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Behavioral Health--> Module One > Neurocognitive Disorders > Flashcards

Neurocognitive Disorders Flashcards

1
Q

What are neurocognitive Disorders (NCDs)?

A

Disorders in which the core feature is acquired dysfunction in a cognitive domain occurring after early life

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2
Q

What are the common NCD conditions?

A

Delirium
Amnesia
Dementia

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3
Q

The first condition in NCD is delirium, what does delirium involve?

A

1) A disturbance in awareness and attention
2) An additional disturbance in a cognitive domain (illusions is a sensory misperception)
3) Sudden Onset of Symptoms (typically fluctuate during the day and start over a few hrs)
4) Evidence for a direct physiological cause (drugs)

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4
Q

What is awareness and attention in regards to delirium?

A

Awareness –> is assessed by one’s orientation to the environment
Attention –> is assessed by one’s ability to direct, focus, sustain, and shift attention

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5
Q

What is the pathology for delirium?

A

Ultimately what is responsible for this is cholinergic functioning within brainstem system is thought to be failing

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6
Q

What are the risk factors for delirium or brain failure problems

A 
poor health 
age 
gender 
poor sleep (less when in ICU)
immobilization 
Use of benzos in the ICU
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7
Q

What is the course of delirium?

A

Resolution typically occurs within 3-7 days (Even though problem is fixed and everything else is back to normal)
Amnesia for events during delirium is common
Suggests shortened longevity

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8
Q

What is the treatment for delirium?

A

1) Treat underlying medical condition
2) Medications:
* Antipsychotics (drug of choice)
* Benzodiazepines (only if delirium is caused by alcohol withdrawal)
3) Environmental Supportive Measures: limit environmental stimulation; provide lighting/windows/ sensory aids; provide safety

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9
Q

The next condition of NCD is amnesia, what is amnesia as an NCD disorder?

A

1) Significant acquired memory impairment

2) Not diagnosed if memory loss occurs in the context of a decline in other cognitive areas

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10
Q

There are a number of Normal Memory Systems. Each card will go through one. 1 –>

A

1) Short- Term Memory (STM) –> online working memory that involves dorsolateral prefrontal cortex (DLPFC) with brief duration

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11
Q

The 2nd normal memory system–>

A

2) Long Term Memory (LTM) –> divided into recent and remote LTMs. Involves neural networks networks distributed throughout the brain.
Impairment in recall of LTM= retrograde amnesia

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12
Q

The 3rd normal memory system –>

A

3) Encoding (consolidation) –> process of turing STM into LTM.
critical for learning new information
involves the hippocampus
Impairment in encoding = anterograde amnesia

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13
Q

What is the typical profile of Amnestics?

A

1) Intact STM
2) Short duration retrograde amnesia (temporal gradient often characterizes the amnesia with recent LTMs more impaired than remote LTMs)
3) Prominent Anterograde Amnesia
4) Patients may confabulate when their memory fails (not really lying; just building in memories)

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14
Q

What are the common causes of Amnestic?

A

1) Hippocampal Damage

2) Indirect damage to hippocampus –> ex: korsakoff’s syndrome

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15
Q

What are the treatments for an Amnestic?

A

1) Treat underlying cause
2) Cognitive rehabilitation –> memory exercises with repeated practice
3) Compensation using mnemonics –> external strategies ( non mental activities that rely on something or someone else); internal strategies ( mental activities like acronyms)

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16
Q

The last NCD disorder is Dementia, what is dementia in regards to NCD?

A
  • -> Refers to multiple and severe cognitive impairment without impaired consciousness
  • -> usually progressive and irreversible
  • -> mostly in elderly
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17
Q

What is Mild Cognitive Impairment (MPI)?

A

refers to cognitive decline that doesn’t cause impairment in activities in daily living

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18
Q

Within Dementia there is Alzheimers Dementia (AD) what does this involve?

A

1) Significant MEMORY impairment in at least 1 other cognitive domain
2) Gradual onset with steady decline

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19
Q

What are the risk factors for AD?

A

Aging, Genetic Profile, Cardiovascular Disease Risk Factors, Traumatic Brain Injury

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20
Q

There are three stages of AD, each card will go through the stages. 1–>

A
  1. Early Stages: memory deficits and anomia (forgetting everyday objects)
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21
Q

2nd stage of AD –>

A
  1. Middle Stages: further memory and language decline; agnosias (loss in meanings in things); mood and personality changes; psychosis
22
Q

3rd stage of AD –>

A
  1. Late Stages: Global Aphasia, motor dysfunction, death from opportunistic infections
23
Q

What is the neuropathology of AD?

A

1) Neuroanatomical –> cortical atrophy; hippocampal atrophy; enlarged ventricles
2) Neurochemical –> loss of cholingeric (ACH) neurons in the nucleus basalis of Meynert due to its role in memory
3) Neurofunctional –> posterior hypometabolism
4) Histopathology–> B-amyloid plaques and neurofibrillary tangles

24
Q

What are the biomarkers of AD?

A

1) CSF amyloid and tau levels

2) PET imaging of amyloid plaques

25
Q

What are the 4 FDA approved drugs for AD treatment?

A 
3 Cholinesterase Inhibitors: 
  * Donepezil (Aricept)
  * Rivastigmine (Exelon)
  * Galantamine (Razadyne) 
1 NMDA receptor blocker 
  * Memmantine (Namenda)
26
Q

Are drugs for AD considered effective?

A

not really :(

27
Q

What are some other interventions for AD?

A

1) Treat neuropsychotic symptoms:
* Antipsychotics –> used off label for demented patients however they are not safe and increase mortality
* Anticonvulsants
* Antidepressants
2) Non drug methods –> changing communication style
3) Psychosocial Considerations –> labels reminding loved ones of what to do; assessment and restriction of driving; safe return program
4) Support for Caregivers –> care giver syndrome giving so much and getting nothing in return (often times turns to abuse)

28
Q

There are multiple causes of dementia that must be ruled out before diagnosing AD, what are they?

A

1) Vascular Disease
2) Frontotemporal Degenerative diseases (Pick’s Disease)
3) Lewy Body Disease
4) Parkinson’s Disease
5) Huntington’s Disease
6) Prion Disease

29
Q

In regards to differential diagnosis of vascular disease for AD, how do you differentiate the two?

A

Vascular Disease is like having little mini strokes –> multiple infarcts caused by cerebral vascular disease
onset of headaches and seizures
Sudden onset with stepwise progression

30
Q

In regards to differential diagnosis for frontotemporal dementia for AD, how do you differentiate the two?

A

Predominate frontal signs early –> frontal lobe atrophy and hypometabolism; personality change

31
Q

In regards to differential diagnosis for Lewy Body Disease (LBD) for AD, how do you differentiate the two?

A

1) Patients will be demented one day but the next day way worse then the next day way better (fluctuating cognition)
2) Visual Hallucinations (AD usually this happens years later)
3) Mild Parkinsonism (just slowness)

32
Q

What sleep disorder is associated with Lewy Body Disease?

A

REM sleep behavior

33
Q

How do you treat Lewy Body Dementia?

A

CAN NOT GIVE ANTIPSYCHOTICS!!!
usually best to not treat it
(if parkinsons experienced then can treat with parkinsons drugs but remember these drugs can cause psychosis….)

34
Q

In regards to differential diagnosis for Parkinson’s Disease Dementia (PDD), how do you differentiate PDD and LBD

A

With the 1 year rule:

  • if dementia develops >12 months after well established parkinsonism –> PDD
  • If dementia develops within first 12 months of parkinsonian signs –>LBD
35
Q

In regards to differential diagnosis for Huntingtons Disease (HD), how do you differentiate HD from AD?

A

HD –> dementia develops after the onset of choreathetosis and psychiatric symptoms

36
Q

In regards to differential diagnosis for Prion Disease, how do you differentiate Prion from AD?

A

–>Dementia progresses rapidly over a few months with death under a year

37
Q

What is pseudodementia (dementia syndrome of depression)?

A

Depressed (MDD) patients often show memory and other cognitive disturbances that resemble a dementia

38
Q

If a patient has cognitive decline associated with NORMAL aging, what is this referred to as?

A

Benign Senscent Forgetfulness

39
Q

What are the different types of diagnoses for NCD?

A

1) Delirium
2) Major NCD significant: decline in at least one cognitive domain (deficits with independence and daily activities)
3) Mild NCD: modest decline in at least one cognitive domain (deficits do not interfere with independence and daily activities)

40
Q

For major and mild NCDs what are the etiological subtypes?

A 
Mild NCD due to or Major NCD due to:
*AD
*Vascular Disease
*Prion 
*HD
*Lewy Body 
*HIV 
etc
41
Q

To assist in the diagnosis of NCDs, patients may be referred for what?

A 
Neuropsychological Testing 
(a comprehensive evaluation of a person's cognitive functions)
42
Q

In a neuropsych evaluation what are some test for intelligence?

A

1) Wechsler Intelligence Tests

assess for intellectual decline and look for lateralizing and localizing signs

43
Q

In a neuropsych evaluation, what are some attention tests?

A 
Visual Attention (Cancellation test) 
Verbal Attention (serial addition test)
44
Q

In a neuropsych evaluation, what are some memory tests?

A

verbal vs. visual memory tests

immediate vs. delayed recall

45
Q

In a memory test how do you determine if deficit is encoding based or retrieval based?

A

Give hints (Cues)

  • -> if cues help then encoding occurred this problem is retrieval based (prefrontal)
  • -> if cues do not help then encoding didnt occur, thus the problem is encoding based
46
Q

In a neuropsych evaluation, what are some language and visuospatial function tests?

A

Language –> naming and verbal fluency test (phonemic (AD patients do better with this type of test) or category (normal ppl do better with this)
Visuospatial –> Copying and drawing tests

47
Q

What are some tests of executive function (prefrontal) in a neuropsych evaluation?

A

Abstraction

Concept formation, mental flexibility (Wisconsin Card Sorting Test), inhibiting responses (Stroop)

48
Q

What are some tests of motor functions in a neuropsych evaluation?

A

Looking for lateralizing signs

–> dexterity and speed (fingertapping and pegboard test)

49
Q

What is the difference in dementia vs benign senescent forgetfulness (BSF)?

A

If BSF, then the person’s cognitive performances will be at expected levels for one’s age, gender, education, etc.

50
Q

What is the difference in Alzheimer’s Dementia vs. Pseudodementia?

A

Alzheimer’s –> Onset: Indeterminant; Duration: Long; Cognitive Impairment: Consistent; Reaction to Impairment: Conceals; Memory Impairment: Encoding deficit; Answers to questions: Mistakes
Pseudodementia –> Onset: Pinpointable; Duration: Short; Cognitive Impairment: Inconsistent; Reaction to impairment: highlights; Memory to impairment: Retrieval deficit; Answers to questions: “dont know”

51
Q

What is the difference in Alzheimer’s vs Vascular Dementia ?

A

–> Different onset and progression
–> Alzheimers (encoding)
–> Vascular (retrieval)
Executive Functioning: worse in Vascular than Alzheimer’s
Motor Functioning: Vascular= Lt-RT discrepancy; Alzheimer’s: NO Lt-Rt discrepancy

Behavioral Health--> Module One (21 decks)

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