Neurocognitive Disorders

Question 1

What is Dementia?

Answer 1

Gradual deterioration of brain functioning - loss of neurons

Question 2

What is Delirium?

Answer 2

Confused state associated with reduced ability to maintain and shift attention. Result of medical problems.

• Rapid onset and worse at night
• Sleep/wake cycle disturbed
• Perceptual disturbances (hallucinations)

Question 3

What cognitive functions are affects by Neurocognitive Disorders?

Answer 3

• Perception and attention
• Memory
• Reasoning adn decision-making

Question 4

What is difference between the onset of Delirium and Dementia?

Answer 4

Delirium is sudden onset while Dementia is slow (months to years)

Question 5

What is difference between the course of Delirium and Dementia?

Answer 5

Delirium is fluctuations while Dementia is stable with general decline

Question 6

What is difference between the duration of Delirium and Dementia?

Answer 6

Delirium is brief while Dementia is long/lifetime

Question 7

What is difference between the hallucinations of Delirium and Dementia?

Answer 7

Delirium is visual/tactile/vivid while Dementia rare in early stages

Question 8

What is difference between the insights of Delirium and Dementia?

Answer 8

Delirium is lucid intervals while Dementia is consistently poor

Question 9

What is difference between the sleep of Delirium and Dementia?

Answer 9

Delirium is disturbed while Dementia is less disturbed

Question 10

What is Major Cognitive Disorder?

Answer 10

Dementia - must exhibit substantial cognitive decline that interferes with independence

Question 11

What is a Minor Cognitive Disorder?

Answer 11

Must exhibit modest cognitive decline that does not interfere with independence

Question 12

What is the most common Neurocognitive Disorder?

Answer 12

Alzeimers

Question 13

How is Alzeimers diagnosed?

Answer 13

By exclusion - autopsy only true diagnosis

Question 14

What age does onset occur for Alzeimers?

Answer 14

40 to 90yo

Question 15

What are the neurocognitive symptoms of Alzeimers?

Answer 15

• Forget name and familiar objects (early Stages)
• Intellectual and motor function disappear (later stages)
• Consistent course of heterogeneous presentation
• Memory and Learning: Retrograde and anterograde amnesia, retrospective and prospective memory, episodic and semantic memory.
• Verbal Communication: Aphasia and apraxia
• Perception - Agnosia, Anosognosia
• Personality and social behaviour: apathy, poor self care, agitation, change in personality (paranoia, negativity), Sundowner Syndrome
• Executive dysfunction
• Judgement
• Motor Behaviour - muscular rigidity, agitation, dyskinesia
• Psychotic disturbances - usually persecutory and theft (later stages)
• Bereavement - frozen grief (forgets loved ones are dead)

Question 16

What is aphasia?

Answer 16

Loss/impairment in language

Question 17

What is apraxia?

Answer 17

Unable to do tasks in response to verbal commands

Question 18

What is Agnosia?

Answer 18

Perception without meaning ie can not tell comb by word, but can by touching

Question 19

What is Anosognosia?

Answer 19

not aware of disease

Question 20

What is Sundowner Syndrome?

Answer 20

Symptoms worse at night

Question 21

What is dyskinesia?

Answer 21

Involuntary muscle movement

Question 22

What is the neuropathology of Alzeimers?

Answer 22

• Beta amyloid plaques create brain sludge
• Neurofibrillary tangles - Tau maintains structural integrity of microtubals within neurons. Tau loses capacity or bind, so proteins tange, microtuble disintegrates causing neuron death.

Question 23

What are the stages of Alzeimers?

Answer 23

Preclinical, Mild, Moderately severe, Severe

Question 24

Define the Preclinical stage of Alzeimers?

Answer 24

Prior to diagnosis - brain changes but no symptoms

Question 25

Define the Mild stage of Alzeimers?

Answer 25

Increased plaques/tangles, increased memory problems, increased difficulties with instrumental activities of daily living, subtle personality changes

Question 26

Define the Moderately severe stage of Alzeimers?

Answer 26

Increased neuropathology, difficulty with basic everyday tasks, motor co-ordination, difficulties, agitation/anger, psychosis, more intense supervision necessary

Question 27

Define the severe stage of Alzeimers?

Answer 27

Plaques and tangles are widespread, complete dependence, seizures, death, aspiration and pnemonia

Question 28

What are the criteria for Frontotemporal Neurocognitive Disorder?

Answer 28

- Dementia associates with atrophy of the frontal and temporal lobes - Memory unaffected in early stages. Changes in personality/behaviour and emotion - Semantic/Temporal variant decline in language ability

Question 29

What is Neurocognitive Disorder with Lewy Bodies (2nd most common)?

Answer 29

- Rounded deposits found in nerve cells (brainstem of Parkinsons) - Recurrent and detailed visual hallucinations, Parkinson features and more rapid progression

Question 30

What is Vascular Neurocognitive Disorder (Equal to Lewy bodies in occurance)?

Answer 30

- Dementia associated with problems of circulation of blood to the brain. - Rapid onset - Must have cognitive disorder and clinical stroke or brain vascular disease by imaging

Question 31

What is multifart?

Answer 31

Lots of little strokes - gradual onset

Question 32

What is Neurocognitive Disorder due to Brain Injury?

Answer 32

Disorder as a result of glascocoma scale, post traumatic amnesia and loss of consciousness

Question 33

What is Neurocognitive Disorder due to Huntington's Disease (rare)?

Answer 33

- Relatively early onset (mid 40's) due to autosomal dominant genetic disorder - Gradual destruction of neurons especially basal ganglia - Movement disorder, emotional changes, cognitive impairments

Question 34

What is Neurocognitive Disorder due to Parkinson's Disease?

Answer 34

- Degeneration of specific area of brain stem (Reduced production of dopamine) - Physical symptoms - tremors, rigidity, postural abnormalities - Must be diagnosed with Parkinsons first

Question 35

What is the frequency of Nuerocognitive Disorder in 65-69 year olds?

Answer 35

1%

Question 36

What is the frequency of Nuerocognitive Disorder in 90+ year olds?

Answer 36

40%

Question 37

What is the frequency of Nuerocognitive Disorder in 75-79 year olds?

Answer 37

6%

Question 38

What is the aeitiology of Delirium?

Answer 38

- Involves neuropathology and neurochemistry - Medication - psychicatric drugs, heart condition, pain killers, stimulants - Medical conditions including infections

Question 39

What is the aeitiology of Neurocognitive Disorders?

Answer 39

- Genetics: Apolipoprotein E allele e-2 (reduced chance), e-3 (50/50), e-4 (increased chance) - Lifestyle: Diet (vascular illness), risk taking (head injury, HIV) - Age - Neurotransmitters: eg Parkinsons - degeneration of dopamine pathways, Huntingtons - deficiences in GAMA - Viral infections eg Cruetzfeldt-Jakob disease - Immune system dysfunction - based on presence of net-amyloid at the core of the amyloid plaques - Environmental Factors: Head injuries (WWII vets with head injuries had increased chance of alzeimers)

Question 40

What is Dementia Pugilistica?

Answer 40

Regular punching to the head resulting in increase chance of alzeimers

Question 41

How to protect against Neurocognitive Disorders?

Answer 41

Intellectual changes Bilinguilism BUT more educated decline faster

Question 42

How are Neurocognitive disorders treated?

Answer 42

- Medication: Acetylcholine (neurotransmitter involved in memory), Donepezil - only effective for 6 to 9 months - Environmental and behavioural management:- structured and predictable schedule, helped to remain active and interested in everyday events, Directions adjusted to level of functioning - Support for caregivers - profound loneliness and sadness, learning to cope with tangible stressors, guilt frustration and depression