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Psychosocial Conditions > Neurocognitive disorders > Flashcards

Neurocognitive disorders Flashcards

1
Q

Name some neurocognitive disorders

A
  • Delirium
  • Alzheimer’s disease
  • Lewy body disease
  • Parkinson’s disease
  • Huntington’s disease
  • Substance use related NCD
  • HIV infection
  • Vascular disease
  • Traumatic brain injury
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2
Q

What was the change from the DSM-IV that changed neurocognitive disorders?

A

this cluster was known as Delirium, Dementia, Amnestic and Other Cognitive Disorders

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3
Q

Neurocognitive disorders are defined by changes of cognitive domains in what?

A
  • Complex attention
  • Executive function
  • Learning and memory
  • Language
  • Perceptual-motor
  • Social cognition
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4
Q

What is the diagnostic criteria for delirium?

A
  • Disturbance in attention and cognition
  • Develops over a short time (hours to a few days), is a change from the person’s normal state, and fluctuates over time
  • Defining characteristic = change in consciousness (not seen in other neurocognitive disorders)
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5
Q

What is the etiology of delirium?

A

Almost always the result of some medical condition, for example, high fever, head injury

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6
Q

What is the prognosis of delirium?

A
  • Resolves if medical condition resolves
  • Early detection and intervention can shorten the course and, in the case of older adults, reduce the risk of injury
  • High mortality b/c of associated medical factors
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7
Q

What is the diagnostic criteria for Major Neurocognitive Disorder?

A

Significant cognitive decline from previous level of performance in one or more cognitive domains based on:

  • Concern of the individual, an informant, or a clinician
  • Substantial impairment documented by neuropsychological or other quantifiable assessment
  • Deficits interfere with independence in daily activities
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8
Q

What is the diagnostic criteria for Mild Neurocognitive Disorder?

A

Modest cognitive decline from previous level of performance in one or more cognitive domains based on:

  • Concern of the individual, an informant, or a clinician
  • Modest impairment documented by neuropsychological or other quantifiable assessment

Deficits do not interfere with independence in daily activities, but greater effort, compensatory strategies or accommodations may be required

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9
Q

What is Alzheimer’s disease?

A
  • Neurodegenerative disorder

- Progressive, deteriorating condition that over the course of years leads to eventual total disability

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10
Q

What is the etiology for Alzheimer’s disease?

A
  • Combination of genetic and environmental factors
  • Genetic: apolipoprotein E ε4 (ApoE e4) is the most important genetic risk factor
  • Excessive amounts of two proteins undergo synaptic dysfunction, oxidative stress, loss of calcium regulation, and inflammation
  • Sociodemographic factors include educational level and physical fitness also factors
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11
Q

What is the most significant risk factor for Alzheimer’s?

A

aging

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12
Q

What is included in the diagnostic criteria for Alzheimer’s?

A

-Insidious onset and gradual progression
-No lab test, only brain tissue autopsy
-For NCD, probable AD is diagnosed if:
-Evidence of a causative genetic
mutation (based on family history or
genetic testing and/or
-Evidence of decline in memory and
learning
-Progressive, graduate decline in
cognition
-No evidence of other or mixed etiology
-Behavioral symptoms: Agitation, aggressiveness, sundowning
-Not a diagnostic criterion, often develop visual processing issues

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13
Q

What is Lewy Body Disease characterized by?

A
  • presence of Lewy bodies in the brain
  • fluctuating cognition with variation in attention and alertness from day to day and hour to hour, visual hallucinations, and Parkinson’s-like motor symptoms
  • changes in rapid eye movement sleep, and abnormalities that can be seen on PET scan
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14
Q

What is the diagnostic criteria for Lewy Body?

A

-Insidious, gradual onset
=Fluctuating cognition with variations in attention and alertness
-Recurrent visual hallucinations
-Features of Parkinsonism
-REM sleep behavior disorder often presents

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15
Q

How is Lewy Body different from Alzheimer’s?

A
  • ADL dysfunction
  • LBD- more motor difficulty
  • AD- both motor and behavior
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16
Q

What is Vascular Disease?

A
  • Interrupted blood flow inevitably results in damage to the central nervous system
  • Characteristic lesions affect cortical regions important for memory, cognition and behavior
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17
Q

What is Vascular Disease often found in conjunction with?

A

Alzheimer’s and other causes of dementia, making it somewhat difficult to classify the cause of the observed clinical symptoms

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18
Q

What are the risk factors for Vascular Disease?

A
  • high blood pressure
  • other vascular disease
  • late-life depression
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19
Q

What is the vascular etiology?

A
  • One or more cerebrovascular events

- Notable deterioration of complex attention and frontal-executive function

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20
Q

What is the diagnostic criteria for Vascular disease?

A
  • Evidence of cerebrovascular disease
  • Neuroimaging evidence of cerebrovascular injury or cerebrovascular disease
  • Onset of symptoms temporally associated with a documented cerebrovascular incident
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21
Q

What is a traumatic brain injury (TBI)?

A

Impact to the head leading to cortical or other central nervous system damage

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22
Q

Why are specific cognitive and functional consequences unpredictable in a TBI?

A

because they depend on the area of the cortex that is damaged

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23
Q

What is an important predictor of outcome following moderate TBI?

A

Pre-injury function

24
Q

What is known to persist for years after even a single TBI?

A

Inflammation and white matter damage

25
Q

What is the diagnostic criteria for a TBI?

A

Evidence of an impact to the head or other mechanism for TBI with one or more of:

  • Loss of consciousness
  • Posttraumatic amnesia
  • Disorientation
  • Neurological signs
26
Q

When is the diagnosis of a substance/medication induced NCD made?

A

only made if there is evidence of substance use or withdrawal. To some extent, the specific symptoms depend on the substance

27
Q

Can substance-related NCD co-exist with other NCDs?

A

yes, and it can complicate the effects of other NCDs

28
Q

Can substance/medication induced NCD be improved?

A
  • Yes, may improve over time if cessation of the substance occurs
  • Even in the absence of the substance, if the cortical damage has been sufficient, the symptoms may persist
  • Neurocognitive impairment persists beyond intoxication and acute withdrawal
29
Q

Can NCD emerge in individuals with HIV?

A
  • NCD can emerge even when individual with HIV is being successfully treated with antiretroviral medications that prevent the development of acquired immunodeficiency syndrome (AIDS)
  • Medications do not pass the blood-brain barrier
  • As individuals with HIV are living into late life, they can develop one or more of the other syndromes associated with NCD
30
Q

How does diagnosis of NCD relate to HIV infection?

A
  • Some of these individuals may have acquired the virus through substance use that contributes to a substance/medication-induced NCD
  • Diagnosis based entirely on presence of HIV infection and cognitive symptoms
31
Q

What are the motor symptoms of Parkinson’s Disease?

A
  • hand-resting tremors
  • pill-rolling tremors at rest
  • shuffling gait
  • bradykinesia
  • hypokinesia
  • akinesia
  • kyphotic posture
  • motor planning
  • speech and swallowing difficulties
32
Q

Can Parkinson’s can cause NCD?

A

Yes, although these symptoms do not appear in every case, and their extent varies

33
Q

What other NCD symptoms may present in those with Parkinson’s?

A

mood, sleep, and autonomic function changes, as well as impairments in cognition and perception

34
Q

What is the etiology of Parkinson’s?

A
  • unclear
  • Genetic research suggests that at least some proportion of cases have gene-related causes (Reichmann, 2011)
  • A toxin, bacterium, or virus may contribute to the condition
35
Q

What is the diagnostic criteria for Parkinson’s Disease- NCD?

A
  • Established diagnosis of Parkinson’s disease

- Onset is insidious and progression is gradual

36
Q

What is Huntington’s Disease?

A
  • Neurodegenerative Disease
  • Autosomal dominant genetic disorder that affects the HTT gene
  • Results in chorea (jerky and involuntary movements), behavioral disturbances, and dementia/ NCD
37
Q

What is the diagnostic criteria for Huntington’s disease?

A
  • Onset is insidious and progression is gradual
  • Based on family history or genetic testing
  • HD before age of 40 with a young family
38
Q

Why is Huntington’s disease difficult to manage?

A

-because of autosomal dominant nature of disorder and late life onset

39
Q

What are the chances of acquiring Huntington’s disease?

A
  • 50% chance one has the gene if a parent is a carrier
  • 50% chance of passing on to offspring
  • Available genetic tests are accurate
  • Careful genetic counseling is required
40
Q

What are the NCD implications for function for Alzheimer’s disease (AD) & Parkinson’s disease (PD)?

A
  • progressive

- decrements in performance, skills, habits, patterns, roles, ADL, IADL

41
Q

What are the NCD implications for function for specifically Alzheimer’s?

A

early signs relate to confusion about everyday activities accompanied by deficits in short-term memory

42
Q

What are the NCD implications for function for specifically Parkinson’s?

A

early symptoms may be motor rather than neurocognitive in nature. Skill deficits may be more motor focused, and cognitive only later

43
Q

What is function like for individuals with late-stage Alzheimer’s disease?

A

ultimately bed-ridden, unable to move purposefully, swallow, talk, or otherwise function

44
Q

Are TBI and substance/medication-related conditions progressive?

A
  • Not necessarily

- Functional consequences of TBI are dependent on the location of the injury and its severity

45
Q

What are the implications for function for Substance/medication-related NCD?

A

-characterized by deficits in abstract reasoning, motor programming, and cognitive flexibility

46
Q

What are implications for function for mild NCD?

A
  • associated with decrements in executive function and long and short-term memory
  • not accompanied by loss of ADL performance, but loss of IADL performance is common
47
Q

What are the implications for function for NCDs in general?

A
  • Comorbidity- An individual may have several NCD simultaneously (PD and AD, TBI may develop AD, HIV & substance use related NCD complicate and worsen)
  • Individuals with NCD, particularly in early stages, may become depressed as they recognize their own functional loss
  • Social performance often well-maintained before late stage, although increasingly superficial over time
  • Perceptual challenges including potential for falls
48
Q

What NCDs are there medications available for?

A
  • Parkinson’s

- Vascular (to control blood pressure, cholesterol)

49
Q

What NCDs are there no medications available for?

A
  • Alzheimer’s (although several being studied; none more than modestly effective)
  • Huntington’s
50
Q

What treatments are available for Parkinson’s?

A
  • may improve with deep brain stimulation, exercise, dance, acupuncture
  • benefits from multidisciplinary intervention including PT, OT, speech
51
Q

What is the treatment focus for AD, PD, and HD?

A

management of symptoms

52
Q

What is the treatment focus for vascular NCD?

A

manage conditions that contribute to vascular damage- hypertension, diabetes

53
Q

What are the treatments for NCDs in general?

A

-Environmental modifications to support function, reduce caregiver burden
-Focus on reducing excess disability from comorbid conditions
-Emphasize prevention of cognitive decline through:
-Physical activity/ Exercise
(strengthening, walking, playing
Nintendo Wii, Tai Chi)
-Cognitive activity (play games,
learning a new thing/ language)
-Maintaining healthy body weight,
blood pressure, lipid levels

54
Q

What are the NCD implications for OT?

A

-Overall goals: Maintain function, prevent deterioration, enhance QOL, support individual and caregiver
-Leisure activities to reduce depression and enhance function
-Gardening, Art, Music- PD, AD
=Behavioral and environmental strategies
-Exercise and physical activity- SAFETY!!!
-Manage self-care activities
-Computer-based cognitive practice
-Sensory stimulation
-ADL & modified IADL training, task oriented training, functional activities, medication management
-Cognitive stimulation therapy (CST) encourages cognitively challenging activities
-Strength-based intervention & self-directed exploration of activities to enhance pleasure, self-concept & satisfaction

55
Q

How can occupation-based program help maximize procedural memory?

A

-Emphasis on the importance of tailoring activities to emotional, physical, and cognitive abilities of the client to reduce frustration and create a “just right” challenge
-Person-centered dementia care, “Best-Ability Care Model” by Kim Warchol
Tailored Activity program (TAP) by Laura Gitlin- activities tailored to their abilities and interests; training for caregivers on how to use activities as part of daily care routines
-Draw on activities that client enjoy prior to cognitive deficits

56
Q

What are the cultural considerations for NCDs?

A
  • Culture has big impact on nature of intervention and probable outcomes of care
  • Neurocognitive impact of the disorders is similar across cultures, the tasks needed and desired, objects, and environments differ
  • This affects structuring of environments, expectations of, support for caregiving, and written caregiver instructions

Psychosocial Conditions (9 decks)

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