Neurocognitive Disorders

What defines the Neurocognitive Disorders (NCD) category?

Disorders where the primary clinical deficit is cognitive, acquired (not developmental), representing decline from a previous level of functioning.

What term did DSM-5 replace with Major Neurocognitive Disorder?

Dementia

What are the 6 cognitive domains in NCD diagnosis?

• Complex attention

• Executive function

• Learning & memory

• Language

• Perceptual-motor

• Social cognition

What are the core features of delirium (Criteria A)?

Disturbance in attention and awareness.

What is the time course of delirium?

Develops over hours to days, fluctuates during the day.

What additional disturbance is required in delirium?

An additional cognitive disturbance (memory, language, disorientation, perception, etc.).

What must delirium NOT be better explained by?

Another NCD or coma-level arousal.

What must be present etiologically for delirium?

Evidence it is a direct physiological consequence of:

• Medical condition

• Substance intoxication/withdrawal

• Medication

• Toxin

• Multiple etiologies

What are the psychomotor subtypes of delirium?

• Hyperactive

• Hypoactive

• Mixed

When do you diagnose substance intoxication delirium instead of intoxication?

When attention/awareness symptoms predominate and require clinical attention.

What is subsyndromal delirium?

Delirium-like presentation that does not meet full criteria.

What level of decline is required for Major NCD?

Significant cognitive decline in ≥1 domain.

How must Major NCD be documented?

Concern + substantial impairment on testing.

How does Major NCD affect functioning?

Interferes with independence (needs help with IADLs).

What severity specifiers exist for Major NCD?

Mild, Moderate, Severe (recorded but not coded).

What behavioral specifiers can be used for major NCD?

With or without behavioral disturbance (psychosis, mood, agitation, apathy).

What level of decline is required for Mild NCD?

Modest cognitive decline.

How does Mild NCD affect functioning?

Independence preserved, but requires extra effort or compensatory strategies.

Typical onset/progression of Alzheimer’s NCD?

Insidious onset, gradual progression.

For Major NCD due to Alzheimer’s, what must be impaired?

Memory + at least one other domain.

What makes Alzheimer’s “probable”?

Genetic mutation OR
Memory decline + gradual progression + no mixed etiology.

Two variants of Frontotemporal NCD?

Behavioral variant & Language variant.

Behavioral variant symptoms?

≥3:
Disinhibition, apathy, loss of empathy, compulsions, hyperorality.

What is relatively spared in FTD?

Memory & perceptual-motor early on.

Core features of Lewy Body NCD?

Fluctuating cognition
Visual hallucinations
Parkinsonism

Suggestive features of Lewy Body NCD?

REM sleep behavior disorder
Severe neuroleptic sensitivity

Key features suggesting vascular etiology?

• Temporal relationship to stroke

• Prominent executive dysfunction

• Neuroimaging evidence

Required TBI evidence?

Head impact + LOC, amnesia, confusion, or neurological signs.

When must NCD symptoms appear in TBI?

Immediately after injury or after recovery of consciousness.

Diagnostic requirement of Parkinson’s Disease NCD?

Established Parkinson’s disease precedes cognitive decline (for probable).

Required feature of Huntington’s Disease NCD?

Clinically established Huntington’s disease or genetic risk.

Key distinguishing feature of Prion Disease NCD?

Rapid progression + myoclonus/ataxia.

Required diagnostic element of HIV-Related NCD?

Documented HIV infection.

Delirium vs Major NCD?

Delirium = acute, fluctuating, attention impaired.
Major NCD = chronic, progressive decline.

Alzheimer’s vs Vascular?

Alzheimer’s = gradual memory-first decline.
Vascular = stepwise decline + executive dysfunction.

Lewy Body vs Parkinson’s NCD?

Lewy Body: Cognitive symptoms occur before or within 1 year of parkinsonism.
Parkinson’s NCD: Parkinson’s disease clearly precedes cognitive decline.

Major vs Mild NCD functional difference?

Major = loss of independence.
Mild = independence preserved.