FOR BLOCK: TRANS 061 Delirium, Dementia, Cognitive

Question 1

is characterized by a notable disturbance in attention
or awareness and cognitive performance that is significantly
altered from one’s usual behavior.

Answer 1

Delirium

Question 2

The onset of delirium is abrupt, occurring for several hours. T or F?

Answer 2

T

Question 3

Criteria for delirium

Answer 3

• A. A disturbance in attention (i.e., reduced ability to direct,
focus, sustain, and shift attention) and awareness (reduced
orientation to the environment).
• B. The disturbance develops over a short period of time
(usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in
severity during a day.
• C. An additional disturbance in cognition (e.g., memory
deficit, disorientation, language, visuospatial ability, or
perception).
• D. The disturbances in Criteria A and C are not better
explained by another preexisting, established, or evolving
neurocognitive disorder and do not occur in the context of a
severely reduced level of arousal, such as coma.
• E. There is evidence from the history, physical examination,
or laboratory findings that the disturbance is a direct
physiological consequence of another medical condition,
substance intoxication or withdrawal (i.e., due to a drug of
abuse or to a medication), or exposure to a toxin, or is due to
multiple etiologies.

Question 4

Indiviiduals with this condition show a
significant decline in both overall cognitive functioning as well
as the ability to independently meet the demands of daily
living such as paying bills, taking medications, or caring for
oneself.
• While it is not necessary, it is helpful to have documentation
of the cognitive decline via neuropsychological testing within
a controlled, standardized testing environment.

Answer 4

Major Neurocognitive disorder I

Question 5

Within the umbrella of major neurocognitive disorder is
__________ a striking decline in cognition and self-help skills
due to a neurocognitive disorder.

Answer 5

dementia

Question 6

whereas
_______________is the preferred term used to describe
conditions affecting younger individuals such as impairment
due to traumatic brain injuries or other medical conditions.

Answer 6

Neurocognitive disorder

Question 7

Criteria For Major Neurocognitive Disorder

Answer 7

DIAGNOSTIC CRITERIA
• A. Evidence of significant cognitive decline from a previous
level of performance in one or more cognitive domains
(complex attention, executive function, learning and memory,
language, perceptual-motor, or social cognition) based on:
o 1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a significant decline in cognitive function; and
o 2. A substantial impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment.
• 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 or managing medications).
• C. The cognitive deficits do not occur exclusively in the context of a delirium.
• D. The cognitive deficits are not better explained by another mental disorder (e.g., major depressive disorder, schizophrenia).

Question 8

what are the cognitive domains?

Answer 8

complex attention, executive function, learning and memory,

language, perceptual-motor, or social cognition

Question 9

It should be noted that the primary difference between major and mild neurocognitive disorder is

Answer 9

the severity of the decline and independent functioning.

Question 10

Diagnostic criteria of Mild Cognitive Disorder?

Answer 10

• A. Evidence of modest cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual motor, or social cognition) based on:
o 1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a mild decline in cognitive function; and
o 2. A modest impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment.
• B. The cognitive deficits do not interfere with capacity for independence in everyday activities (i.e., complex instrumental activities of daily living such as paying bills or managing medications are preserved, but greater effort, compensatory strategies, or accommodation may be required).
• C. The cognitive deficits do not occur exclusively in the context of a delirium.
• D. The cognitive deficits are not better explained by another mental disorder (e.g., major depressive disorder, schizophrenia).

Question 11

is a complex neurodegenerative disease with multifactorial etiology involving multiple neurotransmitter systems

Answer 11

AD

Question 12

is the most important risk factor for AD;

Answer 12

age

Question 13

the prevalence of AD is estimated to double with every ___ year increment in age, after 65 years

Answer 13

5 year

Question 14

the most commonly diagnosed neurocognitive disorder, is observed in nearly 5.5 million Americans

Answer 14

AD

Question 15

The most common causes of TBI are

Answer 15

falls, automobile accidents, and accidental head strikes

Question 16

• Genetic factors directly linked to early-onset AD

Answer 16

o Familial cases account for 1-5% of cases
o Mutations in APP (Amyloid Precursor Protein), PSEN(Presenellin)1, and PSEN2 genes
evidence of link to chromosome 1, 14, and 21

Question 17

Genetics of sporadic AD

Answer 17

o ApoE ε4 – increased risk of AD (3-13 times)

o ApoE ε2 - moderately decreased risk of AD in some studies

Question 18

Education is preventive of dementia. T or F?

Answer 18

T

Question 19

• In practice, AD can be clinically diagnosed by:

Answer 19

• In practice, AD can be clinically diagnosed by:
o Medical history from the patient and, separately, from an informant who knows the patient
o Clinical signs and symptoms
o Neuropsychological tests

Question 20

The most widely investigated biomarkers for AD fall into two

classes:

Answer 20

o Biomarkers of amyloid-beta protein deposition
o Biomarkers of downstream neuronal degeneration or
injury (such as elevated tau, decreased brain
metabolism, and brain atrophy).

Question 21

Diagnostic marker of AD?

Answer 21

Amyloid precursor protein
Presenilin 1
Presenilin 2

Question 22

help differentiate AD from vascular dementia and frontotemporal dementia

Answer 22

SPECT (single-photon emission computed tomography or PET (positron emission tomography

Question 23

`a definitive diagnosis of AD could only be obtained by autopsy. T or F?

Answer 23

T

Question 24

In clinical practice, patients are diagnosed with ‘probable AD’ based on cognitive assessment, laboratory tests, and imaging techniques, among other procedures. T or F?

Answer 24

T

Question 25

is an objective assessment of orientation, registration, attention and calculation, recall, language, and praxis (the performance of an action)

Answer 25

MMSE

Question 26

was designed to screen for cognitive impairment, and is less suitable for tracking the progression of AD.

Answer 26

MMSE

Question 27

In total MMSE score ranges from

Answer 27

0-30

Question 28

MMSE cut-off scores

Answer 28

▪ Mild: 20-26 pts
▪ Moderate: 10-19 pts
▪ Severe: <10 pts
▪ Other cutoffs also exist.

Question 29

The most common type of TBI is a

Answer 29

Concussion

Question 30

is when there is a significant blow to the head, followed by changes in braining functioning. It often causes immediate disorientation or loss of consciousness, along with headaches, dizziness, nausea, and sensitivity to light

Answer 30

concussio

Question 31

which is a progressive, degenerative conditions due to repeated head trauma.
are most seen in athletes (I.e., football players) and military personnel (Baugh et al, 2012). in addition to the neurological symptoms, psychological symptoms such as depression and poor impulse control have been observed

Answer 31

chronic traumatic encephalopathy (CTE)

Question 32

Symptoms include significant fluctuations in attention and alertness; recurrent visual hallucinations; impaired mobility; and sleep disturbance

Answer 32

neurocognitive disorder due to Lewy bodies

Question 33

most individuals do not survive longer than ____ years post-diagnosis of Lewy Body Dementia

Answer 33

8 years

Question 34

are irregular brain cells that result from the buildup of abnormal proteins in the nuclei of neurons. These brain cells deplete the cortex of acetylcholine, which causes the behavioral and cognitive symptoms

Answer 34

Lewy Bodies

Question 35

rare genetic disorder that involves involuntary movement, progressive dementia, and emotional instability. Due to the degenerative nature of the disorder, there is a shortened life-expectancy as death typically occurs 15-20 years post-onset of symptoms

Answer 35

Huntington’s Disease

Question 36

meaningful therapeutic goals for the treatment of beurocognitive disorders?

Answer 36

alleviating the symptoms of AD, and delaying symptom progression

Question 37

In mild AD, treatment outcomes should focus on

Answer 37

memory functions

Question 38

In more severe AD, treatment outcomes should focus on

Answer 38

effects on activities of daily living (ADLs) and psychiatric behavioral disturbances are more clinically relevant.

Question 39

The current treatments for AD are symptomatic; disease-modifying treatments are not yet available. T or F?

Answer 39

T

Question 40

Pharmacological therapies indicated for the treatment of AD are:

Answer 40

o Acetylcholinesterase inhibitors (AChEIs)
o NMDA receptor antagonist
o Other pharmacological therapies used in AD include:
▪ Antipsychotics for psychosis and agitation
▪ Antidepressants for depression
▪ Sedatives for sleep disturbance

Question 41

Psychosocial therapies for AD include:

Answer 41

o Behavioral-oriented approaches
o Stimulation-oriented approaches
o Emotion-oriented approaches
o Cognition-oriented approaches
o Sleep hygiene

Question 42

Examples of stimulation interventions are

Answer 42

Examples of stimulation interventions are recreational activities or therapies (e.g., crafts, games, pets), art therapies (e.g., music, dance, art), and exercise.

Question 43

The aims of emotion-oriented treatments are to

Answer 43

address issues of loss, and to improve mood and behavior.

Question 44

The aim cognition-oriented treatments is to

Answer 44

is to restore cognitive deficits, often in a classroom setting.

Question 45

Examples of cognition interventions are reality orientation cognitive retraining, and skills training

Answer 45

reality orientation cognitive retraining, and skills training

Question 46

Cognition interventions may provide modest and transient improvements; however, they are associated with

Answer 46

adverse emotional consequences (such as frustrations)

Question 47

Medications aimed at improving cognition are prescribed [based/independent] on disease stage, whereas nonpharmacological interventions and psychiatric medications are used [based/independent] of disease stage, based on the patient’s need.

Answer 47

Medications aimed at improving cognition are prescribed based on disease stage, whereas nonpharmacological interventions and psychiatric medications are used independent of disease stage, based on the patient’s need.

Question 48

In terms of pharmacotherapy, the addition of an __________receptor antagonist to an AChEI may be beneficial in delaying symptom progression among patients with moderate AD;

Answer 48

NMDA;

Question 49

In terms of pharmacotherapy, patients with mild AD should be offered a trial of an _________

Answer 49

AchEI