4. Neurocognitive Disorders Flashcards
(32 cards)
1
Q
What are neurocognitive disorders?
A
- distinct from psychological disorders
- experience/environment/genes can give rise to problematic thoughts and behaviours
2
Q
Why did the name in the DSM-5 change to neurocognitive disorders from ‘delirium, dementia and amnestic and other cognitive disorders?
A
- allow for the introduction of mild neurocognitive disorders into diagnostic criteria
- represents the move towards thinking of NCDs as a spectrum
3
Q
What is the benefit of mild neurocognitive disorders receiving early diagnosis?
A
- often progress into major NCDS: allows for early intervention and monitoring of symptom
- ## neuropathology underlying NCDs often emerges well before diagnosis
4
Q
What is amnesia?
A
- widely associated with various NCDS
- diminished ability to learn new information
- failure to recall past/recent events
- often the result of specific traumatic head injury
5
Q
What deficits in executive functions are common across a range of NCDs?
A
- working memory
- problem solving
- goal directed behaviour
- attentional control
- inhibitory control
- planning and monitoring complex behaviour
- change in routine
6
Q
What is the language deficit aphasia?
A
- difficulty producing and/or comprehending speech
- very common feature of NCDs
7
Q
What are the 3 types of aphasias?
A
- Brocas: difficulty initiating speech/producing complex words
- Wernickes: production of incoherent jumbled speech
- Conduction: difficulty repeating speech
8
Q
What is Brocas aphasia?
A
- disruption of ability to produce speech
- comprehension often maintained
- characterised by non-fluent speech
9
Q
What are the symptoms of Brocas aphasia?
A
- anomia: poor word retrieval
- agrammatism: difficulties with word ordering, selection and intention
- articulation difficulties
10
Q
What is Wernickes aphasia?
A
- deficits in understanding written and spoken language
- production often maintained
11
Q
What are the symptoms of Wernickes aphasia?
A
- anomia: poor words retrieval
- structurally intact speech rate (content often meaningless and unaware of impairment)
- reading and writing impairments
12
Q
What is visio-perceptual functioning?
A
- inability to process sensory info due to neural insult
- may be unable to recognise objects/people
- independent to memory loss
13
Q
What forms can agnosia come in?
A
- faces (prosopagnosia)
- music (amusia)
- movement (akinetopsia)
14
Q
What is prosopagnosia?
A
- face processing problems
- loss of familiarity of known faces: may struggle to identify family friends, judge expressions
15
Q
What is akinetopsia?
A
- loss of fluid motor perception
- vision becomes stroboscopic
- acuity for static objects preserved
- basically can no longer stitch things together
16
Q
What is the motor deficit apraxia?
A
- damage to motor cortex
- the loss of ability to execute learned movements
- may be able to perform behaviour as part of a routine, but unable on command
- typically caused by a lesion or degeneration of posterior parietal lobe
17
Q
What are the difficulties with diagnosing NCDs?
A
- symptoms often closely resemble other disorders e.g Sz
- emergence of psychological issues e.g anxiety during early stages: hard to differentiate
- partially alleviated by brain imaging: misdiagnosis
- considerable overlap of symptoms with other neurological disorders
- closed head trauma may produce memory deficits that resemble alzheimers
- single factor e.g brain tumour may cause broad symptoms
18
Q
What is the difference between major and mild NCDs?
A
Major:
- reflect substantial cognitive impairment
Mild:
- reflect moderate impairments
19
Q
How are mild and major NCDs distinct in the DSM?
A
- extent of deterioration
- interference of everyday activities
20
Q
What are the deficits in major NCDs?
A
- language may become very vague and empty (inability to name everyday objects)
- may present with apraxia and agnosia
- EF functions are common: difficulty managing new tasks, recalling basic knowledge and counting/reciting alphabet
- poor judgment and insight
21
Q
How does the Wechsler Adult Intelligence Scale-IV assess NCDs?
A
- aggregate measure that can be used to provide scores on broad indices of ability (verbal comprehension, perceptual organisation, working memory, information processing speed)
- also provided info on source of deficits: alcohol abuse, strokes, AD etc
22
Q
How does the Montreal Cognitive Assessment assess NCDs?
A
- high sensitivity tool used to diagnose mild NCDs
- simpler than WAIS-IV
- useful for those with early deficits
example items:
- trail making tasks: processing speed and integration of visuomotor functions
- clock drawing tasks: visual neglect
- simple word lists: comprehension, working memory
23
Q
What is the role of psychologists in rehabilitation of NCDs?
A
- rehabilitating cognitive and behavioural functions (often difficult)
- help clients develop new skills/strategies to compensate for deficits
- specific = tailored to individual patients
- therapy for comorbid disorders
24
Q
What is the need for cognitive interventions in NCDs?
A
- biological: stabilise/slow degenerative disorders
- can improve quality of life BUT…
- limited long term efficacy: not a cure
- adverse side effects
- surgical: invasive and risky
25
What are cognitive rehabilitation programmes for NCDs?
- flexible to nature and length of cognitive deficits
- gains in cognitive functioning over a range of domains: often basic training the client in the area of their deficit, extended practice at task with feedback on performance/use of assistive technology
- digital interventions: thriving area of research and practice
26
How are everyday prompts used as intervention for everyday memory prompts?
- full recovery of lost memory abilities is often difficult: focus on therapy
basic strategies may include:
- labelling cupboards and rooms
- pager/diary to aid recall of daily events
27
How are visual imagery mnemonics used as intervention for everyday memory prompts?
- mnemonic imagery can lead to reliable memory improvement
- efficacy depends on: severity of memory impairment, parents motivation
- patients may also need explicit prompting and support
28
Are interventions for visuo-perceptual deficits effective?
- limited cases of full recovery from agnosia
29
What are the interventions for apraxia?
- deficits in planning and sequence of actions: assumed to be an impairment of gesture learning due to insult to motor memory systems
- gestural training effective in rehabilitation for e.g limb apraxia
- patients required to... demonstrate use of common object, mimic an observed gesture etc
30
What are the interventions for language deficits?
- for generic deficits, patients may undergo standard speech therapy
- this assists with production and comprehension of speech
- often combined practitioner and home based computer assisted therapy
31
How is constraint induced movement therapy used as an intervention for aphasia?
- patients often develop compensatory behaviours in aphasia e.g gestures, pointing
- can improve communication but may limit recovery of speech productions
32
How is group communication treatment be used as an intervention for aphasia?
- constraint
