14. Neurocognitive Disorders

Neurocognitive disorders (NCDs)

disorders that begin with delirium, followed by major and mild disorder and their etiological subtypes

organic mental disorders

NCD was previously labeled as _, highlighting their presumed association with brain damage

cognitive disorders

NCD was called _ in DSM-IV, emphasizing the primary impairment of cognitive abilities such as memory, attention, and thinking

Delirium

a temporary condition characterized by confusion, disorientation, fluctuating attention, and impaired consciousness, often due to medical conditions or medication effects

Mild neurocognitive disorder

a milder form of cognitive impairment with some noticeable decline but not severe enough to significantly impact daily independence

Major neurocognitive disorder

a more severe cognitive decline affecting memory, language, reasoning, and daily functioning,
Executive function impairment

Cognitive training

mental exercises such as memory games and puzzles that may help maintain or improve cognitive functioning

Delirium

a mental disorder characterized by impaired consciousness and cognition, is a significant concern in healthcare

20%

Delirium prevalence - present in approximately _% of older adults admitted to acute care facilities, especially among older adults, cancer patients, and individuals with AIDS

Substance-induced delirium

delirium caused by improper use of medications, particularly common in older adults

Substance-induced delirium, Drug and Alcohol Withdrawal, Infections, Head Injury

4 causes of Delirium

Psychosocial treatment of delirium

first-line intervention for delirium focused on reassurance, comfort, and reducing agitation, anxiety, and hallucinations

antipsychotics such as haloperidol or olanzapine

Pharmacological treatment of delirium - use meds when symptoms are severe or causes are unclear

Major neurocognitive disorder

gradual deterioration of brain functioning affecting memory, judgment, language, and cognition

Reversible neurocognitive impairment

cognitive decline caused by treatable conditions such as depression or infections

Irreversible neurocognitive impairment

cognitive decline caused by conditions such as Alzheimer’s disease

Delirium - acute

Delirium vs neurocognitive disorder - which has an acute onset with confusion and disorientation, while the other progresses gradually

Memory Impairment

In the initial stages, it is often seen as an inability to register ongoing events, leading to difficulty remembering recent events.

Agnosia

inability to recognize and name objects, including faces

Visuospatial impairment

difficulty navigating and recognizing familiar places

1 new case every 7 seconds globally

Major neurocognitive disorder prevalence

100%

Up to how many percent of centenarians exhibit signs of NCD

Alzheimer’s disease

the most common cause of neurocognitive disorder, accounting for nearly half of all cases

Vascular neurocognitive disorder

cognitive decline caused by damage to blood vessels in the brain, often following stroke

Frontotemporal degeneration

neurocognitive disorder affecting the frontal and temporal lobes, leading to personality, language, and behavioral changes

Alzheimer’s Disease

strange disease of the cerebral cortex

atypical form of senile dementia

Alzheimer’s disease was initially called _

Spinal Fluid Markers

Research on the presence of certain markers for Alzheimer’s (e.g., beta amyloid) in spinal fluid also appears to increase the accuracy of a diagnosis.

Traumatic Brain Injury (TBI)

Caused by severe head trauma, leading to long- term cognitive impairment.

Lewy Body Disease

Microscopic protein deposits damage brain cells, causing cognitive decline and motor impairments

Parkinson’s disease

degenerative disorder affecting motor movement, with up to 75% of patients developing neurocognitive disorder after 10 years. Symptoms include stooped posture, slow movements, tremors, and voice changes

autosomal dominant disorder

meaning 50% of offspring of an affected individual may develop the disease.

Huntington’s disease

autosomal dominant genetic disorder characterized by motor impairment and progressive neurocognitive decline

chorea

involuntary limb movements

Prion disease

rare progressive neurodegenerative disorder caused by prions, including Creutzfeldt-Jakob disease

prions

proteins that reproduce and damage brain cells

Creutzfeldt-Jakob disease

affects one in a million individuals and may be linked to bovine spongiform encephalopathy ("mad cow disease").

Substance/medication-induced neurocognitive disorder

cognitive decline due to prolonged substance use, especially alcohol, inhalants, and sedatives

Subcortical dementia

neurocognitive disorder affecting inner brain structures, commonly seen in Parkinson’s disease, HIV, and Huntington’s disease

Alzheimer’s pathology

accumulation of neurofibrillary tangles and amyloid plaques that disrupt brain functioning and lead to cognitive decline

Amyloid beta

protein that accumulates in Alzheimer’s disease and contributes to neuron death, produced by a gene on chromosome 21

Apolipoprotein E (apo E)

protein involved in cholesterol and amyloid transport, with apo E4 associated with increased risk of late-onset Alzheimer’s disease

Apo E4

Individuals carrying the this gene may be at higher risk for

developing neurocognitive disorder associated with head trauma.