Major Neurocognitive Disorders Quiz
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Questions and Answers

Which medication is NOT typically used to treat psychotic symptoms and delirium?

  • Haloperidol
  • Risperidone
  • Clothiapine
  • Lithium (correct)

According to the diagnostic criteria, which of the following is NOT a major Neurocognitive Disorder?

  • Multiple Sclerosis (correct)
  • Frontotemporal Degeneration
  • Alzheimer's Disease
  • Lewy Body Dementia

In the context of Major Neurocognitive Disorders (NCD), what does the term 'behavioral disturbance' primarily refer to?

  • Impaired memory and cognitive function.
  • Problems with physical mobility and coordination.
  • Presence of psychotic symptoms, mood changes, agitation, or apathy. (correct)
  • Difficulties with instrumental activities of daily living.

What is the primary focus when using antipsychotics for patients with delirium?

<p>To address prominent psychotic symptoms or when benzodiazepines have failed. (C)</p> Signup and view all the answers

What is the level of required monitoring for a patient with delirium?

<p>Frequent and regular monitoring by the doctor. (C)</p> Signup and view all the answers

What is the primary characteristic of a neurocognitive disorder?

<p>Inflexibilities or deficits in cognitive domains that impair adaptation and interaction. (D)</p> Signup and view all the answers

Which of the following best describes the nature of cognitive deficits in major neurocognitive disorders?

<p>Fluctuating cognition that deteriorates over time. (C)</p> Signup and view all the answers

What is the relationship between brain networks and neurocognitive disorders?

<p>Neurocognitive disorders reflect a dysfunction in brain networks that control integrated cognition. (B)</p> Signup and view all the answers

Which of the following is a core criterion for diagnosing delirium?

<p>A clouding of consciousness. (B)</p> Signup and view all the answers

What is a defining characteristic of the 'acute' specifier for delirium?

<p>Symptoms lasting only a few hours or days. (A)</p> Signup and view all the answers

If a patient's cognitive function is described as being like 'cheese with holes', what does this metaphor primarily refer to?

<p>Integrated cognitive function is no longer intact. (A)</p> Signup and view all the answers

In the context of cognitive domains, what does the term ‘inflexibilities or deficits’ signify?

<p>Difficulties in adapting and interacting rationally with the environment. (C)</p> Signup and view all the answers

According to the information provided, what is the typical long-term trend for cognition in major neurocognitive disorders?

<p>Cognition deteriorates over time, with possible daily fluctuations. (D)</p> Signup and view all the answers

What is the primary focus when treating delirium?

<p>Treating the underlying cause of the delirium (C)</p> Signup and view all the answers

Which characteristic is NOT a typical manifestation of delirium?

<p>A consistent and unchanging course of the illness (B)</p> Signup and view all the answers

When managing delirium, what does the acronym 'DIMITOP' represent?

<p>The common causes and risk factors underlying the delirium (D)</p> Signup and view all the answers

When should benzodiazepines be avoided in managing a patient with delirium?

<p>Always, regardless of etiology (A)</p> Signup and view all the answers

Which of these is NOT a recommended nursing intervention for a patient with delirium?

<p>Placing the patient in a noisy environment for stimulation (A)</p> Signup and view all the answers

What is the most important factor for healthcare staff to remember when using medication to manage a patient's behavior?

<p>To use medication only if essential (A)</p> Signup and view all the answers

Which of the following is a key element to consider when diagnosing delirium?

<p>Presence of criteria A followed by criteria C in any activity level (C)</p> Signup and view all the answers

What is NOT a recommended element of general management guidelines for delirium?

<p>Using long-acting benzodiazepines to maintain control (B)</p> Signup and view all the answers

Which behavioral manifestation is MOST commonly observed in individuals with neurocognitive disorder?

<p>Urinary Incontinence (D)</p> Signup and view all the answers

What percentage of individuals with neurocognitive disorder experience delusions?

<p>16-30% (A)</p> Signup and view all the answers

Which of the following is a common thought content manifestation in neurocognitive disorder?

<p>Perseveration (A)</p> Signup and view all the answers

Compared to depressive symptoms, mania is considered with neurocognitive disorder?

<p>Very Rare (D)</p> Signup and view all the answers

Disorientation in neurocognitive disorder most closely relates to which factor?

<p>Memory impairment (A)</p> Signup and view all the answers

What is meant by 'bad cop decisions' in the context of managing neurocognitive disorder?

<p>Necessary but potentially upsetting actions (A)</p> Signup and view all the answers

Which of these is considered a symptom of perceptual disturbance?

<p>Hallucinations (D)</p> Signup and view all the answers

How does the severity of neurocognitive disorder impact thought content?

<p>Is directly related to degree of atrophy (C)</p> Signup and view all the answers

What is the MOST frequent sleep disturbance noted in those with neurocognitive disorder?

<p>Intermittent Insomnia (A)</p> Signup and view all the answers

What percentage of individuals with neurocognitive disorder experience sexual disinhibition?

<p>7% (B)</p> Signup and view all the answers

Flashcards

What is a neurocognitive disorder?

A neurocognitive disorder is a medical condition that affects the cognitive processes of the brain like memory, language, thinking, attention, and executive functioning.

What are cognitive domains?

Cognitive domains are specific areas of cognitive functioning, such as memory, language, attention, executive functioning, and visuospatial ability.

What happens when there are inflexibilities or deficits in cognitive domains?

Inflexibilities or deficits in cognitive domains can mean that a person has problems adapting to new situations or interacting effectively with their environment.

What is integrated cognitive function?

Integrated cognitive function means all the different cognitive domains work together smoothly and effectively. When there are problems with cognitive domains, integrated function is disrupted.

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What is delirium?

Delirium is characterized by a sudden change in mental status, often with confusion, disorientation, and fluctuating levels of consciousness.

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Why is delirium concerning?

Delirium is a serious medical condition that requires prompt evaluation and treatment. It can be triggered by various factors, including infections, medications, and withdrawal from alcohol or drugs.

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What are predisposing and precipitating factors for delirium?

Predisposing factors are those that increase a person's susceptibility to delirium, such as advanced age, dementia, and underlying health conditions. Precipitating factors are those that directly trigger the onset of delirium.

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What are the DSM-5 criteria for delirium?

The DSM-5 criteria for delirium include requirements like a disturbance in attention and awareness, a change in cognition that is not better explained by a pre-existing, established, or evolving neurocognitive disorder, and rapid onset and fluctuating course.

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When to use antipsychotics for NCDs?

Antipsychotics are medications used to manage psychotic symptoms, like hallucinations or delusions, in patients with NCDs, particularly when benzodiazepines haven't been effective.

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Why is Delirium an Emergency?

Delirium is a medical emergency that requires immediate attention and monitoring by a doctor due to its rapid onset, confusion, and fluctuating levels of consciousness.

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What is a Major Neurocognitive Disorder? (NCD)

This is a diagnosis given to people with a decline in cognitive function causing problems with daily activities.

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Name some conditions that can cause Major NCD.

Alzheimer's disease, Frontotemporal Degeneration, Lewy Body Dementia, Vascular disease, brain injuries, substance use disorders, and HIV-associated NCDs are just a few examples.

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What are the severity levels of a Major NCD?

A Major NCD can be mild, moderate, or severe depending on the level of cognitive decline and its impact on a person's ability to perform daily activities. Mild NCD affects instrumental activities of daily living, while more severe forms affect basic activities.

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Delirium: Core Features

A state of altered mental status characterized by an acute onset, fluctuating course with episodes of clarity and relapse, and disturbances in attention, awareness, and cognition.

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Delirium: Key Distinguishing Features

A disturbance in attention (reduced ability to focus, sustain, or shift attention) and awareness (reduced orientation to the environment).

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Delirium Treatment: Primary Goal

The underlying cause of delirium needs to be addressed. It is considered a secondary syndrome arising from an underlying medical, biological, or physiological disruption.

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Delirium Duration

Delirium is typically a temporary condition lasting days to weeks.

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Delirium: Contributing Factors

Delirium can be caused by a variety of factors, including infections, metabolic disturbances, trauma, oxygen deprivation, and psychological stressors.

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Delirium Management: Key Strategies

The management of delirium involves addressing behavioral symptoms and ensuring patient safety.

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Delirium Management: Benzodiazepines

Benzodiazepines are used to manage delirium in cases of withdrawal from alcohol or benzodiazepines, often used with other medications.

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Delirium Management: Antiepileptics

Antiepileptic medications may be used to manage delirium in patients with seizures or post-seizure complications.

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What is a Neurocognitive Disorder (NCD)?

NCD refers to a decline in cognitive function, impacting memory, thinking, language, and overall mental abilities. It's not just a normal part of aging, but a serious condition requiring attention and care.

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How are NCDs Classified?

NCDs are broadly categorized into Major NCD and Mild NCD, depending on the severity of cognitive decline. Major NCD severely impacts daily life, requiring significant assistance, while Mild NCD causes less impairment but noticeable changes.

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What is Aggression in NCDs?

Commonly observed in NCDs, aggression can manifest as verbal outbursts, physical violence, or resistance to care. It often arises from frustration, confusion, or fear stemming from cognitive decline.

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What is Wandering in NCDs?

Wandering, a common behavior in NCDs, involves aimless walking or leaving familiar environments without a clear purpose. It can be triggered by disorientation, restlessness, or an urge to search for something lost.

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What is Overeating in NCDs?

Overeating is a behavioral manifestation of NCD, often leading to weight gain. The underlying reasons can be changes in metabolism due to brain atrophy, confusion about mealtimes, or simply forgetting they've eaten recently.

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What are Hallucinations and Illusions in NCDs?

Hallucinations and Illusions are common in NCDs, with the individual experiencing distorted sensory perceptions. Hallucinations are false perceptions, while illusions are misinterpretations of real stimuli.

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What is Disorientation in NCDs?

Disorientation in NCDs is the inability to correctly ascertain time, place, or person. It results from memory impairment, affecting their ability to recall information and understand their surroundings.

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What are Sleep Disturbances in NCDs?

Sleep disturbances like intermittent insomnia are common in NCDs. This may be due to changes in brain chemistry, anxieties related to cognitive decline, or simply difficulty adjusting to a consistent sleep routine.

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What are Appetite Changes in NCDs?

Appetite changes can occur in NCDs, leading to either increased or decreased food intake. These changes result from various factors like brain damage, confusion about mealtimes, or changes in taste and smell perception.

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What is Symptomatic Treatment in NCDs?

Symptomatic treatment in NCDs aims to manage behavioral issues and improve quality of life. This involves addressing specific problems like aggression, wandering, or disorientation through tailored therapies and strategies.

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Study Notes

Neurocognitive Disorders

  • Neurocognitive disorders are illnesses affecting cognition
  • Cognitive functions are abnormally affected, whether permanently or temporarily
  • Abnormalities appear in cognitive domains

Cognitive Domains

  • Complex attention

  • Executive function

  • Learning and memory

  • Language

  • Perceptual-motor

  • Social cognition

  • Cognitive deficits can be acute, chronic, or acute on chronic

  • Deficits in these domains inhibit rational interaction with the environment

  • Cognitive function becomes fragmented like a 'holey cheese'

  • Major neurocognitive disorders show gradual deterioration, while delirium is acutely severe

Examples of Functions in Brain Regions

  • NA (nucleus accumbens): delusions, hallucinations, pleasure, interest, libido, fatigue, euphoria, reward, motivation
  • PFC (prefrontal cortex): executive function, attention, concentration, emotions, impulses
  • BF (basal forebrain): memory, alertness
  • S (striatum): motor function, relay site from PFC
  • T (thalamus): pain, alertness, sensory input to and from cortex
  • H (hippocampus): memory, re-experiencing events
  • A (amygdala): negative symptoms, fear, guilt, sleep, appetite, anxiety, suicidality, endocrine
  • C (cerebellum): motor function
  • SC (spinal cord):
  • NT (brainstem neurotransmitter centers):

At the Synaptic Level

  • Neurocognitive disorders are caused by insults
  • Deficits or toxicities in neurotransmitters
  • Diffuse neuronal injury (internal/external)
  • Loss/destruction of neuronal mass
  • Neuronal toxicity/damage (encephalopathies)
  • Electrolyte imbalances

Delirium (The Acute Syndrome)

  • Delirium is an acute cerebral insufficiency caused by widespread disruption of cerebral metabolism (encephalopathy)
  • A medical emergency requiring identification and treatment
  • Often mistaken for psychosis, leading to missed diagnoses
  • Characterized by fluctuating awareness & attention, and additional cognitive disturbances (memory, language, perception)
  • Treatment focuses on treating the underlying cause

Risk Factors for Delirium

  • (Predisposing):*
  • Age >75 years
  • Dementia/baseline cognitive impairment
  • Male
  • Depression
  • Functional dependence
  • Malnutrition
  • Substance abuse
  • Visual/hearing impairment
  • Comorbidities/severe illness
  • (Precipitating):*
  • Acute infection
  • Polypharmacy/psychoactive drugs/sedatives
  • Catheterization
  • Electrolyte imbalances
  • Hospitalization
  • Major procedures
  • Low albumin

DSM-V Criteria for Delirium

  • A. Disturbance in attention and awareness
  • B. Disturbance develops quickly, fluctuates in severity, and represents a change from baseline
  • C. Additional disturbance in cognition (e.g., memory, disorientation, language, visuo-spatial ability, perception)
  • D. Disturbances are not better explained by another neurocognitive disorder or severe reduced arousal (coma)
  • E. Evidence from history, exam, or lab findings of a medical condition/substance intoxication/withdrawal/toxin exposure/multiple etiologies as the causality of the symptoms

Specifiers for Delirium

  • Substance intoxication/withdrawal

  • Medication-induced

  • Due to another medical condition

  • Due to multiple etiologies

  • Activity levels can be hyperactive (agitation, mood lability, refusal to cooperate) or hypoactive (sluggishness, lethargy approaching stupor) or mixed.

Problematic Domains in Delirium

  • Mood symptoms: hypomania, irritability, lability
  • Psychotic symptoms: disorganized behavior, thoughts, hallucinations, delusions, mutism
  • Behavioral problems: negativism, aggression, wandering

Parting Comments on Delirium

  • NCD: chronic/insidious onset, clouded consciousness in late stages, normal arousal, deteriorating course, common in geriatrics (nursing homes)
  • Delirium: acute/rapid onset, clouded fluctuating consciousness, agitation/stupor, reversible, common in medical/surgical/neurological wards

Principles of Treatment

  • Identify the underlying cause (blood work, e.g. FBC, DiFF, SMAC, TFT, RPR, HIV, folate, B12, dipstick, LP IF indicated)
  • Address reversible factors (iron def., malnutrition, COPD hypoxia, hypotension, infections, etc)

Symptomatic Management

  • Control behaviors in severely agitated patients
  • Use appropriate agents (e.g. haloperidol, benzodiazepines, clozapine, etc.)
  • Start low and titrate carefully
  • Avoid abrupt discontinuation

Other Management Guidelines

  • Safe environment (quiet, well-lit room)
  • Consistent observation and vital function monitoring
  • Clear reminders regarding family/place/time
  • Use minimal medication
  • Be aware of co-morbidities

Diagnostic Criteria Major NCD

  • Significant cognitive decline (one or more domains)
  • Substantial impairment, preferably through standardized testing or other quantified assessment
  • Interference with daily living activities (e.g., instrumental activities)
  • Not occurring exclusively in delirium
  • Not better explained by another mental disorder, like MDD or schizophrenia

Conceptual Explanation of MNCD

  • Syndrome clinically recognizable but potentially due to multiple underlying etiologies
  • Specifiers:
  • -With behavioral disturbances (psychotic, mood, agitation, apathy)
  • -Without behavioral disturbances

Manifestations of NCD

  • Behavior: Aggression, wandering, overeating, hyperorality, incontinence, sexual disinhibition
  • Thought Content: Delusions, form of thought.
  • Emotions/Mood: Depression, mania, rarer.
  • Perceptions: Hallucinations, illusions, perceptual dysfxn
  • Sleep: Insomnia
  • Appetite: Changes

Treatment of Major Neurocognitive Disorders (MNCD)

  • Identify the etiological subtype (e.g., Alzheimer's)
  • Basic blood tests and/or specialist investigations (CSF for amyloid beta and tau in Alzheimer's)
  • Optimize reversible risk factors (e.g., iron deficiency, malnutrition, hypoxia, hypotension)

Symptomatic Treatment of Major NCDs

  • Behaviour problems: therapeutic program, family collaboration, and possible acute sedation.
  • Aggression: behaviour therapy, sedative if needed
  • Delusions/hallucinations: low-dose antipsychotics (haloperidol, risperidone, olanzapine)
  • Depression: medication for major MDD if evident, avoid anticholinergic meds
  • Anxiety: prescribe only if full syndrome present, avoid benzodiazepines

Proper Medical Treatment of MNCDs

  • Proper physical and neurologic examination
  • Use of acetylcholinesterase inhibitors (Donepezil, Rivastigmine, Galantamine) are often useful in Alzheimer's disease and related disorders.
  • Trial for 8 weeks often needed in vascular NCD or Parkinson's NCD to test if memory/verbal fluency improves

Treatment for Behavioral and Psychological Symptoms of Dementia (BPSD)

  • Use lower dosages of psychotropics
  • Start with low doses gradually
  • Avoid abrupt discontinuation of medication
  • Be mindful of co-morbid meds/drug-drug interactions.

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Test your knowledge on Major Neurocognitive Disorders and delirium with this comprehensive quiz. Explore key concepts such as diagnostic criteria, treatment options, and cognitive deficits. Perfect for students and professionals in psychology and mental health fields.

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