Week 12 Terms: Neurocognitive Disorders, Substance Use, and Trauma

Question 1

What is one of the biggest risk factor of Alzheimer’s Disease?

Answer 1

Advanced Age
An estimated 6.5 million Americans age 65 and older are living with Alzheimer’s in 2022

Question 2

What are the different types of Dementia?

Answer 2

Alzheimer’s
Vascular
Lewy Body
Frontotemporal
Huntington’s
Mixed Demential (Dementia from more than one cause)

Question 3

Dementia

Answer 3

Umbrella term for loss of memory and other thinking abilities severe enough to interfere with daily life.

Question 4

Alzheimer’s Disease

Answer 4

Damage to nerve cells causing memory failure, personality changes, and difficulty with daily activities.

Plaques (deposits of a protein fragment called beta-amyloid) that build up in the spaces between nerve cells.
Tangles (twisted fibers of another protein called Tau) that build up inside cells
- Blocking communication among nerve cells
- - Disrupting cell function

Question 5

True/False
Cognitive disorders are a normal part of aging.

Answer 5

False
Cognitive disorders are NOT a normal part of aging.

Question 6

Three Types of Delirium

Answer 6

Hypoactive
Hyperactive
Mixed

Question 7

Hypoactive Delirium

Answer 7

Sluggish, drowsy
Reduced activity or interaction

Question 8

Hyperactive Delirium

Answer 8

Restlessness
Mood Swings
Hallucinations
Refusing Care

Question 9

Delirium

Answer 9

• An organic mental syndrome
• Acute Onset
• Fluctuating Cognitive FUnctioning
• Changes in physiology - Low Sodium, Medication, Infection, Substance Withdrawl
• Reversible

UTI’s affect older individuals and this can create a rapid change

Question 10

Causes of Delirium

Answer 10

• Seizures
• Trauma/ Concussion
• Brain tissue infections
• Medications
• Infections
  -Fever
  -Sepsis
• Electrolyte imbalance
  -Dehydration
• Metabolic Disorders
  -Diabetic reactions
  -Liver/ kidney dysfunction (UTI)
  -Hypoxia
  -Cardiac dysfunction
• Post-surgery
• Alcohol/ drug use

Question 11

Symptoms of Dementia

Answer 11

Disorganized thoughts
Memory loss
Sensory disturbance
Language difficulty
Behavior disturbance

Question 12

How do you diagnose Alzheimer’s Disease?

Answer 12

• Patient and family report and history of symptoms
  -Cognitive decline
  -Decreased ability to function
• Mental status exam
• Neuropsychological testing
• Rule out depression and other treatable causes of cognitive impairment

Question 13

Early/Pre-Clinical Diagnoses of Alzheimer’s Disease

Answer 13

Changes may begin 20 years or more before diagnosis
Biomarker changes but no symptoms
Forgetting becomes more frequent
Difficulty with complex tasks
Word finding difficulty
Questionable judgment or decision making
May cover up with jokes or deflection

Question 14

Cognitive Impairment of Alzheimer’s Disease

Answer 14

• Memory worsens
• Communication gets more difficult
• Lose/misplace important items
• Trouble solving problems with familiar, routine tasks
• Visual perception and spatial relations problems
  -May have trouble judging distance
• Changes in personality or behavior
• Changes in sleep patterns

Usually diagnosed by this point

Question 15

Dementia Part of Alzheimer’s Disease

Answer 15

• Every day tasks become difficult
• Errors are more frequent
• Unable to recall personal information
• IADLs become dangerous or impossible
• Eventually complete reverse development: unable to walk, talk, care for self
• Incontinence
• Difficulty communicating

Question 16

How can an OT help someone with Alzehimer’s?

Answer 16

Facilitating ADL participation
Safety strategies
Memory aides
Maintain/promote mobility
Facilitate social participation & communication
Sensory interventions
Sleep habits
Educating family & caregivers

Question 17

Substance Use Disorder (SUD)

Answer 17

Continued use of alcohol, tobacco, marijuana, or medications prescribed or not prescribed despite significant disruption to meaningful activities

Question 18

What are the four symptom clusters of Substance Use Disorder?

Answer 18

Impaired Control
Social Impairment
Risky Use
Drug Effects (Withdrawal)

Question 19

Describe the severety of conditions for SUD

Answer 19

Mild
-2-3 symptoms
Moderate
-4-5 symptoms
Severe
-6 or more
Subtypes
delineated by the category of drug
not by amount or patterns of use

Only 4 symptom clusters, 5 or more symptoms in each category

Question 20

What are the ten classes of drugs?

Substance Use Disorders

Answer 20

1. Alcohol
2. Caffeine
3. Cannabis
4. Hallucinogens
5. Inhalants
6. Opiods
7. Sedatives, Hypnotics, and Anxiolytics
8. Stimulants
9. Tobacco
10. Other Substances and Nonsubstance (Gambling)

Question 21

True/False
Alcohol and tobacco are the most common substances abused

Answer 21

True

Question 22

Dual Diagnosis for SUD

AKA Co-Occurring Disorders

Answer 22

Substance use disorder and mental illness or intellectual disability

Question 23

Impact of SUD on Occupational Performance

Answer 23

Substance use is occupation
Continuum of consequences
positive – negative
Environmental factors
-Physical
-Social or cultural
Disruption of routines
Risks compound with dual dx

Question 24

Risk Factors of SUD: Neurobilogical Factors

Answer 24

Genetic predisposition
Process/experience leads to compulsive use
Lack inhibitory control

Question 25

**Risk Factors of SUD: Psychological and Environmental Factors**

Answer 25

Personality Traits Fixed Mindset

Question 26

**Risk Factors of SUD: Sociological Considerations**

Answer 26

Poverty Trauma Exposure Social Endorsement

Question 27

**Complex Trauma**

Answer 27

Subjected to repetitive adverse experience/maltreatment | typically related to children/adolescent

Question 28

**Symptoms of Trauma**

Answer 28

Cognitive Emotional Physiological Behavioral | Degree of impact/effect varies

Question 29

**Trauma**

Answer 29

emotional wound or shock that creates substantial, lasting damage to the psychological development of a person

Question 30

**Stress**

Answer 30

State of tension causing anxiety or worry -Triggered by a stressor *Acute- Short stress response elicited by event Chronic- Repeated and Prolonged Activation Traumatic- Exposure to trauma*

Question 31

**Diagnosis of Adjustment Disorder**

Answer 31

Distress impacts function Stressor can typically be identified

Question 32

**What are the symptom clusters of PTSD?**

Answer 32

* Intrusion *Reexperiencing, with or without a trigger Dissociation * * Persistent avoidance *Avoid triggers Mood & cognition changes* * Persistence negative thoughts & feelings *Memory Shame/guilt/identity* * Altered arousal or reactivity *Stress response Hyper-vigilance Cognition Sleep*

Question 33

**Risk Factors of PTSD**

Answer 33

33% sexual violence 30% interpersonal experience 12% interpersonal violence 14% organized violence 11% life-threatening experience

Question 34

**True/False** Complex trauma typically affects children and/or adolescents subjected to repetitive adverse experiences/maltreatment.

Answer 34

**True**

Question 35

**Risk Factors of Complex Trauma**

Answer 35

* Multiple exposure to traumatic events * Inconsistent or absent protective caregiving * Physical, sexual, or emotional abuse * Transgenerational * Parents/Caregivers *(Young or single parents, Were abused as children, Have psychiatric disorders, Have realistic expectations of child development)* * Families *(Substance abuse, Low income, Transient adults in home)* * Children *(Congenital anomalies, Unwanted child, Adopted/foster children, “Fussy” infants, “Disobedient” children) *

Question 36

**Secure Attachment** | Children

Answer 36

* Normal child-caregiver relationship * Provide safety & protection during stressful situations * Predictable * Consistent * Trustworthy * Translates to meaningful adult connections

Question 37

**Insecure Attachment** | Children

Answer 37

Avoidant-*Caregiver disengaged/unavailable, Self-reliance, Dismissive of emotions/relationships* Ambivalent - *Caregiver inconsistent, Fear abandonment, Dependency* Disorganized- *Caregiver chaotic & abusive, Alternate between high & low arousal emotions, Repeating abusive patterns*

Question 38

**What are some poor attachment outcomes?** | Children

Answer 38

Social isolation Difficulty with perspective taking Establishing/maintain healthy relationships Chronic feelings of distrust / suspicion

Question 39

**What are the 7 domains of impaired attachment?**

Answer 39

Attachment Biology Affect Regulation Dissociation Behavioral Regulation Cognition Self-Concept

Question 40

**What is important to remember with trauma informed care?**

Answer 40

The client is doing the best that they can. There is a high prevalence of trauma, we need to understand the influence of trauma and be sensitive of a client's specific needs/concerns