by a medical condition or developed
during intoxication / withdrawal

Question 2

Delirium Risk Factors

Answer 2

 ↑ severity of physical illness
 Prescription medications
 Recovery from hip fractures
 AIDS
 Terminal cancer

Question 3

Incidence and Prevalence of delirium

Answer 3

 Often untreated / overlooked
 1% adults aged 55 and older
 10% emergency dept patients
 80% critical care patients
 80% patients in end of life care
 60% in nursing homes or post acute care settings

Question 4

Signs and Symptoms of delirium

Answer 4

-Prodromal; restlessness, anxiety, sleep disturbance, & irritability
 Altered arousal and disturbance of the sleep-wake cycle
 Illusions, delusions, or hallucinations
 Emotional lability
 Decreased attention, impaired memory, or disorientation to
time, place, or person
Constructional apraxia
 Dysgraphia
 Motor abnormalities
 Muscle spasms
 Dysnomic aphasia
 Reflex / tone changes

Question 5

Orientation in dementia

Answer 5

-x1 means orientated to person
-x2 is orientated to person and place
-x3 is orientated to person, place and, time
-x4 is oriented to person, place, time, and situation

Question 6

Three Sub-types of Delirium:

Answer 6

(1) Hyperactive-agitation, restlessness, and excessive emotional reactivity or emotional lability
(2) Hypoactive- somnolence, withdrawal, decreased responsiveness, and apathy
(3) Mixed-symptoms of both hyperactive and hypoactive delirium within the same day

Question 7

Course and Prognosis of delirium

Answer 7

 Rapid onset
 Most meet criteria within 48 hrs of symptoms
 Course fluctuates; days or hours
 Symptoms generally worsen at night (sundowning)
 < 1 week duration
 Symptoms will persist if causing condition is present
 Condition treated: 3-7 days symptoms recede

Question 8

Dementia and Alzheimer’s Disease

Answer 8

Dementia is a general term for a decline in mental ability severe enough to
interfere with daily life.
* Alzheimer’s is the most common cause of dementia

Question 9

Alzheimer’s Disease

Answer 9

 Cognitive impairment
 Cause is poorly understood
 There is no perfect biological marker that is diagnostic, made after ruling out
alternate disorders
 Cortical atrophy, widened sulci, and ventricular enlargement often
observed in MRIs
 “Shrinking Brain”

Question 10

Alzheimer’s Disease Neuropathological Degeneration

Answer 10

• neurofibrillary tangles / beta-
  amyloid plaques shrink brain structure
  -Plaques collect outside and around the neurons; neuronal death
  -Neurofibrillary tangles; contaminated tau protein

Question 11

Types

Answer 11

-Early onset: Before age 65 (Less than 5% of AD is early onset, and this
form of the disease is often inherited)
-Late onset: At or after age 65

Question 12

Alzheimer’s Disease Risk Factors:

Answer 12

-Down’s syndrome
-Neurotransmitter abnormalities
-Risk for developing cardiovascular disease

Question 13

Alzheimer’s Disease: Incidence and Prevalence

Answer 13

 ~ 5.3 million Americans
 ~ 200,000 individuals < age 65
 By 2050 18 million Americans with NCD
 14 million NCD due to AD
 Higher incidence in women

Question 14

Mild Stage of AD

Answer 14

difficulty performing tasks and make mistakes along the way. Short term and long term memory will start to decline. The patient may have paraphasia, anomia, and circumlocution. The patient may also have some emotional disturbance.

Question 15

Moderate Stage of AD

Answer 15

trouble maintaining attention to tasks, becoming more sensitive, losing the ability to problem solve and the memory continues to decline. Language becomes non fluent, may feel lost in the surroundings, and lose awareness of social standards.

Question 16

Severe Stage of AD

Answer 16

attention span of seconds and will only respond to stimuli of pain, hunger, and fear. The want to do better in occupations is lost and language is down to only a few words. The patient would become bed bound, acquire dysphagia, agnosia, muscle spasms, and become incontinent.

Question 17

Agnosia
Agrammatica
Analgesic

Answer 17

-Inability to process sensory info
-Difficulty with using basic grammar
-drug to reduce pain

Question 18

Anomia
Aphasia
Apraxia

Answer 18

-Inability to name objects.
-Difficulty with expressive and/or receptive language.
-Loss of skilled purposeful movemen

Question 19

Asterixis
Anxiolytics
Circumlocution

Answer 19

-muscles relax during use
-medications used to treat anxiety
- nonverbal communication

Question 20

Computerized tomography
Disinhibition
Dysnomic aphasia

Answer 20

-(CT) is a noninvasive imaging procedure that uses X-ray techniques to create detailed images of the body
- lack of inhibitory control
-Difficulty naming objects

Question 21

Dysgraphia
Dysphagia
Hyperreflexia

Answer 21

-Inability to write
-Difficulty in swallowing
- increased or overactive reflex response in muscle

Question 22

Lability
Logopenic
Paraphasia

Answer 22

-rapidly shifting or changing emotions
-Rapidly shifting or changing emotions
and repetition of phrases and sentences
-person hears and comprehends words but is unable to speak correctly.

Question 23

Paratonia
Personal episodic memory
Procedural memory

Answer 23

-Involuntary resistance to passive movement of the extremities
-Recall of timerelated information about one’s self,
- memory that aids the performance of particular types of tasks without conscious awareness of these previous experiences

Question 24

Prodromal
Prosopagnosia
Remote memory

Answer 24

• mild cognitive impairment or decline.
  -Inability to recognize faces
• ability to recall information in different area

Question 25

Semantic memory
Semantic variant speech
Somnolence

Answer 25

-long-term memory category involving the recollection of ideas, concepts, and facts general facts
-impaired single word comprehension, poor object and/or person knowledge, errors in reading aloud
-Sleepiness