Term
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Definition
• Cognitive decline acquired in one or more domains of cognition
• Cognitive domains include:
complex attention, executive function, learning and memory, language, perceptual motor and social cognition
• According to DSM 5 , they are called Neurocognitive disorders
• Neurocognitive disorders includes: - Delirium
- Major Neurocognitive disorders - Minor Neurocognitive disorders |
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Term
| Mild and Major Neurocognitive Disorders DSM 5 criteria |
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Definition
• Evidence of cognitive decline
• Major: interfere with independence in everyday activities
• Minor: does not interfere with independence in everyday activities
• Not due to delirium
• Not due to another mental disorder |
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Term
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Definition
• Disturbance in attention and awareness
• Develops over short period and fluctuates
• Disturbance in cognition
• Not explained by neurocognitive disorder or in context of reduced arousal level
• Evidence that it is caused by medical condition, substance or medication |
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Term
| delirium vs dementia epidemiology, etiology, pathophys |
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Definition
epidemiology: delirium- Common among hospitalized patients – about 10% dementia- 5% over age of 65 20% over age of 80
etiology: delirium- Systemic disease CNS disease Metabolic Medication Drugs of Abuse dementia-Alzheimer (70-80%) Vascular Others: Head trauma Alcohol Movement disorders HIV
pathophys: delirium- Dysfunction in reticular formation
Reduced cholinergic transmission dementia- Depends on etiology |
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Term
| delirium vs dementia hx, onset, duration, course, lvl of consciousness, affect, thinking, memory, sleep, attention, reversibility |
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Definition
History: delirium: Acute dementia: Chronic
Onset: delerium- Rapid dementia-Insidious
Duration: delerium-Days to weeks dementia-Month to years
Course: delirium-Fluctuating dementia-Chronically progressive
Level of Consciousness: delirium-Fluctuates dementia-Normal
Affect: delirium-Anxious, irritable dementia-Labile
Thinking: delerium-Often disordered dementia-Decreased Amount
Memory: delirium-Recent memory markedly impaired dementia-Both recent and remote impaired
Sleep delirium-Disrupted sleep wake cycle dementia-Less disruption of sleep wake cycle
Attention: delirium-Prominently impaired dementia-Less impaired
Reversibility: delirium-Often Reversible dementia-Majority not reversible |
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Term
| delirium vs dementia diagnosis, management |
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Definition
diagnosis: delirium-Medical emergency, cause to be identified
Complete blood and urinalysis, urine toxicology, EKG, CT of the head, chest x-ray dementia- Identify reversible cause of dementia
Complete blood work including thyroid function test, Vitamin B12 and Folate, CT head, SPECT
management: delirium- Treat underlying cause
Low dose of haloperidol may be used for agitation dementia-
Treat reversible cause Alzheimer – cholinesterase inhibitors
Generally supportive |
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Term
| delirium differential diagnosis |
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Definition
| dementia, schizophrenia and mania, dissociative disorders |
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Term
| dementia differential diagnosis |
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Definition
- Age associated memory impairment (normal aging) - Depression (pseudodementia)
- Delirium |
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Term
| alzheimer dementia epidemiology |
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Definition
• Most common cause of dementia
• 50-60% of all dementia
• 5% of persons over age 65
• 15-20% of persons over age 85 or older |
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Term
| alzheimer dementia brain changes |
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Definition
| neurofibrillary tangles, amyloid plaques |
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Term
| alzheimer dementia risk factors |
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Definition
• Increasing age
• Family history
• Genetic Risk Factors
• Vascular Risk Factors
• Head trauma
• Education |
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Term
| alzheimer dementia diagnosis |
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Definition
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Term
| alzheimer dementia DSM 5 criteria |
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Definition
Probable if either are present:
1. Evidence of causative Alzheimer genetic mutation
2. All three are present:
a. Clear evidence of decline in memory and learning and atleast one other cognitive domain
b. Progressive, gradual decline in cognition without extended plateaus
c. No evidence of mixed etiology |
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Term
| alzheimer dementia diagnosis |
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Definition
• Neuropsychological testing
• Brain imaging techniques |
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Term
| alzheimer dementia management |
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Definition
• Pharmacology:
- Cholinesterase inhibitors
- Mementine
• Psychological:
- Education to family
- Behavioral: providing orienting cues, using aids including music, film and photographs; Behavioral modification techniques
- Support to caregivers |
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Term
| alzheimer dementia prognosis |
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Definition
• Older age of onset may be associated with slower rate of decline
• Early neuropsychiatric symptoms associated with more rapid decline
• Progress can be measured with mental status scales
• Average life expectancy – 3 to 11 years |
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Term
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Definition
• Development of memory impairment as manifested by impairment in the ability to learn new information or inability to recall previously learned information
• Impairment in social and occupational functioning and represents a significant decline from previous level of functioning
• Does not occur exclusively during course of a delirium or a dementia
• In DSM 5 diagnosed as Major Neurocognitive disorder due to another medical condition |
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