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NCD
Neurocognitive Disorders
| Term | Definition |
|---|---|
| Neurocognitive Disorders (Dementia) Subtypes | Alzheimer's Frontotemporal degeneration Lewy Body disease Vascular Disease TBI Substance/Medication use HIV Prion Parkinson's Huntington's another medical condition Multiple etiologies Unknown etiology |
| Severity | Mild Major |
| Specifier | With behavioral disturbance Without behavioral disturbance |
| Alzheimer's Disease | Most common subtype of dementia Strong genetic component - 1st degree relative 2-3x risk, similar age of onset |
| Alzheimer's Disease Risk Factors | Female Diabetes Atherosclerosis HTN Smoking AFib Late life depression |
| Alzheimer's Disease Course | Prodromal Phase Early Middle Late |
| Alzheimer's Disease Prodromal Phase | Changes in the brain without clinical symptoms -amyloid deposits (plaques) -buildup of Tau Proteins (tangles) |
| Alzheimer's Disease Early Phase | Mild memory loss Language problems Apraxia - muscle movements Agnosia - recognize/identify Mood and personality changes Mild impairment in executive function Independently performs ADLs |
| Alzheimer's Disease Middle Phase | Worsening language impairment Worsening personality changes Unable to learn/recall new information Long-term memory impacted Prosopagnosia - recognize faces Needs assistance for ADLs |
| Alzheimer's Disease Late Phase | Motor disturbances Incontinence Mutism Reliant on others for ADLs |
| Vascular Neurocognitive Disorder Causes | Caused by vascular injury/disease impacting the brain: Post stroke Multi-infarct Subcortical vascular dementia |
| Vascular Neurocognitive Disorder General Symptoms | Executive function impairment > memory impairment progression more discrete, step-wise, decremental focal neurological symptoms depression and apathy common Hallucinations less common Higher mortality Risk factors - > men, CVD |
| Vascular Neurocognitive Disorder Assessment | Neuroimaging evidence of infarcts and/or white matter lesions Carotid bruits Enlarged Cardiac Chambers HTN |
| Frontotemporal Degeneration | Impacts frontotemporal region of brain Evidence of neuronal loss, gliosis, and Pick bodies (masses of Tau Proteins) Divided into Variants (Behavioral & Primary Progressive Aphasia) |
| Frontotemporal Degeneration Variants | Behavioral: disinhibition, apathy, stereotyped behaviors, oral fixation Primary Progressive Aphasia: insidious decline in language skills, semantic aphasia |
| Frontotemporal Degeneration Distinguish Features | Hard to distinguish from Alzheimer's > men, increase risk factor with 1st degree relative Personality changes first, followed by cognitive changes Age of onset usually before 75 yrs Accounts for 3% of dementias |
| Dementia with Lewy Body | Common Cause of Dementia Hallmark is Lewy Bodies - Alpha-synuclein deposits |
| Dementia with Lewy Body Symptoms | Fluctuating with waxing and waning Hallucinations, particularly visual Parkinsonism REM sleep behavior disorder Hypersensitivity to antipsychotics |
| Dementia with Lewy Body - Differentiating from Alzheimer's | Visuospatial and executive function worse Language and memory function better Earlier age and faster progression than Alzheimer's is common |
| Parkinson's Disease | Lewy bodies are present Begins as a movement disorder - bradykinesia, stiffness/rigidity, shuffling walk Visual hallucinations possible Hypersensitivity to antipsychotics REM sleep behavior disorder Not all patients develop dementia - risk factor |
| Neurocognitive Tests | MOCA MMSE SLUMS ADAS-cog VADAS-cog |
| Mental Status Exam Changes | GABA - decreased ADLs, uncooperative Speech/Language - aphasia, dysarthria, anomia, circumlocutions, echolalia, mutism Mood/Affect - depressed, apathetic, irritable, labile |
| Mental Status Exam Changes continued .. | Thought Process - neologism, thought blocking, poverty of ideas or paucity of thought, illogical Thought content - hallucinations, delusions Orientation - disoriented to place and time in later stages |
| Mental Status Exam Changes continued ... | Memory - impaired recent memory in early stages, impaired remote memory in later stages, poor recall Attention/Concentration - distractible Insight - impaired Judgment - impaired |
| Neurocognitive Disorders Treatment | Care Team Support Groups Therapy - art, pet, doll Environmental Considerations Safety Considerations - fall risk, identity bracelets |
| Neurocognitive Disorders Treatment - Care Team | Primary Care Neurology Physical Therapy Speech Therapy Occupational Therapy Caregivers |
| Neurocognitive Disorders Treatment - Environmental Considerations | Lighting Assistive Devices Orienting Cues - Clocks, Calendars, Photos Living Environment |
Created by:
akimball80
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