Sem 2 L4 - Neurocognitive disorders Flashcards
What were neurocognitive disorders previously referred to as? And in what diagnostic manual?
Delirium, dementia and amnesties and other cognitive disorders in DSM- IV- TR
In which diagnostic manual is the diagnostic category now “neurocognitive disorders”?
In DSM-5. Mostly unchanged in DSM-5-TR
What are 3 common causes of neurocognitive disorders?
Dementia’s like Alzheimer’s disease and Parkinsons disease
Stroke
Traumatic brain injury
What are some key features of Neurocognitive disorders?
-primary clinical deficit is in cognitive function
-acquired rather than developmental
-there is a decline from a previous level of function
What is the paradigm shift in diagnostic criteria?
In DSM-IV-TR - Individuals may not have met criteria for dementia despite clearly exhibiting symptoms that interfere with QOL
DSM-5 - Cognitive impairments that do not reach the threshold for a diagnostic of dementia are classified as mild NCDs
For patients with mild NCD there is a problem bc
If they use DSM-IV-TR - Unable to receive diagnosis (bc not sick enough)
DSM-5 - Are able to access support and diagnosis can often relieve some distress
How is dementia the leading cause of death in the UK?
Dementia isn’t screened bc there are limited reliable early bio markers and idiopathic cases
What are benefits of early diagnosis?
Mild NCD diagnosis allows for early intervention and monitoring of symptoms
Neuropathology underlying NCDs often emerges well before symptoms - DA atrophy precedes PD symptoms
BUT diagnosis is not always easy - early interventions are still limited in terms of long term efficacy. Agreement that when we have efficacious treatment, early intervention will be key
How are NCDs on the rise in young and old?
Increases in acquired NCD due to head injury - more people understood to be living w brain trauma
Medical advances: increased survival rate for both military and civilian brain trauma
Examination / understanding: cumulative effects of repeated minor brain injuries
Eg heading the ball in football
Boxing, American football
In NCDs, insult to neural sites give rise to symptoms such as?
Disease
Trauma
Degeneration
NCDs typically result of neural insult or CNS dysfunction - typically physical causes
What do psychologists play a central role in?
Diagnosis
Assessment
Rehabilitation
Supporting caregivers
What are NCDs often comorbid with?
Anxiety/depression/personality changes/ aggression
Vital role of clinicians in assessing these abilities and interpreting deficits within the context of early stages of NCDs - need to be treated suitably
What is an example of a learning and memory deficit?
Amnesia
Specific traumatic head injury resulting in anterograde amnesia
What is amnesia?
The inability to learn new info
Failure to recall past events
Failure to recall recent events
What is anterograde amnesia?
Memory loss for information acquired after onset of amnesia
May also present with gradual onset in dementia
Often a result of damage in the hippocampus or broader temporal lobe injury
What are attention and arousal deficits?
Often the earliest indication of onset of degenerative NCDs
Lack of attention / ^ distractibility
-Performance of well learnt activities slowed (eg using computer/tying shoelaces)
-Difficulty focusing / keeping up with a conversation
-Diffuse neural basis:
- Frontal and parietal regions implicated, but networks extent to sub cortical structures sooooo therefore potentially limited diagnostic value
What executive functions may you find a deficit in?
Working memory
Problem solving
Goal oriented behaviour
Attentional control
Inhibitory control
Planning and monitor complex behaviour
Change in routine
- often expressed in NCDs as poor judgement, inappropriate behaviour or erratic mood swings
What is aphasia and what are the 3 different types of aphasia?
A language deficit - difficulty producing and/or comprehending speech (very common feature of NCDs)
Broca’s Aphasia
Wernicke’s Aphasia
Conduction Aphasia
What is Broca’s aphasia?
Difficulty initiating speech or producing complex words
What is Wernicke’s aphasia?
Production of incoherent jumbled speech
What is conduction aphasia?
Difficulty repeating speech
What is Visuo-perceptual functioning?
-inability to process sensory information due to neural insult
-patient may be unable to recognise objects or people
-independent of memory loss
Agnosia can result which comes in many forms
What are the many forms of agnosia?
Faces (prosopagnosia)
Music (amusia)
Movement (akinetopsia)
Very rare but hugely debilitating
What is prosopagnosia?
Face blindness and a form of Agnosia
-Face processing problems - high incidence rate in right hemisphere stroke
Pure prosopagnosia is rare
Loss of familiarity of known faces so may struggle to identify friends or family and may be unable to judge expressions
Will typically still show an understanding of the components of the face (can name nose, lips, etc)
What is akinetopsia?
Motion blindness
A loss of fluid motion perception so vision becomes stroboscopic
Acuity for static objects preserved
-recognition is normal
(Analogous to watching a poorly loaded video/gif)
Some EXTREME CASES - Motion perception is eliminated completely, and visual perception becomes a series of static images
