Neurocognitive Disorders & Geriatrics Flashcards
Normal Aging Cognitive Changes
Memory recall may require more cues
Decreased processing speed
Crystalized intellegence (Facts) continues to increase, Fluid intelligence declines (processing ability)
Normal age associated decline should NOT dramatically interfere with instrumental activities of daily living
Typical Cognitive Domains that can be affected by Dementia
- Attention
- Processing speed
- Language
- Visuospatial ability
- Memory (verbal & visual)
- Executive functioning
- Psychomotor ability
Dementia Screening questionnaires
MoCA (Montreal cognitive assessment)
MMSE (Mini-mental status exam)
only for dementia NOT delirium
When should you refer someone for a neuropsychological evaluation?
when they have changes in cognitive and/or IADL function
Get a baseline & repeat testing to monitor
same type of test for ADHD
Spectrum of Neurocognitive Disorders
- Delirium (acute change; medical problem)
- Major ND…Dementia –> WITH IADL dysfunction
- Minor ND…Mild cognitive impairment –> W/O IADL dys
Delirium Definition
Disorientation, recent memory loss, and clouding of attention
Rapid onset! Hours to days
Fluctuating course – confusion waxes and wanes
Causes –> infection, illicit drugs, endocrine, pulm, cardio, electrolyte dysfunction
Elderly patients at highest risk… >80 very high risk
Delirium Diagnostic Criteria
- Disturbance in attention & orientation to the environment and awareness
- Disturbance develops over a short period of time & represents a change from baseline…fluctuates in severity during the course of the day
- Disturbance in cognition
Not better explained by another preexisting problem
Delirium Treatment
Treat underlying causes!!!
Avoid polypharmacy – Benzos make confusion worse!
Types of Dementia
- Alzheimers (MC)
- Frontotemporal Dementia
- Lewy Body Dementia
- Vascular Dementia
- Traumatic Brain injury
- Substance Induced
- HIV
- Prion Dz
- Parkinson’s
- Huntingtons
Symptoms of Dementia aka Major Neurocognitive Disorder
Cognitive impairment in 1+ cognitive domains
- reduced memory, language, executive function, etc.
- Aphasia –> deterioration of language
- Echolalia –> repeating what was heard
- Apraxia –> inability to execute common actions (dressing)
- Agnosia –> failure to recognize people or objects
IADL dysfunction
Possible changes in personality
Possible incontinence
Possible sensory changes (loss of taste and smell)
Alzheimer’s Dz
50% of dementia
Often comorbid with vascular disease
Slow gradual decline over 8-20 years
Only definitive diagnosis is autopsy so have to diagnose clinically which is 85% accurate!
- brain atrophy
- amyloid plaques
- neurofibrillary tangles
Alzheimer’s treatment
Medications just slow progression…not a cure!
- Donepezil (common 1st line treatment for mild-mod)
- Namenda (mod-severe)…can use in combo with above
Combo drug = Namzaric…mod-severe symptoms
Can give meds to address specific symptoms
- antipsychoits
- depressive symptoms – SSRI
- sleep disturbance – Belsomra
Vascular Dementia
Caused by infarcts in the brain…stroke, TIA, etc.
Sudden onset, symptoms wax and wane
Variable progression – not a consistent decline like youd expect in Alzheimer’s
Dx with CT or MRI –> lacunar infarcts
Screen for correctable risk factors!!!!
Frontotemporal Dementia
Onset typically in 50’s
Behavioral and Language subtypes
Can see personality changes…decrease in executive functioning
Parkinson’s Dz dementia
Occurs in 1/3 of patients later in PD disease
PD = unilateral tremor, men in their 60’s
Can see associated cognitive changes
- attention
- processing speed
- memory
- language…naming
- depression
EPS symptoms are common
- hypophonic speech
- bradykinesia
- micrographia (small handwriting)
