Neurocognitive Disorders Flashcards
The areas of cognitive functioning affected by the Neurocognitive Disorders represent 6 domains:
- Complex _______________
- Executive function
- Learning and ____________
- Language
- Perceptual-Motor
- Social _____________
- Attention
- Memory
- Cognition
A diagnosis of Delirium requires:
- A disturbance in ____________ and ____________ that develops over a short period of time (hours to days), represents a change from baseline functioning, and tends to fluctuate in severity over the course of a day (often worsening in the evening and at night, and
- At least ___ additional disturbance in cognition (e.g., impaired memory, disorientation, impaired language, deficits in visuospatial ability, or perceptual distortions)
- Attention
- Awareness
- 1
For a diagnosis of Delirium, there must be evidence that symptoms are the direct _________________ of a medical condition, substance intoxication/withdrawal, and/or exposure to a toxin.
Physiological consequence.
Wise (1995) identified 5 high-risk groups for Delirium:
- Older adults
- People with _________________ due to dementia, a stroke, or HIV
- _________________ patients
- Burn patients
- People with _____________________ in withdrawal
- Reduced cerebral reserve
- Postcardiotomy
- Drug dependence
Treatment of Delirium focuses on two goals: treatment of the ________________________ and reduction of _________________.
- Underlying disorder
- Agitated behavior
Major Cognitive Disorder subsumes the DSM-IV-TR diagnosis of ___________________.
Dementia.
Major Neurocognitive Disorder is diagnosed when there is evidence of ______________________________ in one or more cognitive domains that interferes with the individual’s independence, and does not occur only in the context of _______________.
- Significant decline from a previous level of functioning
- Delirium
Mild Neurocognitive Disorder subsumes the DSM-IV-TR diagnosis of ________________________.
Cognitive Disorder NOS.
Mild Neurocognitive Disorder is diagnosed when there is evidence of a ________________ decline from a previous level of functioning in one or more cognitive domains that _________ interfere with the individual’s independence in everyday activities (but may require greater effort or compensatory strategies), and does not occur only in the context of a delirium.
- Modest
- Does not
For both Major and Mild Neurocognitive Disorder, the DSM 5 identifies 13 types based on etiology; which of these is not one of those types?
- Alzheimer’s
- Frontotemporal lobar degeneration
- Lewy body disease
- Stroke type
- Vascular disease
- Traumatic brain injury
- Substance/medication use
- HIV infection
- Prion disease
- Parkinson’s disease
- Huntington’s disease
- Another medical condition
- Multiple etiologies
- Unspecified
Stroke type.
Neurocognitive Disorder Due to Alzheimer’s Disease is characterized by an ________________ of symptoms and gradual progression of impairment in ___ or more cognitive domains.
- Insidious onset
- 1
For Major Neurocognitive Disorder, probable Alzheimer’s disease is diagnosed when there is evidence of:
- Causative ___________________
- Clear evidence of decline in _______________ and at least one other cognitive domain
- Progressive, gradual decline in cognition without extended ____________
- No evidence of a mixed etiology
Otherwise, possible Alzheimer’s disease is diagnosed.
- Genetic mutation
- Memory
- Plateaus
For Mild Neurocognitive Disorder, probable Alzheimer’s disease is diagnosed when there is evidence of _________________. Possible Alzheimer’s disease is diagnosed when there is no evidence of causative genetic mutation, clear evidence of a decline in memory and learning, progressive and gradual decline in cognition without extended plateaus, and no evidence of mixed etiology.
Causative genetic mutation.
A diagnosis of Alzheimer’s requires an _____________ or ___________________ to confirm.
- Autopsy
- Brain biopsy
If a person has Alzheimer’s, their autopsy or brain biopsy should reveal the following:
- ________________-predominant neuritic plaques
- ____________-predominant neurofibrillary tangles, especially in the _______________________ structures (entorhinal cortex, hippocampus, and amygdala)
- Amyloid
- Tau
- Medial temporal
Alzheimer’s disease is the most common cause of ______________, accounting for 60 to 90+% of all cases, with late onset (in the ___th or ___th decade) being more common than early onset.
- Dementia
- 8th
- 9th
Stage ___ Alzheimer’s (___ to ___ years):
- Anterograde amnesia (especially for declarative memories)
- Deficits in visuospatial skills (wandering)
- Indifference
- Irritability
- Sadness
- Anomia
- 1
- 1 to 3
Stage ___ Alzheimer’s (___ to ___ years):
- Increasing retrograde amnesia
- Flat or labile mood
- Restlessness and agitation
- Delusions
- Fluent aphasia
- Acalculia
- Ideomotor apraxia (inability to translate an idea into movement)
- 2
- 2 to 10
Stage ___ Alzheimer’s (___ to ___ years):
- Severely deteriorated intellectual functioning
- Apathy
- Limb rigidity
- Urinary and fecal incontinence
- 3
- 8 to 12
Abnormalities on chromosomes 1, 14, and 21 have been linked to the _____________________ of Alzheimer’s.
Early-onset, familial type.
Abnormalities on the ApoE4 gene on chromosome 19 have been linked to __________________ Alzheimer’s.
Later-onset.
Abnormal levels of several neurotransmitters, especially __________________ (associated with the formation of memories) have been linked to Alzheimer’s.
Acetylcholine (ACh).
Alzheimer’s has also been linked to:
- Lower levels of _________________
- Adult onset _______________
- Depression
- TBI
- ________ Syndrome
- Formal education
- Type 2 Diabetes
- Down
The following have been found useful in treating Alzheimer’s, via reversing ______________ and improving some _______________ symptoms, but they do not cure, and improvements are typically only temporary:
- _________________ inhibitors
- Tacrine (Cognex)
- Donepezil (Aricept)
- Galantamine (Reminyl, Razadyne)
- Rivastigmine (Exelon)
- Cognitive impairment
- Behavioral
- Cholinesterase
______________________________ is diagnosed when the criteria for Major or Mild Neurocognitive Disorder are met, the clinical features are consistent with a ___________________ etiology, and there is evidence of _____________________ from the individual’s medical history/record.
- Vascular Neurocognitive Disorder
- Vascular
- Cerebrovascular disease
The course of Vascular Neurocognitive Disorder can be quite ______________; known risk factors include:
- Hypertension
- Diabetes
- ______________
- Obesity
- High ____________ levels
- Atrial fibrillation
- Variable
- Cigarette smoking
- Cholesterol
Individual’s with Neurocognitive Disorder Due to HIV Infection exhibit symptoms characteristic of damage to _________________ areas of the brain:
- Impaired concentration and memory (epecially difficulty learning new info.)
- Slowed psychomotor speed
- Apathy and depression
- Tremor
- Clumsiness
- Saccadic eye movements
- Other movement disorders
- Subcortical.
In the literature, Neurocognitive Disorder Due to HIV Infection is also known as ________________________________.
AIDS Dementia Complex (ADC).
AIDS Dementia Complex (ADC) is described as developing over the course of ___ stages.
6.
Stage ___ (_____________) ADC: The individual’s mental and motor functions are normal.
- 0
- Normal
Stage ___ (_____________) ADC: The individual has minimal or equivocal symptoms with no impairment in performance of work or ADLs. Mild signs may be present (e.g., slowed ocular or extremity movements).
- 0.5
- Equivocal/Subclinical
Stage ___ (_____________) ADC: There is unequivocal evidence of functional, intellectual, or motor impairment, but the individual is able to perform all but the most demanding aspects of work or ADLs and can walk without assistance.
- 1
- Mild
Stage ___ (_____________) ADC: The individual cannot work but can perform basic activities of self-care and is ambulatory, but may require assistance.
- 2
- Moderate
Stage ___ (_____________) ADC: The individual exhibits signs of major intellectual incapacity (e.g., cannot sustain complex conversations) or motor disability (e.g., cannot walk without assistance).
- 3
- Severe
Stage ___ (_____________) ADC: The individual is nearly vegetative. Intellectual and social functioning are rudimentary and the individual is nearly or completely mute, has paraparesis or paraplegia, and has urinary and fecal incontinence.
- 4
- End Stage
