Tn: Psychiatry - 9

Front 1

What are the 4 As of dementia?

Back 1

• Amnesia
  
• Aphasia
  
• Apraxia
  
• Agnosia
  

Front 2

Criteria A for major neurocognitive disorder?

Back 2

evidence of significant cognitive decline from a previous level of performance in one or morecognitive domains (complex attention, executive function, learning and memory, language,perceptual-motor, or social cognition) based on concern of the individual, a knowledgeable informant, or the clinician that there has beena significant decline in cognitive function;and a substantial impairment in cognitive performance, preferably documented bystandardized neuropsychological testing or, in its absence, another quantified clinicalassessment

Front 3

Criteria B for major neurocognitive disorder?

Back 3

the cognitive deficits interfere with independence in everyday activities (i.e. at a minimum,requiring assistance with complex instrumental activities of daily living such as paying bills ormanaging medications)

Front 4

Criteria C and D for major neurocognitive disorder?

Back 4

• the cognitive deficits do not occur exclusively in
  
• the context of a delirium the cognitive deficits are not better explained by another mental disorder (e.g. major depressive disorder, schizophrenia)
  

Front 5

What are the most common types of dementia? (4)

Back 5

• Alzheimer’s dementia > 50% of cases

• Vascular dementia 15% of cases

• Lewy body dementia

• Fronto-temporal dementia

Front 6

When diagnosing major neurocognitive disorder, what must you specify it is due to?

Back 6

• Either
  
• Alxheimer's disease
  
• Frontotemporal lobar degeneration
  
• Lewy body disease
  
• Vascular disease
  
• TBI
  
• Substance use/meds
  
• HIV infection
  
• Prion disease
  
• Parkinson's disease
  
• Huntington's
  
• another med condition
  
• multiple etiologies
  
• unspecified
  

Front 7

T/F: major neurocognitive disorder prevalence increases with age?

Back 7

True: 10% in patients >65 yr of age; 25% in patients >85 yr of age

Front 8

How does down syndrome/head trauma impact prevalence of major neurocognitive disorder?

Back 8

prevalence increases

Front 9

Average duration of illness?

Back 9

Average duration of onset of symptoms to death is 8-10 years

Front 10

Substypes of major neurocognitive disorder?

Back 10

• with or without behavioral disturbance (e.g. wandering, agitation)

• early onset: age of onset <65 yr

• late onset: age of onset >65 yr

Front 11

What investigations to rule out reversible causes when diagnosing major neurocognitive disorder?

Back 11

• standard: same as delirium
  
• as indicated: VDRL, HIV, SPECT, CT head in dementia
  
• indications for CT head: same as for delirium, plus: age <60, rapid onset (unexplained declinein cognition or function over 1-2 mo), dementia of relatively short duration (<2 yr), recentsignificant head trauma, unexplained neurological symptoms (new onset of severe headache/seizures)
  

Front 12

How to manage major neurocognitive disorder

Back 12

• treat underlying medical problems and prevent others

• provide orientation cues for patient (e.g. clock, calendar)

• provide education and support for patient and family (e.g. day programs, respite care, support groups, home care)

• consider long-term care plan (nursing home) and power of attorney/living will

• inform Ministry of Transportation about patient’s inability to drive safely

• consider pharmacological therapy

Front 13

Pharmacological therapy in major neurocognitive disorder?

Back 13

• cholinesterase inhibitors (e.g. donepezil [Aricept®]) for mild to severe disease
  
• NMDA receptor antagonist (e.g. memantine) for moderate to severe disease
  
• low-dose neuroleptics (e.g. risperidone, quetiapine), antidepressants or trazodone if behavioral or emotional symptoms prominent – start low and go slow
  
• reassess pharmacological therapy every 3 mo