Neurocognitive Disorders Flashcards
What is Dementia?
Gradual deterioration of brain functioning - loss of neurons
What is Delirium?
Confused state associated with reduced ability to maintain and shift attention. Result of medical problems.
- Rapid onset and worse at night
- Sleep/wake cycle disturbed
- Perceptual disturbances (hallucinations)
What cognitive functions are affects by Neurocognitive Disorders?
- Perception and attention
- Memory
- Reasoning adn decision-making
What is difference between the onset of Delirium and Dementia?
Delirium is sudden onset while Dementia is slow (months to years)
What is difference between the course of Delirium and Dementia?
Delirium is fluctuations while Dementia is stable with general decline
What is difference between the duration of Delirium and Dementia?
Delirium is brief while Dementia is long/lifetime
What is difference between the hallucinations of Delirium and Dementia?
Delirium is visual/tactile/vivid while Dementia rare in early stages
What is difference between the insights of Delirium and Dementia?
Delirium is lucid intervals while Dementia is consistently poor
What is difference between the sleep of Delirium and Dementia?
Delirium is disturbed while Dementia is less disturbed
What is Major Cognitive Disorder?
Dementia - must exhibit substantial cognitive decline that interferes with independence
What is a Minor Cognitive Disorder?
Must exhibit modest cognitive decline that does not interfere with independence
What is the most common Neurocognitive Disorder?
Alzeimers
How is Alzeimers diagnosed?
By exclusion - autopsy only true diagnosis
What age does onset occur for Alzeimers?
40 to 90yo
What are the neurocognitive symptoms of Alzeimers?
- Forget name and familiar objects (early Stages)
- Intellectual and motor function disappear (later stages)
- Consistent course of heterogeneous presentation
- Memory and Learning: Retrograde and anterograde amnesia, retrospective and prospective memory, episodic and semantic memory.
- Verbal Communication: Aphasia and apraxia
- Perception - Agnosia, Anosognosia
- Personality and social behaviour: apathy, poor self care, agitation, change in personality (paranoia, negativity), Sundowner Syndrome
- Executive dysfunction
- Judgement
- Motor Behaviour - muscular rigidity, agitation, dyskinesia
- Psychotic disturbances - usually persecutory and theft (later stages)
- Bereavement - frozen grief (forgets loved ones are dead)
What is aphasia?
Loss/impairment in language
What is apraxia?
Unable to do tasks in response to verbal commands
What is Agnosia?
Perception without meaning ie can not tell comb by word, but can by touching
What is Anosognosia?
not aware of disease
What is Sundowner Syndrome?
Symptoms worse at night
What is dyskinesia?
Involuntary muscle movement
What is the neuropathology of Alzeimers?
- Beta amyloid plaques create brain sludge
- Neurofibrillary tangles - Tau maintains structural integrity of microtubals within neurons. Tau loses capacity or bind, so proteins tange, microtuble disintegrates causing neuron death.
What are the stages of Alzeimers?
Preclinical, Mild, Moderately severe, Severe
Define the Preclinical stage of Alzeimers?
Prior to diagnosis - brain changes but no symptoms
Define the Mild stage of Alzeimers?
Increased plaques/tangles, increased memory problems, increased difficulties with instrumental activities of daily living, subtle personality changes
Define the Moderately severe stage of Alzeimers?
Increased neuropathology, difficulty with basic everyday tasks, motor co-ordination, difficulties, agitation/anger, psychosis, more intense supervision necessary
Define the severe stage of Alzeimers?
Plaques and tangles are widespread, complete dependence, seizures, death, aspiration and pnemonia
What are the criteria for Frontotemporal Neurocognitive Disorder?
- Dementia associates with atrophy of the frontal and temporal lobes
- Memory unaffected in early stages. Changes in personality/behaviour and emotion
- Semantic/Temporal variant decline in language ability
What is Neurocognitive Disorder with Lewy Bodies (2nd most common)?
- Rounded deposits found in nerve cells (brainstem of Parkinsons)
- Recurrent and detailed visual hallucinations, Parkinson features and more rapid progression
What is Vascular Neurocognitive Disorder (Equal to Lewy bodies in occurance)?
- Dementia associated with problems of circulation of blood to the brain.
- Rapid onset
- Must have cognitive disorder and clinical stroke or brain vascular disease by imaging
What is multifart?
Lots of little strokes - gradual onset
What is Neurocognitive Disorder due to Brain Injury?
Disorder as a result of glascocoma scale, post traumatic amnesia and loss of consciousness
What is Neurocognitive Disorder due to Huntington’s Disease (rare)?
- Relatively early onset (mid 40’s) due to autosomal dominant genetic disorder
- Gradual destruction of neurons especially basal ganglia
- Movement disorder, emotional changes, cognitive impairments
What is Neurocognitive Disorder due to Parkinson’s Disease?
- Degeneration of specific area of brain stem (Reduced production of dopamine)
- Physical symptoms - tremors, rigidity, postural abnormalities
- Must be diagnosed with Parkinsons first
What is the frequency of Nuerocognitive Disorder in 65-69 year olds?
1%
What is the frequency of Nuerocognitive Disorder in 90+ year olds?
40%
What is the frequency of Nuerocognitive Disorder in 75-79 year olds?
6%
What is the aeitiology of Delirium?
- Involves neuropathology and neurochemistry
- Medication - psychicatric drugs, heart condition, pain killers, stimulants
- Medical conditions including infections
What is the aeitiology of Neurocognitive Disorders?
- Genetics: Apolipoprotein E allele e-2 (reduced chance), e-3 (50/50), e-4 (increased chance)
- Lifestyle: Diet (vascular illness), risk taking (head injury, HIV)
- Age
- Neurotransmitters: eg Parkinsons - degeneration of dopamine pathways, Huntingtons - deficiences in GAMA
- Viral infections eg Cruetzfeldt-Jakob disease
- Immune system dysfunction - based on presence of net-amyloid at the core of the amyloid plaques
- Environmental Factors: Head injuries (WWII vets with head injuries had increased chance of alzeimers)
What is Dementia Pugilistica?
Regular punching to the head resulting in increase chance of alzeimers
How to protect against Neurocognitive Disorders?
Intellectual changes
Bilinguilism
BUT more educated decline faster
How are Neurocognitive disorders treated?
- Medication: Acetylcholine (neurotransmitter involved in memory), Donepezil - only effective for 6 to 9
months - Environmental and behavioural management:- structured and predictable schedule, helped to remain active and interested in everyday events, Directions adjusted to level of functioning
- Support for caregivers - profound loneliness and sadness, learning to cope with tangible stressors, guilt frustration and depression
