Delerium, Dementia, And Amestic & Other Cog Disorders

Front 1

294.1X Dementia due to Other GMC

Back 1

Criteria A & B + evi from history, phys exam, or lab findings that a gmc (not Alz or cerebrovascular disease) is etiologically related to the dementia + symptoms don't only occur during delirium.

.10 w/o Bx Disturbance
.11 w/Bx Disturbance

Front 2

294.1X Dementia due to HIV

Back 2

Dementia is judged to be the direct pathophysiological consequence of HIV disease

Characs include: apathy, social w/drawal, forgetfulness, slowness, poor concentration

Front 3

294.1X Dementia due to Head Trauma

Back 3

-Dementia is judged to be the direct pathophysiological conseq of head trauma
-Often w/ posttraumatic amnesia & persisting memory impairment.
-1 injury - usually nonprogressive
-Rptd - may lead to progressive dementia

Front 4

294.1X Dementia due to Parkinson's Disease

Back 4

Dementia is judged to be direct conseq of Parkinson's disease

Features: cog & motor slowing, exec dysfunction, impairment in memory retrieval

Front 5

294.1X Dementia due to Huntington's DIsease

Back 5

Dementia judged to be direct conseq of Huntington's disease

Front 6

294.1X Dementia due to Pick's DIsease

Back 6

Dementia judged to be direct conseq of Pick's disease

Charac by change in personality, deterioration of social skills, emotional blunting, bx disinhib, big lang abnormalities.

Front 7

294.1X Dementia due to Creutzfeldt-Jakob DIsease

Back 7

judged to be direct conseq of C-J

Front 8

Substance - Induced Persisting Dementia

Back 8

Criteria A-B +
C. Deficits don't only occur during course of delirium & persist beyond usual duration of Subs Intox or W/drawal
D. Evi from history, phys exam, or lab findings that defs are etiologically related to persisting effects of subs use

Code by subs that is causing or 292.82 Other/Unknown Subs

Front 9

Dementia due to Multi Etiologies

Back 9

Criteria A-B +
C. Evi that disturbance has 1+ etiologies (ex Alz Dementia w/subseq dvlpmnt of Vasc Dementia)
D. Deficits don't only occur during delirium

Front 10

294.8 Dementia NOS

Back 10

All other dementias (insufficient evi to estab a specific etiology)

Front 11

Amnestic Disorders - Types

Back 11

AD due to GMC
Substance-Induced Persisting AD
AD-NOS

Common Feats: often follows clinical history w/confusion & disorientation; confabulation can occur; lack insight into memory def; diminished range of affective expression

Front 12

294.0 Amnestic Disorders - Diagnostic Feats

Back 12

A. Dvlp memory impairment shown by inability to learn new info or unable to recall previously learned info
B. Mem disturb causes significant impairment in soc/occu function & represents a significant decline from previous level of functioning
C. Memory disturb. doesn't only occur during course of a delirium or dementia
D. Evidence that disturbance is direct physiological consequence of a GMC (including physical trauma)

Specify if:
Transient (impairment is <1 month)
Chronic (impairment is 1 month +)

Front 13

Substance-Induced persisting Amnestic Disorder

Back 13

Criteria A & B +
C. memory disturbance doesn't only occur during course of a delirium or a dementia & persists beyond usual duration of Subs Intox or W/drawal
D. Evidence that the memory disturbance is etiologically related to persisting effects of substance usue

Onset is usually after age 20

Front 14

294.8 Amnestic Disorder NOS

Back 14

ex. clinical presentation of amnesia w/insufficient evi to establish a specific etiology (ie, dissociative, substance induced, or due to gmc)

Front 15

294.9 Cognitive Disorder NOS

Back 15

Disorders characterized by cognitive dysfunction presumed to be due to direct physiological effect of a gmc that doesn't meet criteria for any of the specific deliriums, dementias, or amnestic disorders and can't be better classified as Delerium NOS, Dementia NOS, or Amnestic Disorder NOS

Front 16

Dementia

Back 16

Memory + AND is abnormal
+Aphasia - language disturance
+Apraxia - lack of motor control
+Agnosia - leave intact senses but can't ID objects

AND
SLOW onset
That these are severe enough for sig impairment in social/occupational functioning & feature a decline from previous functioning

Front 17

Dementia of the Alzheimer's Type
294.XX - Early
294. XX - Late
294.10 - w/o disturbance
294.11 - w/disturbance

Back 17

-no definitive test but delayed recall is best
- name 3 things and test recall
- mini - MSE - language (name things, anunciation, instruction completion)

Front 18

Vascular Dementia - strokes
(will be on test)

Back 18

80% are ischemic (caused by blocked blood flow in brain); anti-coagulants help prevent

20% are hemmoragic (ruptured bloods cells) and are more often fatal; big treatment is surgical intervention but recovery level is much less

Front 19

Vascular Disease vs Alzheimer's

Back 19

Vascular's progression is step like along w/strokes while Alzheimer's is more gradual

Front 20

290.4X Vascular Dementia - diagnostic criteria

Back 20

Criteria:
A. 1+ cognitive deficits appearing in the form of memory impairment AND at least 1 of these:

-Aphasia (language disturbance)
-Apraxia (motor)
-Agnosia (recognition)
-Disturbance in executive functioning

B. The 1+ cognitive deficits manifested cause significant impairment in social or occupational functioning & represent a big drop in functioning

C. Focal neuro signs & symptoms or lab evi of cerebro disease judged to be etiologically related

D. Deficits don't happen only during the course of a delirium

Front 21

294.1 Dementia of Alzheimer's Type - Special Codes

Back 21

294.10 - w/o Bx Disturbance (cog disturbance not accompanied by clinically sig Bx disturbance)

294.11 - W/ Bx Disturbance (if cog disturbance is accompanied by clinically sig Bx disturbance)

w/early onset - 65yrs old or younger
late onset - older than 65 yrs old

Front 22

What are some curable causes of Dementia?

Back 22

Depression
Thyroid Disorder
B-12 Deficiency
Complications caused from too many meds

Front 23

294.1X Dementia Alzheimer's Type - diagnostic criteria

Back 23

NOTE: no definitive test for this but the best way to assess is using delayed recall

Criteria: Meets the basic criteria for Dementia (multiple cognitive deficits including memory + 1 or more (Aphasia, Apraxia, Agnosia, disturbance in executive functioning) AND that these symptoms are severe enough for sig impairment in social/occupational functioning & show a decline from previous functioning)

+

C. The course of this decline is gradual onset & continual cog decline

D. The symptoms are not due to other CNS conditions, systemic conditions, or substance-induced conditions

E. Deficits don't only appear during a delirium

F. Disturbances aren't accounted for by another Axis 1 disorder

Front 24

What are some examples of Incurable Dementia?

Back 24

Alzheimer's
Vascular
Parkinson's
Huntington's
Korsikhoff's

Front 25

What is a Mental Status Examination?

Back 25

A method of organizing/evaluating clinical observations pertaining to mental status/conditions

-It is used in medical settings to evaluate current cognitive processing

-categories include: appearance, Bx & psychomotor, attitude, affect/mood, speech/though, perceptual disturbs, orientation, memory, IQ, reliability, judgment

Front 26

What is Orientation x 3?

Back 26

Used in the cognition aspect of the Mental Status Exam (MSE)

It tests to see if someone is oriented to their person, place, and time

Front 27

What are Serial Sevens?

Back 27

They are part of cognition testing during the MSE

You test by counting back from 100 by subtracting 7

Front 28

What is Confabulation?

Back 28

Confabulation can come up when testing cognition during the MSE and it is when someone constructs things to fill gaps in their memory

Front 29

What is Substance Withdrawal Delirium?

Back 29

Fits the criteria for a delirium:
(impaired ability to focus, sustain, shift attention + this is coupled w/a change in cognition/development of a perceptual disturbance + these symptoms develop over a short time period & fluctuate)

+

There is evidence from history, phys exam, or lab findings that these symptoms developed during/shortly after a withdrawal syndrome.

Front 30

What are the major symptoms of a Delirium?

Back 30

A disturbance in consciousness & cognition that can't be attributed to pre-existing or evolving dementia ("memory +")

that occurs over short period of time (hours - days) & fluctuates throughout day

And most likely appears in children or elderly men who are near death

Front 31

What are the diagnostic criteria for a Delirium?

Back 31

Criteria:
A. Impaired ability to focus, sustain, shift attention
B. Accompanying change in cog/development of perceptual disturbances
C. Develops over short period of time & fluctuates

Front 32

What is the diagnostic criteria for

Substance Induced Delirium?

Back 32

Symptoms for a delirium (disturb in consciousness & cognition not better explained by a dementia + impaired ability to focus/shift attention + change in cog/development of a perceptual disturbance + all occurs over short time & fluctuates)

+

Evidence from history, phys exam, or lab finding of subs intox or withdrawal, med side effects, or toxin exposure found to be etiologically related to delirium.

NOTE: often coincides w/Delirium due to GMC & if it does, it should be Dx as Delirium Due to Multiple Etiologies

Front 33

What is the diagnostic criteria for

Substance-Intoxication Delirium?

Back 33

Delirium (disturb in consciousness & cog not attributable to a dementia + features impaired ability to focus/shift attention + change in cog/development of perceptual disturbance + onset is over short time & fluctuates)

+

There is evi from history, phys exam, or lab findings that EITHER these symptoms developed during substance use OR med use is etiologically related to disturbance

Symptoms must be greater in severity than usually seen w/intox syndrome & warrant independent clinical attention.

Front 34

What is the difference between a Substance Induced Delirium and a Substance Intoxication Delirium?

Back 34

????????

Front 35

293.0 Delirium Due to a GMC
Symptoms/signs?
History?
Associated medical conditions?

Back 35

Delirium (change in consciousness/cognition, not explained by dementia, development of perceptual disturb, short onset & fluctuates)

+

Evidence from history, phys exam, lab findings that cog disturbance is direct physiological consequence of a GMC

Assoc medical conditions -
CNS disorders (head trauma, stroke, Pick's disease), metabolic disorders, cardiopulmonary, & systemic illness/effects

*INCLUDE NAME OF GMC

Front 36

780.09 Delirium - NOS

Back 36

A delirium (disturb in consciousness/cog not explained by dementia, impaired ability to focus, sustain, shift attention, coupled w/change in cog/dvlpmnt of perceptual disturbs, short onset & fluctuates)

+

doesn't meet criteria for any specific type

Front 37

What are Syndromes?

Back 37

Syndromes are NOT disorders.

Include Delirium, Dementia, & Amnestic Syndromes

(Delirium = consciousness, Dementia = Memory +, Amnestic=Memory only)

A collection of signs and symptoms that classify a disorder