Neurocognitive Disorders

  • often result from disease processes or medical conditions

  • MUST complete a medical assessment to better determine the etiology behind the disorder

  • 3 categories

    • delirium

    • major neurocognitive disorder

    • mild neurocognitive disorder

Based on Defined Cognitive Domains

  • complex attention → sustained, divided, or selective attention, planning, working memory

  • executive function → planning, decision-making, mental flexibility

  • learning and memory → long term + recent memory, ability to learn new tasks

  • language → understand + use language

  • perceptual-motor → any abilities related to visual perception, visuo-construction

  • social cognition → recognition of emotions, theory of mind, behavioral self-control

Delirium

  • A) a disturbance in attention & awareness

    • reduction in ability to direct, focus, sustain, shift attention

    • reduced orientation to the environment

  • B) develops over a short period of time (hours to days), represents a change from baseline, tends to fluctuate during the day

  • C) an additional disturbance in cognition (memory deficit, disorientation, language, visuospatial ability, or perception)

  • D) 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) evidence from history, physical exam, or lab findings that disturbance is a direct physiological consequence of another medical condition, substance use, or toxin exposure

Delirium Treatment

  • treat underlying causes

  • supportive care

Major Neurocognitive Disorder (DSM-5-TR)

  • A) evidence of significant decline in 1+ cognitive domains based on:

    • concern of individual, a knowledgeable informant, or clinician that there has been a significant decline

    • substantial impairment in cognitive performance, preferably documented by a standardized neuropsychological assessment

  • B) cognitive deficits interfere with independence in everyday activities (e.g., paying bills, medication management)

  • C) cognitive deficits do not occur exclusively in the context of delirium (disturbance in attention and awareness)

  • D) not better explained by another psychological disorder (e.g., schizophrenia)

Mild Neurocognitive Disorder (DSM-5-TR)

  • A) evidence of modest decline in 1+ cognitive domains based on:

    • concern of individual, a knowledgeable informant, or clinician that there has been a modest decline

    • modest impairment in cognitive performance, preferably documented by a standardized neuropsychological assessment

  • B) cognitive deficits DO NOT interfere with independence in everyday activities, but greater effort, compensatory strategies, or accommodation may be required

  • C) cognitive deficits do not occur exclusively in the context of delirium (disturbance in attention and awareness)

  • D) not better explained by another psychological disorder (e.g., schizophrenia)

Neurocognitive Disorders

  • mild vs major → severity of the decline and independent functioning

Examples of Subtypes of Mild + Major Neurocognitive Disorders

  • Alzheimer’s Disease

  • Frontotemporal Degeneration

  • Lewy Body Disease

  • Vascular Disease

  • Traumatic Brain Injury

  • HIV Infection

  • Parkinson’s Disease

  • Huntington’s Disease

Alzheimer’s Disease

  • most prevalent neurocognitive disorder

  • age is a robust risk factor

  • women account for 2/3 of cases

    • why? women live longer

  • DSM-5-TR overview

    • criteria for major or mild neurocognitive disorder is met

    • insidious onset & gradual progression of impairment in 1+ cognitive domains (2+ for major cognitive)

    • decline should be documented via genetic testing or by repeated standardized neuropsychological evaluations

  • we don’t know as much as we thought about Alzheimer’s Disease

    • Sylvain Lesne: neuroscientist and associate professor at the University of Minnesota

    • research (especially 2006 article) → amyloid beta star 56 → cause of memory loss in rats

    • more than 70 instances of image tampering in his studies

      • doctored to inflate the protein’s role in the progression to Alzheimer’s

      • findings couldn’t be replicated

Alzheimer’s Disease & The Brain

  • shrinking of the cerebral cortex

  • increased ventricle size

  • neurofibrillary tangles

  • beta-amyloid plaques - not confident in this

Etiology of Alzheimer’s Disease

  • genes: apolipoprotein E gene

  • 40,000 brain scans

    • alcohol consumption

    • diabetes (Type II specifically)

    • air pollution

Nun Study

  • 1200 nuns, priests, brothers take part in study

  • participants provide detailed records of who they spend their time, extensive physical and cognitive tests

  • after they die, participants give up their brain for science

  • nearly 1/3 of brains tested had characteristic signs of Alzheimer’s Disease

  • but, cognitive tests revealed that they did not show the cognitive signs

  • keeping the brain active prevented the cognitive signs

Alzheimer’s Disease Protective Factors

  • vitamin C and E supplements

  • anti-inflammatory drugs (like aspirin and ibuprofen)

  • an active lifestyle

  • education

Alzheimer’s Disease Treatment - Biological

  • the two classes of drugs approved to help slow the progression of AD (acetylcholinesterase inhibitors and memantine) have not shown robust effects

  • other biological treatments are still being developed

Alzheimer’s Disease Treatment - Environmental Support

  • bright light during the day - improve sleep at night

  • writing answers to repeatedly asked questions can reduce frustration

  • labeling photos of family members & other people client comes into contact with on a daily basis

  • supporting caregivers

    • nearly 90% of all individuals with Alzheimer’s Disease are cared for by a relative

    • emotion & physical toll on caregivers can lead to increased anger & depression in a caregiver

    • routinely check caregiver’s psychosocial wellbeing

    • encourage participation in caregiver support groups

    • offer individual therapy for caregivers

Neurocognitive Disorder Due to Traumatic Brain Injury

  • what is a traumatic brain injury (TBI)

    • a head injury causing damage to the brain by external force or mechanism

    • it can cause long term complications or death

Neurocognitive Disorder Due to Traumatic Brain Injury (DSM-5-TR)

  • A) criteria for mild or major neurocognitive disorder is met

  • B) evidence of brain injury with 1+ of the following

    • loss of consciousness

    • posttraumatic amnesia (loss of memory before or after injury)

    • disorientation and confusion

    • neurological signs (e.g., loss of balance, cortical blindness, etc.)

  • C) persistent cognitive impairment is observed immediately following the head injury

Functional Consequences of TBI’s

  • the severity, duration, and symptoms of TBI vary depending on the extent and location of the brain damage + person’s age

  • can see headaches, deficits in attention, poor concentration, fatigue, and irritability, as well as emotion and behavioral changes (including loss of emotional control and prone to aggressiveness)

  • symptoms can compromise ability to work, interfere with independent living, etc.

Chronic Traumatic Encephalopathy (CTE)

  • caused by repeated head injuries

  • cannot fully diagnose without autopsy

  • common symptoms: poor impulse control, sudden outbursts or explosions of anger, difficulty concentrating, etc.

  • Aaron Hernandez

    • CTE is a growing concern for American football players

    • college football offers opportunities for scholarships, national recognition, and potential careers in professional athletics

    • many college football players come from socioeconomic backgrounds where a scholarship can be life-changing

    • is it the responsibility of the NCAA, colleges, or family members, individual players to manage the risk of CTE?

The Brain Can Recover From Injury?

  • the brain reorganizes in response to brain damage - neuroplasticity

  • michelle mack

    • stroke in the womb that affected left hemisphere

    • still able to develop language skills

Treatment for TBI

  • rehabilitation - most likely a team for multiple aspects