3- Neurocognitive Disorders

Question 1

What are the 6 broad categories of neurocognition?

Answer 1

1. Complex attention
2. Executive function
3. Learning and memory
4. Language
5. Perceptual-motor
6. Social cognition

Question 2

What is defined as an acute, rapidly progressive change in cognition characterized by inattention and disturbance of consciousness in which sxs fluctuate over the course of 24 hrs?

Answer 2

Delirium (aka acute confusional state)

Question 3

What is the DSM-5 criteria for delirium? (5)

Answer 3

1. Disturbance in attention and awareness
2. Develops over short period of time + fluctuates
3. Disturbance in cognition
4. Not better explained by NCD/ reduced level of arousal
5. Physiological consequence

Question 4

What must be specified for a DSM-5 dx of delirium? (3)

Answer 4

Substance intoxication vs withdrawal delirium

Acute vs persistent

Hyperactive vs hypoactive vs mixed

Question 5

Age > 70yo, poor functional status, hearing/ visual impairment, dehydration, sleep deprivation, metabolic derangement, infection, and polypharmacy are all RFs for what condition?

Answer 5

Delirium

Question 6

What 3 things should be avoided or used with caution in the practice of geriatric medicine? (3)

Answer 6

Benzos/ sedative-hypnotics

Physical restraints

Antipsychotics

Question 7

What general non-pharmacologic measures are used for the tx of delirium?

Answer 7

Reassure, reorient, education

Question 8

How does the onset differ between dementia and delirium?

Answer 8

Dementia- progressive, insidious

Delirium- acute, rapid

Question 9

Disturbance of consciousness, fluctuation of sxs, and attention deficit are characteristic of dementia or delirium?

Answer 9

Delirium

Question 10

How can you differentiate between major vs minor neurocognitive disorder?

Answer 10

Major

• significant cognitive decline
• substantial impairment in cognitive performance
• interference w/ independence

Minor

• modest cognitive decline
• modest impairment in cognitive performance
• does not interfere with independence

Question 11

What are the similaries between major and minor neurocognitive disorder?

Answer 11

Deficits do not occur due to delirium

Not better explained by another mental disorder

Question 12

What must be specified for DSM-5 criteria of major NCD? (3)

Answer 12

Which NCD

With/ without behavioral disturbance

Severity of interference

Question 13

What must be specified for DSM-5 criteria of minor NCD? (2)

Answer 13

Which NCD

With/ without behavioral disturbance

Question 14

DSM-5 criteria for ALL NCDs includes what?

Answer 14

Criteria met for major or mild NCD

Not better explained by other disease/ disorder

Question 15

What is the DSM-5 criteria specific to Alzheimer’s Disease (AD)? (2)

Answer 15

1. Insidious onset, gradual progression in 1+ cognitive domains
2. Probable or possible AD

Question 16

How do you define probable (vs possible) AD?

Answer 16

Evidence of causative agent +

• Clear memory decline + 1 other domain
• Steadily progressive, gradual, no extended plateaus
• No evidence of mixed etiology

Question 17

At what age is AD considered early onset?

Answer 17

Under 65 yo

Question 18

What populations are a/w higher rates of AD?

Answer 18

Repeated head trauma

Down Syndrome

Question 19

What is the only way to confirm dx of AD?

Answer 19

Histopathology

Question 20

What is the DSM-5 criteria specific to frontotemporal degeneration? (3)

Answer 20

1. Insidious onset, gradual progression
2. Either:
   
   • 3+ behavioral variant
   • languange variant
3. Sparing of learning/ memory and perceptual motor (differentiates from AD)

Question 21

Disinhibition, apathy/ inertia, loss of sympaty/ empathy, perseverative/ stereotyped behavior, hyperorality, and prominent decline in social cognitive/ executive function describe what?

(inertia: emotional states resistant to change)
(hyperorality: tendency to examine objects by mouth)

Answer 21

Behavioral variants

(part of DSM-5 criteria for frontotemporal degeneration)

Question 22

Decline in speech, word finding, naming, grammar or comprehension describe what?

Answer 22

Language variants

(part of DSM-5 criteria for frontotemporal degeneration)

Question 23

What is the DSM-5 criteria specific to Lewy body disease? (3)

Answer 23

1. Insidious onset, gradual progression in 1+ cognitive domains
2. Core diagnostic features (1+)
   
   • Fluctuating cognition
   • Visual hallucinations
   • Parkinsonism
3. Suggestive diagnostic features (1+)
   
   • REM sleep disorder
   • Severe neuroeleptic sensitivity

Question 24

What is the DSM-5 criteria specific to vascular disease? (2)

Answer 24

1. Consistent w/ vascular etiology w/
   
   • onset related to CV event OR
   • decline in complex attn/ frontal-exec functions
2. Evidence of CV disease (H+P or neuroimaging)

Question 25

Vascular dementia/ NCD is aka?

Answer 25

Multi-infarct dementia

Question 26

What condition is a/w vascular RFs (HTN, hypercholesterolemia) and usually has neuro deficit from previous CVA?

Answer 26

Vascular dementia/ NCD

Question 27

What is useful for dx of vascular dementia/ NCD?

Answer 27

Imaging (CT)

Question 28

What is the DSM-5 criteria *specific* to traumatic brain injury? (2)

Answer 28

1. Evidence of TBI w/ 1+ of: 1. LOC 2. Post-traumatic amnesia 3. Disorientation/ confusion 4. Neuro signs 2. NCD presents immediately after TBI or after acute post-injury period

Question 29

What conditions are a/w poorer outcomes for a TBI? (4)

Answer 29

Repeated concussions \> 40 yo Poor motor function Non-reactive pupils

Question 30

What is the DSM-5 criteria *specific* to Prion disease?

Answer 30

1. Insidious onset, **rapid** progression 2. Motor features (myoclonus, ataxia, biomarker evidence)

Question 31

Creutzfeldt-Jakob disease, Kuru, and 'mad cow' are examples of what condition?

Answer 31

Prion disease

Question 32

What disease usually lasts \< 6 months and is a/w psychiatric sxs and characteristic EEG patterns?

Answer 32

Prion disease

Question 33

NCD due to Parkinson's disease exhibits what sxs and is exacerbated by what?

Answer 33

**Motor sxs**- tremor, rigidity, bradykinesia, postural instability Exacerbated by **depression**

Question 34

Pt presents with forgetfulness, slowness, poor problem solving abilites, poor concentration, apathy and delirium. PE shows tremor and ataxia. You are concerned for NCD due to what?

Answer 34

HIV (can usually isolate in CSF)

Question 35

What NCD is a/w an autosomal dominant gene, has an onset in late 30s to 40s and exhibits choreiform movements?

Answer 35

Huntington's dementia

Question 36

What imaging finding is a/w Huntington's dementia?

Answer 36

Boxcar ventricles

Question 37

Does a pt with an NCD typically present with complaint of "memory loss"?

Answer 37

NO- spouse, family, friend usually notices/ reports to clinician

Question 38

How do NCDs affect neuro processing?

Answer 38

Affect ALL steps (difficulty: retaining new info, complex tasks, reasoning, spatial ability/ orientation, language, behavior)

Question 39

What cognitive tests are used to eval dementia?

Answer 39

Neuropsych testing MMSE (high false negatives)

Question 40

How is dementia diagnosed?

Answer 40

Clinically Postmortem pathology only definitive confirmation

Question 41

What is included in the general management of dementia? (4)

Answer 41

Tx of cognitive sxs Behavioral management EDU/ caregiver support Prevention

Question 42

What drugs are FDA approved for the tx of AD? (4)

Answer 42

Donepezil Galantamine Memantine Rivastigmine

Question 43

What supplements may have a small benefit for dementia?

Answer 43

Vit E/ Selegiline Anti-oxidants Anti-inflammatories

Question 44

What modifiable RFs are a/w dementia?

Answer 44

Level of EDU/ cognitive training CV fitness Healthy diet