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.
