Week 9 - Neurocognitive Disorders

Question 1

What are the characteristics of neurocognitive disorders/dementia?

Answer 1

gradual, chronic, progressive, irreversible

Question 2

What do pt with neurocognitive disorder/dementia have problems with?

Answer 2

learning, memory, attention, language, recognition, planning, decision-making, problem solving, concentration, judgement, perceptual motor ability

Question 3

Acute behavioral or mood changes think?

Answer 3

likely delirium

Question 4

Chronic low mood or depressed mood w/ or w/o cognitive impairment?

Answer 4

assess for depression

Question 5

less likely to report congitive impairment?

Answer 5

assess for dementia

Question 6

How do you treat these disorders?

Answer 6

underlying condition, cognitive deficits
treat other disorders
educate pt and family
support for caregivers and families

Question 7

What are some issues to consider for tx?

Answer 7

self care
safety issues
hearing or vision impairment
providing support for caregivers and families
nursing home placement

Question 8

What is the DSM-5 for MAJOR neurocog disorder?

Answer 8

A. evidence of significant cognitive decline from previous level in >1 congitive domains based on:
-significant - decline in cognitive function (memory, learning, attention, motor, planning, decision making, language, social)
AND
-substantial (standardized neuro testing or clinical assessment)
B. interferes with independence and everyday activities
C. cognitive deficits do not occur exclusively in context of delirium
D. cognitive deficits are not better explained by another mental disorder

Question 9

What is the MINOR neuro disorder DSM-5 criteria?

Answer 9

same as major except
A. modest cognitive decline and modest impairment
B. do not interfere with independence in everyday activies

Question 10

What are some specifiers of neurocognitive disorder?

Answer 10

alzheimer disorder, TBI, parkinson’s disease, huntington’s disease

TON MORE

Question 11

What is the most common cause of dementia?

Answer 11

alzheimer’s disease

Question 12

What are the features of Alzheimer’s?

Answer 12

slowm irreversible, gradual

Question 13

What is the average time btw onset and death in alzheimer’s?

Answer 13

3-15 years

Question 14

impaired ability to use or comprehend spoken language related to AD

Answer 14

aphasia

Question 15

impaired voluntary movement despite adequate sensory and muscle functioning related to AD

Answer 15

apraxia

Question 16

impaired ability to recognize people or common objects, related to AD

Answer 16

agnosia

Question 17

impaired ability to plan or organize daily activities, engage in abstract thinking or understand the sequence of events, related to AD

Answer 17

executive functioning deficits

Question 18

How does early AD present?

Answer 18

mild memory problems, occasional mild and transitory confusion, slowed down quality to thinking, increase in personal rigidity and intolerance, social isolations, loss of interest, possible incrase in restlessness and impulsivity

MAY GO UNNOTICED

Question 19

How does middle AD present?

Answer 19

severe memory issues
frank and persistant confusion
aphasia, apraxia, visuospatial
serious difficulties in managing everday activites
agitation, paranoia, delusion

OTHERS START TO NOTICE

Question 20

How does late AD present?

Answer 20

profound memory issues
severe confusion
incontinence
primitive reflex present
szs
signs of gross neuro impairment
bodily wasting

Question 21

What are teh biological risk factors in AD?

Answer 21

neurofibrillary tangles, senile plaques, atrophy

Question 22

What are other causes of dementia?

Answer 22

Dementia with Lewy Bodies 
Vascular Dementia 
Frontotemporal dementias (FTDs) 
Parkinson’s disease
Chronic alcohol abuse 
HIV/AIDs

Question 23

What is the prevalance of dementia?

Answer 23

doubles every 5 years after 60 yo

45% of 85+ yo

Question 24

How would the history differentiate dementia with DSD?

Answer 24

dementia- slow onset, no preciptating event, family complains
DSD- rapid onset, stress, previous depression, pt complains of problem, somatic complaints

Question 25

How does the evaluation of dementia and DSD present?

Answer 25

Dementia - indifferent, anxious, willing to put forth effort, excuses or denies deficits
DSD - sad, withdran, little motivation, poor effort of MMSE, complains of deficits

Question 26

What are risk factors for depression in older pts?

Answer 26

Stroke 
Myocardial infarction
Trauma 
Loss of spouse or family 
Development of serious illness or terminal illness

Question 27

Who is at highest risk of suicide?

Answer 27

white males over age of 65

Question 28

What are causes of delirium?

Answer 28

substance tox or withdrawal
TBI
Szs
Infection
High fever
stroke
coronary event
meds
heat stroke
hypothermia
radiation
electrocution
Post op
dehydration
electrolyte imbalance
renal insufficiency

Question 29

What are the characters of delirium?

Answer 29

acute, symptoms fluctuate, reversible

Question 30

How do you screen for dementia?

Answer 30

mini-cog

Question 31

How do you screen for depression?

Answer 31

geriatric depression scale

Question 32

What are the recommended labs for these disorders?

Answer 32

CBC, thyroid, BUN, creatinine, Ca, albumin, vit B12, electrolytes

Question 33

What is the DSM-5 for delirium?

Answer 33

A. disturbance in attention and awareness
B. last short period of time, represents a change from baseline and fluctuates in severity in course of a day
C. additional disturbance in cognition
D. not better explained
E. evidence from hx, PE or labs IS a direct physiological consequence of anotehr mediacl condition, substance intoxication or withdrawal or exposure to toxin

Question 34

How do you differentiate delirium from dementia?

Answer 34

delirium - rapid onset, short duration, heightened autonomic arousal, clouded consciousness, wax and wanes, restless, agitated, hypervigilant or lethargic, gross perceptual distortions and hallucination
Dementia - insidious onset, progressive, no arousal, alertness retained, consistant symptoms, less agitation, vague if any psych symptoms

Question 35

What are the drugs for dementia?

Answer 35

donepezil, rivastigmine, galantamine, memantine