Neurocognitive Dxs Mild and Major Flashcards
Mild Neurocognitive Dx Diagnosis:
A. Evidence of modest cognitive decline from a previous level of performance in more than 1 cognitive domain based on:
- Concerns of the patient, a knowledgeable informant, or the clinician that there has been a mild decline
AND - A modest impairment in cognitive performance, preferably documented by standardized neuropsychological testing OR, in its absence, another quantified clinical assessment
Mild Neurocognitive Dx Diagnosis:
Mild Neurocognitive Dx means…
Mild = performance between 1 and 2 standard deviations below mean on testing.
Mild Neurocognitive Dx Diagnosis:
B. The cognitive deficits _______ interfere with capacity for independence in everyday activities
i.e. complex instrumental activities of daily living are _____ but greater effort, compensatory strategies, or accommodations may be required.
do not interfere; are preserved
Mild Neurocognitive Dx Diagnosis:
C. Cognitive deficits do not occur exclusively in the context of a ______
Delirium
Mild Neurocognitive Dx Diagnosis:
D. Not better explained by another _______
mental disorder (major depressive dx, schizophrenia
Mild Neurocognitive Dx Diagnosis:
Exception to a general rule…Normally the DSM-5 requires _____ (felt by the person) or ________ to be a Dx
distress; functional impairment
Qualitative review of impact of Mild Neurocognitive Dx
- Loss of control
- Living with ambiguity
- Anxiety re future
- Changing view of identity
- Partners no long include them equally in decisions
- Will this lead to Alzheimers? Are normal signs of aging really signs of dementia?
- Imagining individuals with dementia causes anxiety
- Nothing further noted
Major Neurocognitive Dx Diagnosis:
A. Evidence of significant cognitive decline from a previous level of performance in more than 1 cognitive domain based on:
- Concerns of the patient, a knowledgeable informant, or the clinician that there has been a significant decline
AND - A substantial impairment in cognitive performance, preferably documented by standardized neuropsychological testing OR, in its absence, another quantified clinical assessment
Major Neurocognitive Dx Diagnosis:
Major Neurocognitive Dx means…
Major = performance is greater than or equal to 2 standard deviations below the mean
Major Neurocognitive Dx Diagnosis:
B. The cognitive deficits ______ interfere with independence in everyday activities
i.e. at a minimum, requiring assistance with complex instrumental activities of daily living such as paying bills and managing medications
significantly
Major Neurocognitive Dx Diagnosis:
C. Cognitive deficits do not occur exclusively in the context of a ______
Delirium
Major Neurocognitive Dx Diagnosis:
D. Not better explained by another _______
mental dx (eg. major depressive Dx, schizophrenia)
Major Cognitive Dx Specifiers:
Types =
Alzheimers Lewy Body Frontotemporal Vascular Parkinsons
Major Cognitive Dx Specifiers:
Behavioral Disturbance Specifiers =
Psychotic Sxs
Mood
Agitation
Apathy
Major Cognitive Dx Specifiers:
Probably or Possible =
Relates to the certainty re: the causal agent
Exceptions to the general coding rules:
DSM-5 normally lists the medical cause before the psychiatric Dx, except for:
- Mild Neurocognitive Dx
- Unspecified Neurocognitive Dx
- Major Neurocognitive Dx - Possible Cause
Frontotemporal:
Onset
Insiduous - gradual. Remember Bolero. Different from Alzheimers in that occurs earlier in lifespan …45-65
Frontotemporal:
Cause
Deterioration in frontal and temporal lobes. Strong family hx
Frontotemporal
Sx Profile:
Behavioral Subtype
2/3 of patients experience a behavioral subtype (disinhibited, loss of empathy/sympathy, apathy, compulsive repetitive behaviors, hyperorality/pica)
Frontotemporal
Sx Profile:
Other 2 subtypes
- Semantic
- Progressive non-fluent
Language deficits (grammar errors, halting speech, word finding, word comprehension problems, etc.)
Vascular NCD:
Onset
Abrupt. Linked to cerebrovascular event (stroke or stroke-like event)
Vascular NCD:
Cause
Microscopic bleeding and blood vessel blockage
Vascular NCD:
Sx Profile
Depends on where event took place... Typically problems seen in... -Complex attention -Processing speed -Executive functioning -Impaired judgment -Often motor problems (shuffling gait, etc.)
Vascular NCD:
Prevalence
2nd most common cause for NCD after Alz.
Vascular NCD:
Course
Freq. stepped deterioration course (moves in stepwise fashion - different from the normal decline of dementia)
Alcohol-Induced NCD:
Onset
Korsakoff’s
Often preceded by Wernicke’s encephalopathy
Alcohol-Induced NCD:
Cause
- Prominent white matter and neuronal loss
- Due to thiamine (vitamin B1) deficiency
Alcohol-Induced NCD:
Sx profile
- Impaired executive functions
- difficulty with learning
- apathy
- memory impairment leads to confabulation
Alcohol-Induced NCD:
Course
Wernicke’s encephalopathy - can be reversed if Tx administered early
-Tx = intravenous thiamine
Parkinson (Lewy body):
Onset
- Insidious
- If motor Sxs present more than 1 year before NCD then NCD due to Parkinson
- If motor Sxs NOT present for more than 1 year before NCD then NCD with Lewy bodies
Parkinson (Lewy body):
Cause
-Deposits of the protein alpha-synuclein (called Lewy bodies) then this disrupts neurotransmitters (esp. dopamine and acetylcholine)
Parkinson (Lewy body):
Sx profile
- REM sleep behavior Dx
- Vivid visual hallucinations
- Delusions
- Executive functioning problems
- Drowsiness
- Muscle rigidity/tremors
Parkinson (Lewy body):
Course
-Periods of stability with abrupt periods of deterioration
Parkinson (Lewy body):
Misc
-Antipsychotics worsen motor Sxs
-Tx = Dopamine agonists
These dopamine agonists can cause illusions and daytime sleepiness
Alzheimer’s:
Onset
-Slow, insidious
Alzheimer’s:
Cause
-Plaques (amyloid beta deposits), neurofibrillary tangles (protein-tau) accumulate in cell bodies
Alzheimer’s:
Sx profile
-Decline memory/learning + more than 1 other cognitive domain
Alzheimer’s:
Course
- Steady progression
- Death approximately 8-10 years after Sxs
Alzheimer’s:
Misc
Sundowning - Sxs worsen after sunset
Alzheimer’s Dementia -Basic info:
Brain changes may begin more than _____ before Sxs
more than 20 years
Alzheimer’s Dementia -Basic info:
30% of those with ______ show signs of Alzheimer’s in their 50s
Down Syndrome
NCD Tx:
Acetylcholine Breakdown Inhibitors
Donepezil - ARICEPT
Rivastigmine- EXELON Galantamine - RAZADYNE
- All are equal in efficacy but effect size of any is not large.
- Effect is slightly better for Parkin’s/Lewy body than for Alzheimer’s or Vascular
Antipsychotics and Exercise:
Use of antipsychotics in elderly patients with dementia _____ risk of death
Increases
Antipsychotics and Exercise:
FDA issued a _______ against their use in dementia
Black box warning
Antipsychotics and Exercise:
Reduction in antipsychotic use has been ______
limited
Antipsychotics and Exercise:
Exercise has _______ impact on health and ____ effect on cognition
positive; some
Cognitive Stimulation Therapy:
Stimulation of one’s _____, _____, and _______
thinking; concentration; memory
Cognitive Stimulation Therapy:
Usually in a ______ group, social setting
small
Cognitive Stimulation Therapy:
May include elements of _______ therapy
reminiscence therapy
(discussion of past experiences - with physical prompts - such as phots
Cognitive Stimulation Therapy:
Results
Positive effect on language and cognition
Small effect size when compared with active controls
Tx of Dementias - Psychosocial:
Be aware of ______ in Sxs
variations
sundowning in Alz.
Tx of Dementias - Psychosocial:
Supportive and _______
affectionate
Tx of Dementias - Psychosocial:
Gentle ______
reminders: orientation; signs and notes
Tx of Dementias - Psychosocial:
Maintain familiar _______
schedules
Tx of Dementias - Psychosocial:
Ask ______ to tap ______ vs. recall memory
questions; recognition
Was that x or y at the door? vs. Who was at the door?
Tx of Dementias - Psychosocial:
Most care for dementia is delivered by _____
family members
