Week 9 - Neurocognitive Disorders Flashcards
What are the characteristics of neurocognitive disorders/dementia?
gradual, chronic, progressive, irreversible
What do pt with neurocognitive disorder/dementia have problems with?
learning, memory, attention, language, recognition, planning, decision-making, problem solving, concentration, judgement, perceptual motor ability
Acute behavioral or mood changes think?
likely delirium
Chronic low mood or depressed mood w/ or w/o cognitive impairment?
assess for depression
less likely to report congitive impairment?
assess for dementia
How do you treat these disorders?
underlying condition, cognitive deficits
treat other disorders
educate pt and family
support for caregivers and families
What are some issues to consider for tx?
self care safety issues hearing or vision impairment providing support for caregivers and families nursing home placement
What is the DSM-5 for MAJOR neurocog disorder?
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
What is the MINOR neuro disorder DSM-5 criteria?
same as major except
A. modest cognitive decline and modest impairment
B. do not interfere with independence in everyday activies
What are some specifiers of neurocognitive disorder?
alzheimer disorder, TBI, parkinson’s disease, huntington’s disease
TON MORE
What is the most common cause of dementia?
alzheimer’s disease
What are the features of Alzheimer’s?
slowm irreversible, gradual
What is the average time btw onset and death in alzheimer’s?
3-15 years
impaired ability to use or comprehend spoken language related to AD
aphasia
impaired voluntary movement despite adequate sensory and muscle functioning related to AD
apraxia
impaired ability to recognize people or common objects, related to AD
agnosia
impaired ability to plan or organize daily activities, engage in abstract thinking or understand the sequence of events, related to AD
executive functioning deficits
How does early AD present?
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
How does middle AD present?
severe memory issues frank and persistant confusion aphasia, apraxia, visuospatial serious difficulties in managing everday activites agitation, paranoia, delusion
OTHERS START TO NOTICE
How does late AD present?
profound memory issues severe confusion incontinence primitive reflex present szs signs of gross neuro impairment bodily wasting
What are teh biological risk factors in AD?
neurofibrillary tangles, senile plaques, atrophy
What are other causes of dementia?
Dementia with Lewy Bodies Vascular Dementia Frontotemporal dementias (FTDs) Parkinson’s disease Chronic alcohol abuse HIV/AIDs
What is the prevalance of dementia?
doubles every 5 years after 60 yo
45% of 85+ yo
How would the history differentiate dementia with DSD?
dementia- slow onset, no preciptating event, family complains
DSD- rapid onset, stress, previous depression, pt complains of problem, somatic complaints
How does the evaluation of dementia and DSD present?
Dementia - indifferent, anxious, willing to put forth effort, excuses or denies deficits
DSD - sad, withdran, little motivation, poor effort of MMSE, complains of deficits
What are risk factors for depression in older pts?
Stroke Myocardial infarction Trauma Loss of spouse or family Development of serious illness or terminal illness
Who is at highest risk of suicide?
white males over age of 65
What are causes of delirium?
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
What are the characters of delirium?
acute, symptoms fluctuate, reversible
How do you screen for dementia?
mini-cog
How do you screen for depression?
geriatric depression scale
What are the recommended labs for these disorders?
CBC, thyroid, BUN, creatinine, Ca, albumin, vit B12, electrolytes
What is the DSM-5 for delirium?
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
How do you differentiate delirium from dementia?
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
What are the drugs for dementia?
donepezil, rivastigmine, galantamine, memantine
