6. Major and minor neurocognitive disorders (Dementia): etiology, diagnostic criteria, and clinical management

Question 1

Neurocognitive disorder def

Answer 1

a group of conditions defined by a decline from a previous level of cognitive functioning.

Question 2

six cognitive domains that may be affected in neurocognitive disorders

Answer 2

1) Complex attention
*
2) Executive function
*
3) Learning and memory

4) Language
*
5) Perceptual-motor skills
*
6) Social cognition (interaction

Question 3

The DSM-5 divides the NCDs into

Answer 3

three main categories:
* delirium,
* minor NCDs, and
* major NCDs (dementia).

Question 4

Minor NCDs

Answer 4

individuals with mild cognitive impairment.

These individuals have trouble with some of the more complex activities of living but are able to maintain their independence

Question 5

Major NCDs

Answer 5

: these individuals require assistance with independent activities of daily living (e.g., paying bills, managing medications, or shopping for groceries).

Over time, the basic activities of daily living (e.g., feeding, toileting, and bathing) are affected, eventually leading to total dependence.

Question 6

The dementias are —- and —–

Answer 6

progressive and irreversible major NCDs that primarily affect the elderly.

Question 7

what is dementia

Answer 7

Dementia is not a disease,
but rather a set of symptoms comprising poor memory, and difficulties with learning and language.

Question 8

dementia dsm5

Answer 8

Question 9

name other major NCDs present similarly to the dementias, but their progression may be arrested or even reversed with treatment

Answer 9

• vitamin B12 deficiency,
• thyroid dysfunction)

Question 10

Pseudodementia def

Answer 10

• symptoms of major depression in the elderly often include problems with memory, concentration, and cognitive functioning.
• Because this clinical picture may be mistaken for a major NCD (dementia), it is termed pseudodementia; the presence of apparent cognitive deficits in patients with major depression.

Question 11

Diagnosis dementia

Answer 11

• Mini Mental State Exam (MMSE):
  *Assess orientation, attention/concentration, language, constructional ability, immediate and delayed recall
• Mini-Cog: item recall (3 items) and clock-drawing tasks

Question 12

Mini Mental State Exam (MMSE is sensitive for which NCDs

Answer 12

Sensitive for major NCDs (dementias), particularly moderate-to-severe forms

Maximal score: 30,
dysfunctional score: < 25

Question 13

etiology of dementia

Answer 13

• Alzheimer’s disease (most common)
• Vascular dementia
• Lewy body dementia
• Frontotemporal dementia
• Prion disease
• Normal pressure hydrocephalus
• HIV infection

Question 14

Alzheimer’s disease characteristics

Answer 14

Gradual progressive decline in cognitive functions; primary domains affected are memory, learning, and language

Question 15

etiology of alzheimers

Answer 15

Accumulation of
* extra-neuronal beta-amyloid plaques and
* intra-neuronal tau protein tangles
→ result in brain atrophy

Question 16

Alzheimer’s disease types

Answer 16

o Sporadic type: 95%
▪Late onset
▪Genetic and environmental factors

o Familial type:
▪Early onset
▪Dominant gene

Question 17

Alzheimer’s disease treatment

Answer 17

o Cholinesterase inhibitors (rivastigmine, galantamine)
o NMDA receptor antagonist (memantine)
o Supportive care via behavioral, social, and environmental interventions

Lecanemab

Question 18

Vascular dementia how does it happen

Answer 18

Cognitive decline 2° to: large vessel strokes, small vessel strokes, or microvascular disease affecting the periventricular white matter

oLong-term poor blood flow to the brain → ischemic stroke → permanent tissue damage
▪The brain tissue liquefies → liquefactive necrosis
▪As a result, there is a loss of mental function

Question 19

which cognitive domains are lost in vascular dementia

Answer 19

Complex attention and executive function are the cognitive domains typically affected in small vessel disease

Question 20

in vascular dementia Symptoms vary depending on

Answer 20

the region of damage

Question 21

Vascular dementia treatment

Answer 21

o
Prevent further strokes
o
Supportive and symptomatic care

eg. prevent Hypertension

Question 22

Lewy body dementia

Answer 22

Lewy bodies (accumulation of alpha-synuclein) in the brain, primarily in the basal ganglia

Question 23

which cognitive domain affective in lewy body dementia

Answer 23

Waxing and waning of cognition esp
attention and alertness

Question 24

symptoms in lewy body dementia

Answer 24

• Visual hallucinations (usually vivid, colorful, well-formed images)
• REM sleep behavior disorders
• Called Lewy body dementia if there is development of extrapyramidal signs (Parkinsonism) and cognitive decline start less than 1 year apart

Question 25

Lewy body dementia treatment

Answer 25

o Cholinesterase inhibitors → for cognitive and behavioral symptoms o Quetiapine or clozapine → for psychotic symptoms o Levodopa-carbidopa → for Parkinsonism o Melatonin or clonazepam → for sleep disorder

Question 26

Frontotemporal dementia

Answer 26

* Marked atrophy of the frontal and temporal lobes (visible on brain imaging) * Early changes in personality and behavior

Question 27

Frontotemporal dementia subtypes

Answer 27

o Behavioral variant: disinhibited verbal, physical, or sexual behavior o Language variant: difficulties with speech and comprehension

Question 28

Frontotemporal dementia treatment

Answer 28

o Symptom-focused approach o Serotonergic medications (SSRIs) → may help reduce disinhibition, anxiety, impulsivity, and repetitive behavior

Question 29

Prion disease what is it

Answer 29

Subacute spongiform encephalopathy caused by proteinaceous infectious particles The most common type is Creutzfeldt-Jakob disease

Question 30

Prion disease onset

Answer 30

Insidious onset with rapidly progressive cognitive decline

Question 31

prion disease symptoms

Answer 31

* Difficulties with concentration, memory, and judgment occur early * More than 90% of patients experience myoclonus * nystagmus, and hypokinesia (due to Basal ganglia and cerebellar dysfunction)

Question 32

Prion disease: definitive diagnosis done by

Answer 32

brain tissue analysis (biopsy or autopsy)

Question 33

Prion disease treatment

Answer 33

no effective treatment is available; most patients die within 1 year of diagnosis

Question 34

Normal pressure hydrocephalus

Answer 34

* Enlarged ventricles with an episodic elevation of CSF pressure

Question 35

Normal pressure hydrocephalus etiology

Answer 35

* Idiopathic or secondary to obstruction of CSF reabsorption sites

Question 36

Normal pressure hydrocephalus Characteristic triad of:

Answer 36

1) gait disturbance 2) urinary incontinence 3) cognitive impairment → executive dysfunction, psychomotor retardation

Question 37

Normal pressure hydrocephalus treatment

Answer 37

o Lumbar puncture o Ventriculoperitoneal shunt

Question 38

HIV infection

Answer 38

The most common infectious agent to cause cognitive impairmen

Question 39

HIV infection: neurocognitive impaiment presentation

Answer 39

Variable presentation depending on the part of the brain affected

Question 41

in HIV infection congntive impairement Decline may be observed in

Answer 41

executive functioning, attention, working memory and motor activity

Question 42

HIV infection treatment

Answer 42

antiretroviral therapy