Neurocognitive Disorders II

Question 1

describe vascular dementia (differential diagnosis of AD)

Answer 1

• dementia results from multiple infarcts caused by cerebral vascular disease (CVD)
• typical patient history includes signs and symptoms of CVD (high BP, high cholesterol, smoker, overweight, etc.)
• sudden onset with stepwise progression
• usually focal neurological signs (asymmetrical signs)
• headaches and seizures are more common in early stages of vascular dementia than AD
• treatment:
  
  • treatunderling CVD to prevent further damage
  • AD drugs for cognitive problems

Question 2

describe the progression of AD vs vascular dementia on a graph

Answer 2

Question 3

describe frontotemporal dementia (FTD)

Answer 3

e.g. Pick’s disease

• earlier age of onset (40s-50s)
• similar to AD but “frontal” signs prominent early in the dementia (e.g. disinhibition and personality changes)
• frontal lobe atrophy and hypometabolism
• histopathological changes (e.g. Pick bodies in Pick’s disease)

Question 4

describe Lewy Body dementia (LBD)

Answer 4

• core clinical features:
  
  • fluctuating cognition/alertness
  • visual hallucinations
  • mild parkinsonism (but usually not tremors)
• additional features
  
  • histopathological changes (e.g. lewy bodies)
  • REM-sleep behavior disorder often precedes the onset of LBD (or Parkinson’s) by many years

Question 5

describe treatment for LBD

Answer 5

• hallucinations
  
  • patients have severe neuroleptic sensitivity (EPS, NMS), so antipsychotics usually not advised
  • treat hallucinations with “benign neglect”
• Parkinsonism
  
  • Parkinson’s drugs (l-dopa) are relatively ineffective in LBD and worsen psychosis

Question 6

describe Parkinson’s disease dementia (PDD)

Answer 6

• up to 50% of PD patients develop dementia
• similar pathology to LBD
• use 1-year rule for classifying PDD vs LBD:
  
  • if dementia develops > 12 months after well-established PD → PDD
  • if dementia develops first or within first 12 moths of motor signs → LBD

Question 7

describe the one-year rule for PDD vs LBD

Answer 7

Question 8

describe order of dementia and motor signs in Huntingtons and prion disease

Answer 8

• Huntington’s Disease Dementia (HDD)
  
  • dementia develops AFTER the onset of choreoathetosis and psychiatric symptoms
• prion disease (e.g. CFJ)
  
  • dementia progresses rapidly over a few months with death under a year

Question 9

Answer 9

frontotemporal

Question 10

describe pseudodementia (aka Dementia Syndrome of Depression) and Benign Senescent Forgetfulness

Answer 10

• pseudodementia:
  
  • depressed elderly patients often show memory and other cognitive disturbances that resemble a dementia
• benign senescent forgetfulness:
  
  • cognitive decline associated with normal aging
  • neuropsych testing helps determine whether current cognition reflects a pathological process

Question 11

contrast DSM-5 diagnoses of major vs mild NCD

Answer 11

• major NCD: significant decline in at least one cognitive domain
  
  • deficits interfere with independence in daily activities
• mild NCD: modest decline in at least one cognitive domain
  
  • deficits do NOT interfere with the capacity for independence in daily activities

Question 12

clicker 2

Answer 12

both patients have compromise to their daily living because of their deficits, therefore both major NCD

even though pt 1 has fewer symptoms, still major NCD

Question 13

describe tests of intelligence during a neuropsych evaluation

Answer 13

• Wechsler intelligence tests (produces overall IQ score and several indices [e.g. verbal comprehension, perceptual reasoning])
• assess for intellectual delcine and look for hemispheric lateralizing and localizing signs
• attention:
  
  • visual attention (e.g. cancellation test)
  • verbal attention (e.g. serial addition test)

Question 14

describe memory tests during neuropsych evaluations

Answer 14

• free recall (uncued) vs. recognition (cued) memory tasks
  
  • performance after cues helps to determine if deficit is encoding-based or retrieval-based:
    
    • if cues help: encoding occured; thus the problem is retrieval based (prefrontal)
    • if cues don’t help: encoding didn’t occur; thus the problem is encoding-based (mesial temporal)

Question 15

describe neuropsych tests for language and visuospatial functions

Answer 15

• language = left hemi language areas
  
  • naming and verbal fluency
• visuospatial functions = right parietal
  
  • copying and drawing tests (e.g. draw a clock)

Question 16

describe neuropsych tests for executive functions and motor functions

Answer 16

• executive functions (prefrontal)
  
  • abstraction (proverb interpretation, similarities)
  • concept formation and mental flexibility (Wisconsin Card Sorting Test)
  • inhibiting responses (Stroop test)
• motor functions (looking for lateralizing signs)
  
  • dexterity and speed (finger tapping, pegboard test)

Question 17

describe neuropsych tests for verbal vs. visual memory tests

Answer 17

• verbal vs visual memory tests
  
  • word lists/paragraphs = left hemisphere
  • spatial designs = right hemisphere

Question 18

how to differentiate between dementia vs benign senescent forgetfulness (BSF)?

Answer 18

if BSF, then the person’s cognitive performances will be at expected levels for one’s age, gender, education, etc.

Question 19

how to differentiate between AD vs pseudodementia?

Answer 19

• important distinctions are in:
  
  • the onset and course of problems
  • the pattern of neuropsych deficits (esp. whether memory deficits relate to memory encoding vs retrieval)

Question 20

how to differentiate between Alzheimer’s vs vascular dementia in neuropsych testing?

Answer 20

• memory deficits:
  
  • AD = encoding problem
  • vascular = retrieval problem
• motor functioning:
  
  • vascular = left/right discrepancy
  • AD = no L/R discrepancy

Question 21

Answer 21

problems started after his wife died, cues help performance, he gives up early = depression, pseudodementia

Question 22

summarize the neurocog disorders

Answer 22