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Drug Action III > Neurocognitive Dx (Physiology) - Block 2 > Flashcards

Neurocognitive Dx (Physiology) - Block 2 Flashcards

1
Q

What is cognition?

A

The way people acquire, store, learn, use, and communicate information

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2
Q

What is development?

A

The ability to adapt to the environement

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3
Q

What are the 3 stages of cognitive development?

A
  1. Begins with simple tasks
  2. Moves on to complex tasks
  3. Severe and chronic developmental alterations may give rise to a neurocognitive dx
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4
Q

What are NCDs?

A

Disorders whose primary features are cognitive impairments including delirium or dementia
* Any condition that impairs cerebral perfusion and causes inflammation and metabolic changes

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5
Q

What is necessary for normal cognitive functionging and what does it depend on?

A

Cerebral perfusion: adequate O2 and sufficient osmotic pressure to maintain adequate BF

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6
Q

What are causes of that diminish cerebral tissue perfusion?

A
  1. Cerebral edema
  2. Cerebral vascular accidents
  3. Spasms
  4. Hypotension
  5. Shock
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7
Q

Cerebral perfusion and cognitive intergretity depend ofn what factor?

A

Normal gas exchange
* Fluid and electrolye balance are necessary to maintain adequate perfusion and cellular function

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8
Q

What are some processes that cause NCD?

A
  1. Complesx metabolic processess
  2. Inflammation
  3. Alcohol, illicit drugs, pharmaceuticals
  4. Permanent brain injury
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9
Q

How does maternal health contribute to NCD?

A

Circumstances surrounding birth may influence neurodevelopment and neurocognition during both the prenatal and postnatal periods (smoking and alcohol)
* Prenatal development issues need to be identified and understood early.

Leads to fetal stress

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10
Q

What are the consequences of fetal stress?

A
  1. Permanent change fetal brain development
  2. Cause disease late in life
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11
Q

How does maternal nutrition affect a child?

A
  1. Induces developmental potential
  2. Breastfeeding support neurocognitive development
  3. Link between issues such as breastfeeding and socioeconomic status reinforces the need to target socially disadvantaged groups
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12
Q

What is developmental potential?

A

Ability to think, learn, remember, relate, and articulate ideas appropriate to age and level of matur

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13
Q

Identify a maternal disease that may influce a child’s ND?

A

HIV

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14
Q

The presence of maternal depression increasesesa child’s risk for developing?

A
  1. ADHD
  2. Oppositional defiant disorder
  3. Social engagement
  4. Empathy
  • Healthy mother-infant engagement promotes health infant brain activity.
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15
Q

What is alzheimers?

A

Genetic mutation of amyloid precursor protein and two presenilin genes

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16
Q

How many gene variants are linked to late-onset AD risk?

A

20

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17
Q

What factors differ dementia from delirium?

A
  1. Onset
  2. Illness
  3. trajectory
  4. Treatment consideration
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18
Q

Describe the onset of dementia

A

Chronic or persistant disorder of mental processes from brain disease or injury (memory dx, personality changes, impaired reasoning):
1. Slow progressive onset
2. Impairment in abstract thought and memory
3. Depression and apathy
4. Functional disability, dependence, and mortality

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19
Q

Describe the prevalence of AZ?

A

5-10% in older aldults in the US

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20
Q

What is the clinical definition of dementia?

A

A syndrome that is not a normal aging process of acquired, persistant impairment in:
1. Memory
2. Language
3. Visuospatial ability
4. Cognition
* Impair social and occupational function
* Mood and personality changes

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21
Q

What are the causes of dementia?

A
  1. Illness
  2. Head trauma
  3. AD
  4. Vascular dementia

Primary determinants for dementia diagnosis are clinical manifestations and the progressive nature of the illness.

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22
Q

What is the cause of AD?

A
  1. Senile plaques consisting of beta amyloid (brain protien) in the neuron
  2. Neurofibrillary tangles of tau protein that develop within neurons
  3. Cortex thins and brain shrinks gradually
23
Q

How does neural plaquae cause AD?

A
  1. Neuronal damage and cell death in braind
  2. Inflammation destroying neighboring neurons
  3. Cholinergic neuron involvement causes Ach levels in synapse ot decline (drop)
24
Q

How is AD diagnosed?

A
  1. Examination of brain tissue on autopsy
  2. Positron emission tomography (PET) scans
  3. Mini-Mental State Examination (MMSE) tool - measures cognitive function
25
Q

What is the function of PET scans in identifying AD?

A

Determines the regional cerebral patterns of amyloid plaques and tau neurofibrillary tangles

26
Q

What is vascular dementia?

A

Vascular cognitive impairment: changes in thinking follows a series of small strokes

27
Q

What are the clinical manifestations of dementia?

A

Slow, progressive dx:
Initial
AD: memory lapses
Vascular dementia: imparied judgement, planning, and organization

28
Q

A majority (80%) of people with dementia in the U.S. are cared for in the community by?

A

unpaid, informal caregives

29
Q

What are examples of informal caregivers?

A
  1. Spouses
  2. Family
  3. Friends
30
Q

What is the role of a caregiver to a patient with dementia?

A
  1. Intiate formal dementia evalves
  2. Manage patient sx
  3. Provide support
  4. Monitor effects of care management strategies
31
Q

What are the sx of vascular dementia?

A
32
Q

What is Frontotemporal Dementia (FTD)?

A

Developed in patients with ALS with executive dysfunction

33
Q

What is the presentation of FTD?

A

problems with behavior and language (Wernicke and Broca)

34
Q

What is Broca?

A

Part of brain that expresses language

35
Q

What is Wernicke?

A

Part of brain that understands language

36
Q

What is Lewy body dementia?

A
  1. α-synuclein protein deposits (called Lewy bodies) develop in nerve cells in brain regions involved in thinking, memory and movement
  2. Progressive decline of mental ability (hallucination, lack of alertness)
  3. May develop PD
37
Q

What is the prevalence of delirium?

A
  1. Occur in any age group
  2. Onset in the demented person may be mistaken
38
Q

What is delirium?

A

Acute disturbance in cognition with rapid onset that may last between hours and days,

39
Q

What are the manifestation of delirium?

A

Hallmark: acute confusion
1. Mood swings
2. Delusions
3. Hallucinations

40
Q

What are sx of delirium?

A
  1. DIsturbances of cognition
  2. Psychomotor disturbances: Deliurm phenotyle
  3. Emotional dysregulation
  4. Distruptions in sleep cycle
  5. Lack of consciousness and attention
41
Q

What are other names of delirium?

A
  1. Encephalopathy
  2. Acute brain failure
  3. Acute confusional state
  4. Postoperative or ICU psychosis
42
Q

What are the causes of delirium?

A
  1. Hospitalized older adults at risk: increased length of hospital stay and poor clinical outcomes
  2. Infection
  3. Dehydration
43
Q

How is delirium defined in the DSM?

A

Organic mental syndrome:
1. Global cognitive impairment.
2. Disturbances of attention.
3. Reduced level of consciousness.
4. Increased or decreased psychomotor activity.
5. Disorganized sleep-wake cycle.

more pronounced in the late afternoon or evening

44
Q

How does delirium affect the pathology of the body?

A
  1. Reversible impairment of multiple neurotransmitters
  2. Vision and hearing impairments
  3. Psychological stress
  4. Dx of other organ sx
45
Q

What are the key sx of delirium?

A

Agitation, disorientation, and fearfulness

46
Q

When would children experience delirium?

A
  1. High fevers
  2. Sepsis
  3. Chemotherapy
  4. Closed head injuries
  5. Hypoxia
47
Q

When would adolescents and adults experience delirium?

A
  1. Substance abuse, overdose, or withdrawal
  2. Head injury
  3. Neoplasm
  4. Autoimmune disorders (e.g., hypothyroidism)
  5. Exposure to environmental toxin
48
Q

When would older adults experience delirium?

A

Precipitants of delirium:
1. Drug toxicity or adverse effects
1. Urinary retention
1. Stroke
1. Acute myocardial or pulmonary events (e.g., MI, pneumonia)
1. Use of anticholinergic medications

49
Q

What are the states of delirium?

A

Hyperactive: restlessness and agitation
Hypoactive: drowsiness and lethargy

50
Q

How do you diagnose delirium

A

Confusion Assessment Method (CAM) or CAM-ICU

51
Q

What are the pharm tx for delirium?

A
  1. benzodiazepine and antipsychotic medications, and cholinesterase inhibitors
  2. Opiouds

Avoid drugs with central anticholinergic effects.

52
Q

What is the preferred management option for delirium?

A

Non-pharm:
1. Correct metabolic abnormalities
2. Maintain cerebral blood flow to prevent hypoxemia
3. Minimize modifiable factors
4. Behavioral mod
5. Geriatric consultation.

53
Q

Describe the progression and development of delirium?

A

Drug Action III (23 decks)

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