Neurocognitive Disorders Flashcards
Neurocognitive Disorders - Definition
Disorders of executive functions (self control, inhibitory control, attention, working memory) that share common symptoms, starting with delirium, followed by major and minor NCDs. Due to progressive neurodegenerative processes.
Vascular Dementia - Symptoms and Cause
Impaired judgement to make decisions
Disturbance to planning and organizing
From vessel blockage/damage resulting in infarcts (strokes) or brain bleed.
Lewy Body Dementia - Symptoms and Cause
Memory loss and thinking problems.
Sleep disturbance, hallucinations, slowness, gait imbalance.
Abnormal aggregation of protein alpha-synuclein.
Frontotemporal Dementia - Symptoms
Changes in personality, behavior, difficulty with language.
Primary progressive aphasia, Pick’s disease, corticobasal degeneration and supranuclear palsy.
Delirium
Disturbance in attention and awareness, fixation on an idea. Develops over a short period (hours to days). Causes additional disturbances in cognitive function (memory, orientation, language, visuospatial ability).
At least one of 3 aspects:
- Substance intoxication
- Substance withdrawal
- Medical condition (PFC damage)
Corticobasal Degeneration - Etiology, Motor and cognitive/behavioral symptoms
Idiopathic
Motor: Similar to PD, starting unilateral developing to bilateral. Dyspraxia (motor procedure deficit), dysarthrophonia, dysphagia.
Cognitive/behavioral: dementia and psychiatric disorders (paranoid schizophrenia), medicine induced.
Progressive Supranuclear Palsy - Etiology, Motor and cognitive/behavioral symptoms
Probably related to oxidative stress.
Motor: Ophthalmoplegia, bradykinesia, rigidity, nuchal dystonia (difficulty maintaining muscle tone in neck)
Cognitive/behavioral: dementia
PD/Secondary Parkinsonism vs PSP (5)
Falls become a problem in moderate/severe stage vs early falls
Dysarthrophonia related to bradykinesia (monotone, not alot of movement of the mouth) vs related to spasticity (large mouth movements)
Tremor always present vs tremor is rare
Asymmetric functional impairment vs symmetric functional impairment
Good response to DA agonist vs no response
Biomarkers for MS, PD, PSP, CBD, ALS, HD
Multiple sclerosis: Plaques
Parkinson’s: Substantia nigra (except secondary)
Progressive Supranuclear Palsy: Subthalamic nuclei
Corticobasal degeneration: Meynert nucleus
Amyotrophic Lateral Sclerosis: Thalamus
Huntington’s disease: Caudate
Alzheimer’s Disease - Definition, First symptoms and Degeneration
Progressive, neurodegenerative.
Formation of senile plaques in PFC and neurofibrillary (tau protein) tangles, that disrupt conduction of neuron impulses, leading to apoptosis.
First symptoms: lack of memory, attention, odd behavior.
NBM first thing that deteriorates.
Clinical Presentation of Alzheimer’s - Behavioral and Psychological Symptoms of Dementia (BPSD)
Depression
Delusion (delirium that doesn’t go away)
Agitation
Hallucinations
Apathy
Disturbance of circadian rhythm
Amnesia (epithalamus degeneration)
Global Deterioration Scale (GDS) - Level 1-7
1: No cognitive disorder
2: Very mild cognitive impairment
3: Mild cognitive impairment
4: Moderate cognitive disorder
5: Early severe cognitive disorder (early phase dementia)
6: Severe cognitive disorder (moderate dementia)
7: Late severe cognitive disorder
Pharmacological Treatment - Dementia
Should be limited in time! 6 months, max 1 year. Psycho-pharmacotherapy has detrimental effect on the CNS after this time. Dementia patients particularly vulnerable to adverse side effects of drugs.
Physiotherapy Treatment - Dementia
Cognitive stimulation therapy (physical exercise and cognitive learning) has shown efficiency in treating mild to moderate dementia.
