Chp 15: Aging Disorders

Delirium

A sudden, temporary disturbance in attention & awareness, usually triggered by a medical condition. It comes on quickly and symptoms can fluctuate throughout the day.

DMS5 Delirium

Disturbance in attention & awareness, quick onset(hours-days) ; Fluctuates in severity during the day; Caused by a medical condition. Periods of lucidity

Treatments of Delirium

Underlying medical cause; Stop/reduce medications (sedatives); Reorientation techniques; Supportive care in calm, quiet environment.

Major Neurocognitive Disorder (Dementia)

A significant decline in memory, language, reasoning, or other thinking abilities that interferes with daily life and independence.

DSM for Major Neurocognitive Disorder

Substantial cognitive decline 1> areas (memory, executive function); Interferes with independence; Not due to delirium or another mental disorder.

Treatments for Major Neurocognitive Disorder

Cholinesterase inhibitors (donepezil, rivastigmine); Moderate/severe cases (Memantine); Cognitive stimulation therapy; Caregiver & routine

Mild Neurocognitive Disorder

A mild but noticeable decline in cognitive ability that DOES NOT yet interfere with daily independence.

DSM5 Criteria for Mild Neurocognitive Disorder

Modest cognitive decline in 1> domains; Does NOT interfere with daily functioning; Individual may need extra effort or compensatory strategies.

Treatments for Mild Neurocognitive Disorder

Cognitive training; Monitor for progression to major NCD; Address vascular risk (e.g., blood pressure, cholesterol); Social & physical engagement

Alzheimer's Disease

A progressive brain disease causing memory loss, language decline, and eventually loss of self-care abilities. Most common form of dementia.

DSM5 Criteria for Alzheimer's Disease

Gradual decline; Memory impairment often first symptom; No evidence of other causes (injury); Confirmed by history and sometimes brain imaging.

Treatments for Alzheimer's Disease

Cholinesterase inhibitors; Memantine; Structured routines; Caregiver support and safety planning.

Vascular Neurocognitive Disorder

Cognitive decline resulting from reduced blood flow to the brain, often due to stroke or small vessel disease.

DSM5 for Vascular Neurocognitive Disorder

cerebrovascular disease occurrence; Stepwise decline (symptoms worsen after each event); Focal neurological signs (weakness brain functions, numbness)

Treatments for Vascular Neurocognitive Disorder

Manage stroke risk; Physical & speech therapy; Memory training; Heart-healthy lifestyle.

Frontotemporal Neurocognitive Disorder (FTD)

A form of DEMENTIA involving personality changes, impulsivity, and/or language problems due to frontal and temporal lobe atrophy. NOT MEMORY & has genetic component

DSM5 Criteria for FTD

Early change in behavior or language, disinhibition, apathy, or compulsive behavior, memory remain relatively intact early.

Typical Treatments for FTD

No cure; symptom management, SSRIs for behavior problems, occupational therapy, family counseling.

Neurocognitive Disorder with Lewy Bodies

A dementia marked by visual hallucinations, fluctuations in alertness, REM sleep disorder, and Parkinson-like movement problems. May act out dreams

DSM5 Criteria for Lewy Bodies

Visual hallucinations, fluctuating cognition/alertness, Parkinsonism (tremor/ rigidity), REM sleep behavior disorder.

Typical Treatments for Lewy Bodies

Rivastigmine (FDA-approved), avoid antipsychotics unless necessary (can worsen symptoms), Parkinson meds if motor symptoms are severe, sleep support.

Neurocognitive Disorder due to Parkinson's Disease

Cognitive decline that appears in patients with long-standing Parkinson's disease. Impacts memory, executive function, and attention.

DSM5 Criteria for Parkinson's Disease

Established Parkinson's diagnosis, dementia develops later in the illness, cognitive decline not better explained by another cause.

Treatments for Parkinson's Disease

Rivastigmine, Levodopa (for motor symptoms), cognitive behavioral therapy, supportive services and planning.

Neurocognitive Disorder due to Traumatic Brain Injury (TBI)

Ongoing cognitive issues caused by a significant head injury. May include memory, attention, language, or personality changes. Symptoms last after injury heals

DSM5 Criteria for TBI

History of TBI with loss of consciousness, amnesia, or neurological signs, cognitive impairment begins shortly after injury, deficits persist beyond acute recovery.

Typical Treatments for TBI

Cognitive rehabilitation, occupational therapy, mood stabilizers if irritability/mood shifts occur, safety monitoring.

Depression in Older Adults ('Pseudodementia')

Severe depression in older adults that may mimic dementia, with memory and attention problems. Unlike true dementia, it may improve with treatment.

DSM5 Criteria for Pseudodementia

Depressed mood or loss of interest, cognitive complaints (but test performance may be better than reported), reversible with treatment.

Treatments for Pseudodementia

Antidepressants (SSRIs), psychotherapy (CBT, interpersonal therapy), social support and engagement, rule out underlying medical conditions.

Substance/Medication-Induced Neurocognitive Disorder

Cognitive decline caused by prolonged use or withdrawal from substances like alcohol, sedatives, or opioids.

DSM5 Criteria for Substance-Induced Disorder

Cognitive symptoms develop during or shortly after substance use/withdrawal, symptoms persist beyond intoxication period, substance is capable of causing symptoms.

Typical Treatments for Substance-Induced Disorder

Detox or tapering off medication.