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2. Geriatric Psychiatry + Neuroanatomy > Neurocognitive Disorders--General > Flashcards

Neurocognitive Disorders--General Flashcards

1
Q

what characteristics unify those disorders listed under “neurocognitive disorders” listed in the DSM

A
  1. the primary clinical deficit is in cognitive function 2. they are acquired rather than developmental –> they represent a DECLINE in previous levels of functioning *although cognitive deficits are present in many if not all mental disorders, only disorders whose core features are cognitive are included in the NCD category
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2
Q

how is the term “dementia” used in the DSM 5

A

it is subsumed under the term “major neurocognitive disorder”

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3
Q

list the cognitive domains on which the criteria for the various NCDs are based

A
  1. complex attention 2. executive function 3. learning and memory 4. language 5. perceptual-motor 6. social cognition
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4
Q

what are the elements included in complex attention

A

sustained attention divided attention selective attention processing speed

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5
Q

define the following cognitive domain, and give an example of an assessment for: sustained attention

A

maintenance of attention over time, i.e pressing a button every time a tone is heard, over a period of time

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6
Q

define the following cognitive domain, and give an example of an assessment for: selective attention

A

maintenance of attention despite competing stimuli and/or distractors i.e hearing numbers and letters read out loud and asked to count only letters

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7
Q

define the following cognitive domain, and give an example of an assessment for: divided attention

A

attending to two tasks within the same time period i.e rapidly tapping while learning a story being read

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8
Q

define the following cognitive domain, and give an example of an assessment for: processing speed

A

can be quantified on any task by timing it i.e time to put together a design of blocks

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9
Q

describe what might be observed in a patient with MILD deficits in the domain of: complex attention

A

normal tasks take longer than previously begins to find errors in routine tasks finds work needs more double checking than previously thinking is easier when not completing with other things (radio, TV, etc)

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10
Q

describe what might be observed in a patient with MAJOR deficits in the domain of: complex attention

A

has increased difficulty in environments with multiple stimuli easily distracted by completing events in the environment is unable to attend unless input is restricted and simplified has difficulty holding new information in mind, such as recalling phone numbers or addresses just given or reporting what was just said is unable to perform mental calculations all thinking takes longer than usual and components to be processed must be simplified to one or a few

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11
Q

list the components of executive function

A

planning decision making working memory responding to feedback/error correction overriding habits/inhibition mental flexibility

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12
Q

define the following cognitive domain, and give an example of an assessment for: planning

A

ability to find the exit to a maze, or interpret a sequential picture or object arrangement

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13
Q

define the following cognitive domain, and give an example of an assessment for: decision making

A

performance of tasks that assess process of deciding in the face of competing alternative i.e simulated gambling

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14
Q

define the following cognitive domain, and give an example of an assessment for: working memory

A

ability to hold information for a brief period and to manipulate it i.e adding up a list of numbers or repeating a series of numbers or words backwards

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15
Q

define the following cognitive domain, and give an example of an assessment for: feedback/error utilization

A

ability to benefit from feedback to infer the rules for solving a problem

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16
Q

define the following cognitive domain, and give an example of an assessment for: overriding habits/inhibition

A

ability to choose a more complex and effortful solution to be correct (i.e looking away from direction indicated by an arrow, naming the color or words font instead of naming the word)

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17
Q

define the following cognitive domain, and give an example of an assessment for: mental/cognitive flexibility

A

ability to shift between two concepts, tasks or response rules i.e from number to letter, from verbal to key press response

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18
Q

describe what might be observed in a patient with MILD deficits in the domain of: executive function

A

increased effort required to complete multistage projects has increased difficulty multitasking or difficulty resuming a task interrupted by a visitor or a phone call may complain of increased fatigue from the extra effort required to organize, plan and make decisions may report that large social gatherings are more taxing or less enjoyable because of increased effort required to follow shifting conversations

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19
Q

describe what might be MAJOR deficits in the domain of: executive function

A

abandons complex projects needs to focus on one task at a time needs to rely on others to plan iADLs or make decisions

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20
Q

what are the components of learning and memory relevant to NCDs

A

immediate memory recent memory (including free recall, cued recall, and recognition memory) very long term memory (semantic, autobiographical, implicit learning)

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21
Q

define the following cognitive domain, and give an example of an assessment for: immediate memory span

A

ability to repeat a list of words or digits *immediate memory sometimes is subsumed under “working memory” in executive function

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22
Q

define the following cognitive domain, and give an example of an assessment for: recent memory

A

assesses the process of encoding new information (i.e word lists, diagrams) aspects of recent memory: 1. free recall 2. cued recall 3. recognition memory

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23
Q

how to test free recall

A

person asked to recall as many words, diagrams or elements of a story as possible

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24
Q

how to test cued recall

A

examiner aids recall by providing semantic cues

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25
Q

how to test recognition memory

A

examiner asks about specific items i.e was apple on the list?

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26
Q

describe what might be MAJOR deficits in the domain of: learning and memory

A

repeats self in conversation, often within the same conversation cannot keep track of short list of items when shopping or of plans for the day requires frequent reminders to orient to task at hand

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27
Q

describe what might be MILD deficits in the domain of: learning and memory

A

has difficulty recalling recent events and relies increasingly on list making or calendar needs occasional reminders or re-reading to keep track of characters in a movie or novel occasionally may repeat self over a few weeks to the same person loses track of whether bills have been paid already

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28
Q

which types of learning and memory are generally preserved in NCDs

A

except in severe forms of major NCD, semantic, autobiographical, and implicit memory are relatively preserved, compared with recent memory

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29
Q

what are the components of language

A

expressive language (naming, word finding, fluency, grammar and syntax) receptive language

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30
Q

define the following cognitive domain, and give an example of an assessment for: expressive language

A

confrontational naming (ID objects or pictures) fluency (name as many items as possible in a semantic or phonemic category)

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31
Q

define the following cognitive domain, and give an example of an assessment for: grammar and syntax

A

errors observed during naming and fluency tests are compared with norms to assess frequency of errors and compare with normal slips of the tongue

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32
Q

define the following cognitive domain, and give an example of an assessment for: receptive language

A

comprehension (word definition and object pointing tasks involving animate and inanimate stimuli)–> performance of actions based on a verbal command

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33
Q

describe what might be MAJOR deficits in the domain of: language

A

has significant difficulties with expressive or receptive language often uses general-use phrases such as “that thing” and “you know what i mean” and prefers general pronouns rather than names with severe impairment, might not even recall names of closer friends and family idiosyncratic word usage, grammatical errors and spontaneity of output and economy of utterances occur stereotypy of speech occurs–> echolalia and automatic speech typically precede mutism

34
Q

describe what might be MILD deficits in the domain of: language

A

has noticeable word finding difficulties may substitute general for specific terms may avoid use of specific names of acquaintances grammatical errors involve subtle omission or incorrect use of articles, prepositions, auxiliary verbs etc

35
Q

what are the elements included under “perceptual motor” cognitive domain

A

visual perception visuoconstructional perceptual-motor praxis gnosis

36
Q

how do you test visual perception skills

A

line bisection tasks can be used to detect basic visual defect or attentional neglect

37
Q

how do you test visuoconstructional skills

A

assembly of items requiring hand eye coordination such as drawing, copying

38
Q

how do you test perceptual-motor skills

A

integrating perception with purposeful movement–> inserting blocks into form board without visual cues

39
Q

how do you test praxis

A

integrity of learned movements, such as ability to imitate gestures (wave goodbye) or pantomime use of objects to command (show me how you would use a hammer)

40
Q

how would you test gnosis

A

perceptual integrity of awareness and recognition such as recognition of faces and colors

41
Q

describe what might be MILD deficits in the domain of: perceptual motor

A

may need to rely more on maps or others for directions uses notes and follows others to get to a new place may find self lost or turned around when not concentrating on task is less precise in parking needs to expend greater effort for spatial tasks such as carpentry, knitting, sewing, assembly

42
Q

describe what might be MAJOR deficits in the domain of: perceptual motor

A

has significant difficulties with previously familiar activities (using tools, driving motor vehicle), navigating in familiar environments often more confused at dusk, when shadows and lowering levels of light change perceptions

43
Q

what are the elements of social cognition

A

recognition of emotions theory of mind

44
Q

how do you test recognition of emotions

A

ID of emotions in images of faces representing a variety of both positive and negative emotions

45
Q

how do you test theory of mind

A

ability to consider another persons mental state or experience–> story cards with questions to elicit info about the mental state of the individuals portrayed

46
Q

describe what might be MILD deficits in the domain of: social cognition

A

has subtle changes in behaviour or attitude often described as change in personality, such as less ability to read facial expressions, decreased empathy, increased extraversion or introversion, decreased inhibition or subtle or episodic apathy or restlessness

47
Q

describe what might be MAJOR deficits in the domain of:

A

behaviour clearly out of acceptable social range shows insensitivity to social standards of modesty in dress or of political, religious or sexual topics of conversation focuses excessively on a topic despite groups disinterest or direct feedback behavioural intention without regard to family or friends makes decisions without regard to safety typically has little insight into these changes

48
Q

What is criterion A for major neurocognitive disorder

A

evidence of SIGNIFICANT COGNITIVE DECLINE from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, social cognition) based on: 1. concern of the INDIVIDUAL, a knowledgeable INFORMANT or the CLINICIAN that there has been a SIGNIFICANT decline in the cognitive function AND 2. a SUBSTANTIAL impairment in cognitive performance, preferably documented by a standardized neuropsychological testing or, in its absence, another quantified clinical assessment

49
Q

what is criterion B for major neurocognitive disorder

A

the cognitive deficits interfere with INDEPENDENCE in everyday activities (i.e at a minimum, requiring assistance with complex iADLs such as paying bills or managing meds)

50
Q

what is criterion C for major neurocognitive disorder

A

cognitive deficits do not occur exclusively in the context of a delirium

51
Q

what is criterion D for major neurocognitive disorder

A

the cognitive deficits are not better explained by another mental disorder

52
Q

what is the minimum level of disability one would need to have to meet criterion B for major neurocognitive disorder

A

requiring assistance with complex iADLs like bill pay or managing meds

53
Q

list the etiologic specifiers listed in the DSM 5 for major/minor neurocognitive disorder

A
  1. alzheimers disease 2. frontotemporal lobar degeneration 3. lewy body disease 4. vascular disease 5. traumatic brain injury 6. substance/medication use 7. HIV infection 8. Prion disease 9. Parkinsons disease 10. Huntington’s disease 11. Another medical condition 12. Multiple etiologies 13. Unspecified
54
Q

what other specifiers are present in the DSM for major /mild neurocognitive disorder

A
  1. without behavioural disturbance–> if the cognitive disturbance is not accompanied by any clinically significant behavioural disturbance 2. with behavioural disturbance–> *specify disturbance* if the cognitive disturbance is accompanied by a clinically significant behavioural disturbance (i.e psychotic symptoms, mood disturbance, agitation, apathy, or other behavioural symptoms)
55
Q

how do you classify severity of major neurocognitive disorder

A

*specify this in process of diagnosis* mild moderate severe

56
Q

define mild major neurocognitive disorder

A

difficulties with iADLs (i.e hosuework, managing money)

57
Q

define moderate major neurocognitive disorder

A

difficulties with basic ADLs (feeding, dressing)

58
Q

define severe major neurocognitive disorder

A

fully dependent

59
Q

what is criterion A for mild neurocognitive disorder

A

evidence of MODEST cognitive decline from a previous level of performance in one or more cognitive domains based on: 1. concern of the INDIVIDUAL, a knowledgeable INFORMANT or the CLINICIAN that there has been a MILD decline in the cognitive function AND 2. a MODEST impairment in cognitive performance, preferably documented by a standardized neuropsychological testing or, in its absence, another quantified clinical assessment

60
Q

what is criterion B for mild neurocognitive disorder

A

the cognitive deficits DO NOT interfere with capacity for independence in everyday activities (i.e complex iADLs like paying bills, managing meds are preserved, but greater effort, compensatory strategies, or accommodation may be required)

61
Q

what is criterion C for mild neurocognitive disorder

A

cognitive deficits do not occur exclusively in the context of a delirium

62
Q

what is criterion D for mild neurocognitive disorder

A

cognitive deficits are not better explained by another mental disorder

63
Q

how do you distinguish the different subtypes/etiologies of major/mild neurocognitive disorder

A

distinguished based on a combination of: time course characteristic domains affected associated symptoms

64
Q

in which NCDs are psychotic features common? what are common psychotic features?

A

alzheimers lewy body Frontotemporal lobar degeneration *paranoia and other delusions are common features and often a persecutory theme may be a prominent aspect of delusional ideation

65
Q

how do you distinguish psychotic disorders with onset later in life (i.e schizophrenia) from NCDs with psychotic features

A

disorganized speech and behaviour seen in other psychotic disorders are not characteristic of psychosis in NCDs

66
Q

how might hallucinations differ when seen in NCDs vs other disorders

A

visual hallucinations are more common in NCDs compared to other disorders (though hallucinations can occur in any modality)

67
Q

in which NCD might you see elation as a mood disturbance

A

early in course of frontotemporal lobal degeneration

68
Q

in which NCDs are depression common early in the course of the illness

A

alzheimers and parkinsons

69
Q

list other associated clinical features common in NCDs

A

agitation (especially in moderate to severe) sleep disturbance (insomnia, hypersomnia or circadian rhythm disturbance) apathy (especially in alzheimers and frontotemporal) wandering disinhibition hyperphagia hoarding

70
Q

define apathy, and indicate how it might manifest in NCDs

A

typically characterized by diminished motivation, and reduced goal oriented behaviour accompanied by decreased emotional responsiveness may manifest early in course of NCDs when loss of motivation to pursue daily activities or hobbies may be observed

71
Q

what is the DSM 5 synonym for dementia

A

major neurocognitive disorder

72
Q

how does performance on standardized neuropsychological testing usually differ for those with major NCD

A

performance is typically 2 or more standard deviations below appropriate norms (3rd percentile or below)

73
Q

how does performance on standardized neuropsychological testing usually differ for those with mild NCD

A

performance lies in the 102 standard deviation range (3rd-16th percentiles)

74
Q

which populations make norms (of neuropsychological tests) more difficult to interpret

A

those with very high or very low levels of educational attainment individuals being tested outside their language or cultural background

75
Q

what is the major functional distinction between major and mild NCD

A

impaired vs preserved independence

76
Q

how does prevalence of NCD change over the lifespan

A

among those over age 60, prevalence increases steeply with age

77
Q

what are the overall prevalence estimates for dementia (major NCD)

A

1-2% at age 65 as high as 30% by age 85

78
Q

what are the overall prevalence estimates for mild cognitive impairment (mild NCD)

A

2-10% at age 65 5-25% by age 85

79
Q

what is the strongest risk factor for major and mild NCDs

A

age primarily because age increases risk of neurodegenerative and cerebrovascular disease

80
Q

ddx for NCDs

A

normal cognition delirium MDD specific learning disorder or other neurodevelopmental disorders

81
Q

what is the Go-No-Go test used for

A

tests for frontal lobe pathology-→ part of the frontal assessment battery (FAB)

82
Q

how do you perform the Go-No-Go test

A

examiner instructs patient to tap once in response to a single tap, and to withhold a response for two taps

can be made more difficult by changing the initial rule after several trials

2. Geriatric Psychiatry + Neuroanatomy (14 decks)

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