Neurocognitive Disorders

major neurocognitive disorder: diagnostic criteria

• A. Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition) based on:

  • 1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a significant decline in cognitive function; and

  • 2. A substantial impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment

• B. 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 or managing medications).

• C. The cognitive deficits do not occur exclusively in the context of a delirium.

• D. The cognitive deficits are not better explained by another mental disorder (e.g., major depressive disorder, schizophrenia)

delirium: diagnostic criteria

• A. A disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment).

• B. The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day.

• C. An additional disturbance in cognition (e.g., memory deficit, disorientation, language, visuospatial ability, or perception)

• D. The disturbances in Criteria A and C are not better explained by another preexisting, established, or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal, such as coma.

• E. There is evidence from the history, physical examination, or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal (i.e., due to a drug of abuse or to a medication), or exposure to a toxin, or is due to multiple etiologies

  • Specify if:

    • Acute: Lasting a few hours or days.

    • Persistent: Lasting weeks or months.

  • Specify if:

    • Hyperactive: The individual has a hyperactive level of psychomotor activity that may be accompanied by mood lability, agitation, and/or refusal to cooperate with medical care.

    • Hypoactive: The individual has a hypoactive level of psychomotor activity that may be accompanied by sluggishness and lethargy that approaches stupor.

    • Mixed level of activity: The individual has a normal level of psychomotor activity even though attention and awareness are disturbed. Also includes individuals whose activity level rapidly fluctuates.

major or mild neurocognitive disorder due to Alzheimer’s disease

• Major NCD: Alzheimer’s disease

  • Probable or Possible: Probable if either is present, otherwise possible.

  • 1. Genes

  • 2. Three things:

    • 1.decline in memory and learning and at least one other cognitive domain

    • 2.gradual decline

    • 3. no evidence of mixed etiology

• Mild NCD: Alzheimer’s Disease

  • Probable Alzheimer’s disease: evidence of a causative Alzheimer’s disease genetic mutation from either genetic testing or family history.

  • Possible Alzheimer’s disease: no evidence of genetic mutation, and all three of the following are present:

    • 1. Clear evidence of decline in memory and learning.

    • 2. Steadily progressive, gradual decline in cognition.

    • 3. No evidence of mixed etiology

• Alzheimer’s disease core features: memory deficit, insidious onset, gradual progression

  • Probable Alzheimer’s disease is diagnosed in both major and mild NCD if there is evidence of a causative Alzheimer’s disease gene

  • Major NCD, typical picture: also probable.

  • Mild NCD, cognitive deficits, no genetic evidence: possible AD.

neurocognitive disorders

group of conditions characterized by a decline in cognitive function due to medical diseases affecting the brain, distinct from psychiatric disorders 

Major neurocognitive disorder (previously known as dementia)

• Major neurocognitive disorder (previously known as dementia) 

  • Characterized by a significant decline in cognitive function that affects daily living activities 

  • This disorder exists on a spectrum, indicating varying degrees of cognitive and functional impairment, and is recognized as an acquired deficit in thinking ability severe enough to impact daily functioning 

• Delirium  

  • Sudden change in mental function, characterized by confusion, altered consciousness, and disturbances in attention and awareness 

Delirium 

• Sudden change in mental function, characterized by confusion, altered consciousness, and disturbances in attention and awareness

• It can develop rapidly, often within hours or days, and is particularly common in older adults, especially those who are acutely ill 

Alzheimer’s

• A progressive neurodegenerative disorder that is the most common cause of dementia

• Characterized by memory loss, cognitive decline, and changes in behavior 

• Gradually destroys memory and thinking skills, ultimately interfering with daily life and activities