Neurocognitive Disorders Flashcards
What are Neurocognitive Disorders (NCDs)
Disorders in which the core feature is acquired dysfunction in a cognitive domain occurring after “early life.”
development went normally
What are common NCD conditions?
Delirium, Amnesia, Dementia
Delirium
AKA?
What are the cognitive domains?
Acute confusional state, acute brain syndrome, encephalopathy, ICU syndrome
•memory, language, executive functions, visuospatial functioning, etc.
What are the four things it involves?
1) A disturbance in awareness and attention: • Awareness is assessed by one’s orientation to the environment. • Attention is assessed by one’s ability to direct, focus, sustain, and shift attention.
2) An additional disturbance in a cognitive domain (e.g., memory, language, thoughts [delusions], and perceptions [incl. hallucinations, illusions]) Sensory misperception
3) Sudden onset of symptoms (over hrs to a few days) that typically fluctuate during the day.
4) Evidence for a direct physiological cause (e.g., a medical condition, drug intoxication/ withdrawal).
Pathology:
Where are the core deficits? (2 areas)
Core deficits in central cholinergic functioning
•Deficits in the Reticular Activating System and its ascending connections (important for attention and arousal)
What are the risk factors?
What is its course?
Risk Factors
• Non-modifiable (e.g., poor health, older age,
male gender)
• Modifiable (e.g., immobilization, poor sleep, and use of benzodiazepines in an ICU)
Course
• Symptoms persist until cause is reversed.
• Resolution typically occurs within 3-7 days.
• Amnesia for events during delirium is common.
• Delirium is a poor prognostic sign for long-term survival and results in longer ICU stays.
Treatments for Delirium?
There are 3
Treat underlying medical condition
•Manage associated symptoms (e.g., agitation, psychosis)
•Use antipsychotics to treat associated symptoms (e.g., agitation, psychosis) of most deliriums
•Use benzodiazepines to treat delirium caused by alcohol withdrawal
Utilize environmental supportive measures
▪regulate amount of environmental stimulation
▪provide orienting stimuli (e.g., lighting, personal effects, sensory aids)
▪provide for safety needs (e.g., attendant, bedrails, and possibly restraints)
What is an Amnesia
What area of the brain?
- A significant acquired memory deficit
- Caused by a medical condition or the effect of a substance (not from dissociation)
- NOT diagnosed if it occurs in the context of general cognitive decline (i.e., a dementia).
- Typically caused by damage to the mesial temporal lobe
What is a typical profile of someone with Amnesia?
Intact short-term (working) memory (STM)
•Short-duration retrograde amnesia
•If lengthy retrograde amnesia, there is often a temporal gradient to the memory loss with recent long-term memories (LTMs) more impaired than remote LTMs.
•Prominent anterograde amnesia
Treatment for Amnesia?
•Treat underlying cause (e.g., B1 deficiency in Korsakoff’s to stop amnesia progression)
•Cognitive rehabilitation
▪Restoration of Function: Memory exercises to strengthen memory through repetition.
▪Compensation (e.g., using mnemonics): ❖External strategies (non-mental activities
such as using lists, calendars)
❖Internal strategies (mental activities such as acronyms [e.g., RICE] and acrostics [e.g., “On Old Olympus Towering Tops…”])
What is a Dementia?
-Multiple and severe cognitive
impairment without impaired consciousness (is usually progressive and irreversible)
•most commonly occurs in the elderly
➢Note: “Mild Cognitive Impairment” (MCI) refers to cognitive decline that doesn’t cause impairment in activities of daily living.
What is Alzhemier’s Dementia?
Significant memory impairment plus impairment in at least 1 other cognitive domain
•A gradual onset with steadily progressive decline
•Exclusion of other causes of the symptoms
(e.g., stroke)
What is the general course of AD?
- Onset in late 70’s with 10+ yr progression
- Early Stages: Memory deficits (rapid forgetting) and anomia (labeling problem-but you know what it does)
- Middle Stages:
- further memory and language decline •visuospatial deficits
- agnosias-you lose knowledge about the object (incl. anosognosia and prosopagnosia-can’t recognize yourself in the mirror
- mood changes, personality changes
- psychosis
•Late Stages: Global aphasia, motor dysfunction, death from opportunistic infections.
- Neuroanatomical pathology of AD
- Neurochemical?
- Neurofunctional?
- Histopathological?
- Markers?
- cortical atrophy, hippocampal atrophy, enlarged ventricles
- loss of cholingeric (ACH) neurons in the nucleus basalis of Meynert due to its role in memory formation
- Posterior
hypometabolism (parietal/temporal - ß-amyloid plaques and neurofibrillary tangles
- CSF amyloid & tau levels, PET imaging of amyloid plaques
What are the four FDA approved drugs?
Are these considered effective?
What are the side effects?
What is research on?
3 cholinesterase inhibitors ■ donepezil (“Aricept”) ■ galantamine (“Razadyne”) ■ rivastigmine (“Exelon”) *keep Ach in the cleft for longer
1 NMDA receptor blocker
■ memantine (“Namenda”)
*block glutamate release
No.
Side effects (e.g., hypotension, GI) have notable consequences for the elderly (e.g., risk of falls)
Efforts are on ↓ production and ↑ clearance of ß-amyloid through antibody drugs.
