NCD--Substance Induced, + d/t HIV, Prion, Parkinsons, Huntingtons, Other Flashcards
(44 cards)
what are the DSM criteria for substance/medication induced Major or Mild NCD
A–> criteria are met for a major or mild NCD
B–> neurocognitive impairments do not occur exclusively during the course of a delirium and persist beyond the usual duration of intoxication and acute withdrawal
C–> involved substance or medication and duration and extent of use are capable of producing the neurocognitive impairment
D–> temporal course of the neurocognitive deficits is consistent with the timing of substance or medication use and abstinence (i.e deficits remain stable or improve after a period of abstinence)
E–> neurocognitive disorder not attributable to another medical condition and is not better explained by another disorder
what types of alcohol relayed NCDs are there
major NCD: nonamnestic-confabulatory type
major NCD: amnestic-confabulatory type
mild NCD
what are the 4 types of substances listed in the DSM for substance/medication induced Major or Mild NCD
alcohol
inhalant
sedative/hypnotic/anxiolytic
other or unknown
what is a specifier for substance/medication induced Major or Mild NCD
persistent–> neurocognitive impairment continues to be significant after an extended period of abstinence
what neurocognitive impairment is seen most predominantly in NCDs due to sedative/anxiolytic/hypnotic drugs/meds
greater disturbances in MEMORY than in other cognitive functions
NCD due to alcohol frequently manifests with a combination of what impairments
impairments in EXECUTIVE FUNCTIONING and MEMORY and LEARNING domains
what are the features of alcohol-induced amnestic confabulatory NCD (korsakoffs)
prominent amnesia (severe difficulty learning new information with rapid forgetting)
tendency to confabulate
*may co occur with signs of thiamine encephalopathy (wernicke’s) with associated features such as nystagmus and ataxia
what ocular abnormality is associated with wernicke’s encephalopathy
lateral gaze paralysis (ophthalmoplegia)
what are the more common neurocognitive symptoms related to methamphetamine use? what kind of overall NCD profile is seen in methamphetamine use
difficulties with learning and memory
difficulties with executive function
*most common neurocognitive profile approximates that seen in vascular NCD
what ocular abnormalities can be associated with methamphetamine use
evidence of vascular injury–> i.e focal weakness, unilateral incoordination, asymmetrical reflexes)
what is the rate of NCD of intermediate duration in those with hx alcohol abuse
30-40% in the first 2 months of abstinence
–> mild NCD may persist especially in those who do not achieve stable abstinence before until after age 50
is major NCD due to alcohol abuse common
no–> MAJOR NCD is rare, may result from concomitant nutritional deficits as in alcohol-induced amnestic confabulatory NCD
what is seen on MRI of individuals with chronic alcohol abuse
cortical thinning
white matter loss
enlargement of sulci and ventricles
*it is possible to observe NCDs without neuroimaging correlates however
*many of these changes reverse after period of of succesful abstinence
those with sub/med induced NCD may have deficits in what areas that are beyond that seen in many other NCDs
reduced cognitive capacity
difficulty concentrating
what are the criteria for major/mild NCD due to HIV infection
A–The criteria are met for major or mild neurocognitive disorder.
B–There is documented infection with human immunodeficiency virus (HIV).
C–The neurocognitive disorder is not better explained by non-HIV conditions, including secondary brain diseases such as progressive multifocal leukoencephalopathy or cryptococcal meningitis.
D–The neurocognitive disorder is not attributable to another medical condition and is not better explained by a mental disorder.
what pattern of NCD is seen in major/mild NCD due to HIV infection
“subcortical pattern”
–> prominently impaired EXECUTIVE FUNCTION, slowing of processing speed, problems with more demanding attentional tasks, difficulty in learning new information
–> in major NCD due to HIV, SLOWING may be prominent
major/mild NCD due to HIV infection show relatively preserved function in what cognitive areas
recall of learned information is relatively preserved
language difficulties are uncommon
what % of those infected with HIV have at least mild neurocognitive disturbance
1/3 to 1/2
*may not meet full criteria for NCD
estimated 25% meet criteria for mild NCD
estimated fewer than 5% meet criteria for major NCD
how might major/mild NCD due to HIV infection present in developing countries in which perinatal HIV transmission is common
may present as neurodevelopmental delay
what are the criteria for major/mild NCD due to Prion disease
A–The criteria are met for major or mild neurocognitive disorder.
B–There is insidious onset, and rapid progression of impairment is common.
C–There are motor features of prion disease, such as myoclonus or ataxia, or biomarker evidence.
D–The neurocognitive disorder is not attributable to another medical condition and is not better explained by another mental disorder.
what type of onset and progression would you expect for major/mild NCD due to Prion disease
insidious onset, rapid progression of impairment (i.e progression to major NCD over as little as 6 months)
what are some motor features of prion disease
myoclonus
ataxia
what is the most common spongiform encephalopathy/prion disease
sporadic creutzfeldt-jakob disease (CJD)
how do those with CJD typically present
neurocognitive deficits
ataxia
abnormal movements–> myoclonus, chorea, dystonia
startle reflex is common
