Neurocognitive disorders Flashcards
(14 cards)
cognitive disorder definition and 2 most common
cause a clinically significant deficit in cognition that represents a major change from the person’s previous baseline level of function
delirium
dementia
delirium
syndrome, not a disease
acute onset that causes short term changes in cognition
hallmark sx is disturbance of consciousness accompanied by changes in cognition
delirium subtypes
hyperactive
–agitated, restless, hyperalert
hypoactive
–lethargic, slowed, apathetic
Mixed
–cycles
delirium assessment instrument
Confusion Assessment Method (CAM)
delirium assessment
Key findings
-disturbance of consciousness develops over short time (hours to days)
-tends to fluctuate during the day
Sleep/rest cycle disturbances
–reversal is common
Impaired recent and intermediate memory
Psychomotor agitation
-purposeless random actions
Course may resolve within hours to days
-Quick response/identification of source means quick resolution
-Unrecognized may last months
-Most sx resolve 3-6 mo
delirium pneumonic
Drugs
Electrolyte abnormality
Low oxygen saturation
Infection
Reduced sensory input
Intracranial
Urinary or renal retention
Myocardial
Dementia
a group of disorders characterized by gradual development of multiple cognitive deficits
–impaired executive functioning
–impaired global intellect with preservation of LOC
–impaired problem solving
–impaired organizational skills
–altered memory
forms of dementia
DAT (alzheimers type)
-most common
-gradual onset and progressive decline
VD (vascular dementia)
-2nd most common
-CVD cause, step type declines
-more men with preexisting CVD
Dementia due to HIV
-subcortical dementia
-MRI shows parenchymal abnormalities
-progressive cognitive
-comorbid OCD/PTSD/GAD etc
-late stage
-Note CYP for HIV rx and psychotropics
Picks disease
-frontotemporal dementia
-neuronal loss, picks bodies
-more men
-personality changes early
-cognitive changes later
Creutzfeldt-Jakob Disease
-fatal/rapid
-start fatigue/flulike/cognitive
-later aphasia/apraxia/psychosis
-death in 6 mo
Huntington’s disease
-subcortical type of demential
-motor abnormalities
-psychomotor slowing
-memory/language ok til later
-MDD and psychosis common
Lewy Body disease
-Lewy bodies in cortex
-recurrent visual hallucinations
-parkinson features
-adversely react to antipsychotics
dementia assessment
detailed history (routine +)
-PMH heart, head, psych
-validate hx with family/caregiver
-how deficit like cant learn new info, forget past info, lost valuables, forget ADL, easily lost, other cognitive like exec function
instruments
-MMSE
-MoCA
-Mini-cog
-SLUMS
always consider visual, sensory, language, physical disabilities and education when doing mental status tests
Amaurosis fugax
unilateral transient vision loss
described as curtain over eye
seen in dementia physical exam
dementia mgmt
Cognitive sx
-N-methyl D-aspartate glutamate receptor antagonists
—–memantine for mod-severe alzheimers. Can combo with donepezil
-cholinesterase inhibitors
—–Donepezil, mild to moderate alzheimers but treats only sx
Psychosis/Agitation
-nonpahrm first
-antipsychotics
-lowest effective dose and attempt to wean periodically
-beware of AEs in older adults (EPS, sedation, postural hypotension, anticholinergic)
-BZD for anxiety, infrequent agitation
Depression
- lowest effective dose
- 6-12 mo then try to taper. Tx as chronic if reoccur
-may be less as gets worse and they are less aware
Nonpharm
- education
-planning
-safety
-behavior therapy
-recreational therapy
-reminiscence therapy
-simple daily routine
-integrate cultural beliefs
major or minor neurocognitive disorder due to TBI
If DSM dx not met for major/minor neurocognitive disorder
evidence of TBI with LOC, post amesia, disorientation/confusion, neuro signs
MGMT of major or minor neurocognitive disorder due to TBI
Pharm
-Tx sx
-Inc sensitivity to AE of rx
-cognitive disorders
—–Methylphenidate, dextroamphetamine
Nonpharm
- Tx comorbid
-safety plan suicide
-teach family
-1 yr f/u agter suicide attempt
-Tx vestibular dysfunction with PT
-Tx traumatic vision syndrome with OT
-Tx memory with OT
-educate about sx and implications
-avoid substance
-psychotherapy
CBT and aspects of cognitive impairment
Impulsivity
–stop–think–reflect
Decreased awareness, encoding, recall
–monitoring problems and successes
Memory
–use of audiotapes of sessions
Executive Impairment
–develop independent problem solving for everyday difficulties
