Neurocognitive Disorders (Dimentia)

Question 1

Define Cognition

Answer 1

Cognition is the mental action/process of acquiring knowledge and understandung through thoughts experiences and senses.

Question 2

What are the 6 domains of cognition?
LLEAPS

Answer 2

Learning and memory
Language
Executive function
Attention
Perceptual motor skills
Social cognition

Question 3

Classification of Neurocognitive disorders

Answer 3

1. Delirium (specified or unspecified)
2. Major Neurocognitive disorder
3. Mild Neurocognitive disorder
4. Sub-types of major or mild Neurocognitive disorder (due to specified cause)

Question 4

What is Delirium?

Answer 4

Its a Neurocognitive disorder characterized by disturbances in attention, awareness and cognition.

Results from physiological consequences of a medical condition, substance intoxication or withdrawal from exposure to a toxin.

Its a medical emergency
It has an acute onset

Question 5

What is the DSM 5 criteria of Delirium?

Answer 5

A. Disturbances in attention and awareness
B. The disturbance develops ver a short period of time and represents a change from baseline attention and awareness and tend to fluctuate in seriry dueing the course fo the day.

C. An additional fisturbance in cognition (e.g memory or languge)

D. Disturbances in A and C not explained by anothe rpee established Neurocognitive disorder.

E. Evidence from hx, exam or lab finding that the disturbance is a direct consequence of another medical conditin, substance intoxication or withdrawal.

Question 6

Specifier of Delirium

Answer 6

Substance intoxication delirium
Substance withdrawal delirium
Medication induced delirium
Delirium due to another medical condition
Delirium due to multiple aetiologies

Question 7

Other specifiers of delirium

Answer 7

Acute or persistent
Hyperactive, hypoactive or mixed level of activity

Question 8

What are the risk factors of delirium?

Answer 8

Hospitilised patients
Polypharmacy
Male gender
Pre existing cognition impairment or depression
Prior hx of delirium
Severe or terminal illness
Recent surgery or anesthesia
Bone fracture or impared mobility
Systemic infections

Question 9

What are the causea of Delirium?
I WATCH DEATH nmemonic

Question 10

Clinican management of Delirium

Answer 10

Treatment of underlying cause

Environmental interventions
- nurse in quiet place
- minimize switching staff
- frequnt family and friend visit
- orientation cues such as calender, clock, windows or family pictures
- restraint patient if agitated

Pharmacological
- if agitated: low doses of high potent antipsychotics or 2bd geneation antipsychotics
* haloperidol, risperidone and olanzapine

• benzodiazepines- if alcohol withdrawal delirium