PSYC 2011 Final: Neurocognitive Disorders - Ch14
Chapter 14: Neurocognitive Disorders
• Overview of Neurocognitive Disorders
o As people age, we experience changes in memory and other cognitive
processes
▪ Under ordinary conditions, these changes are mild
▪ However, due to various specific circumstances people develop
disorders were those changes are major
• Delirium
o First neurocognitive disorder (often plays part in other disorders as well)
o DSM Definition
▪ Significance disturbance in attention and awareness
▪ Don’t know where you are, who you are, what day it is (3
orientations)
▪ Impairment with short term memory
▪ Disturbance develops over a short period of time (few
hours;days), represents a change from baseline, and tends to
fluctuate in severity throughout the day
▪ Additional disturbance in cognition
o Usually come out of it quickly (some cases when don;t)
o Can happen when:
▪ Coming out of general anesthesia
▪ Becoming rehydrated
▪ Recovering from fever
▪ Reducing stress or exhaustion
o Symptoms:
▪ Disorganized thinking
▪ Fluctuating mental status
▪ Acute mental status changes
▪ Inattention
▪ Psychomotor disturbance
o Caused by:
▪ CNS disease
▪ Drugs
▪ Metabolic insufficiency
▪ Alcohol withdrawal syndrome
▪ Deficiency disease
▪ Electrolyte imbalance
▪ Postoperative states
▪ Trauma
Comparing Delirium vs. Dementia
Delirium
Dementia
• Abrupt
• Fluctuates
• Hours to weeks
• Impairments in attention,
alertness, orientation
• Agitated or depressed
behaviors
• Disorganized thoughts
• Usually insidious
• Slow decline
• Months to years
• Attention, alertness, orientation are mostly
intact (impaired only later on)
• Impoverished thoughts
• Major Neurocognitive Disorder
o General case
o DSM Definition:
▪ Evidence of significant cognitive decline from a previous level
of performance in one or more cognitive domains based on:
▪ Reports of concern coming from individual, knowledgeable
informant or clinician regarding decline in functioning
▪ Substantial impairment in cognitive functioning as
documented by standardized neuropsychological tests
(often neuroimaging) or clinical assessment
▪ Cognitive deficits interfere with independence in everyday
activities
▪ People often won’t be able to live alone
• Mild Neurocognitive Disorder
o DSM Definition:
▪ Evidence of modest cognitive decline from previous level of
performance in one or more cognitive domains based on:
▪ Reports of concern coming from individual, knowledgeable
informant or clinician regarding decline in functioning
▪ Substantial impairment in cognitive functioning as
documented by standardized neuropsychological tests
(often neuroimaging) or clinical assessment
▪ Cognitive deficits do not interfere with capacity for
independence
• Major Neurocognitive Disorder: Alzheimer Disease
o DSM Definition:
▪ Criteria for major cognitive disorders are met.
▪ Insidious onset or gradual progression of impairment in one or
more cognitive domains
▪ Criteria are met for either probable or possible Alzheimer's
disease as follows:
▪ Probable diagnosed when (otherwise it is possible):
▪ Evidence of causative Alzheimer’s disease
genetic mutation
▪ All 3 of the following are present:
▪ Clear evidence of decline in memory and
learning, and at least one other cognitive
domain
▪ Steadily progressive, gradual decline in
cognition, without extended plateaus
▪ Start by forgetting keys, led to
forgetting family members
▪ No evidence of mixed etiology
o A progressive disease that ultimately leads to death
▪ Death often caused by medical complications (ex: pneumonia,
COVID, viral infection)
o Can cause select cognitive deficits
• Impaired abi
Aphasia
Apraxia
Agnosia
Executive Functioning
Deficits
• difficulty to use
or
comprehend
spoken
language
• Difficulty
speaking
• Can’t
understand
what is being
said to them
• Impaired
voluntary
movement
despite
adequate
sensory and
muscle
functioning
• Impaired ability
to recognize
people or
common
objects
• Failed to
recognize
loved ones or
basic items
• Impairment in
ability to plan or
organize, engage
in abstract system
o 3 stages
Early Stage
Middle Stage
Late Stage
• General forgetfulness
• Problems with short
term memory - what just
read, where placed
something, recent
events, wanders and
becomes lost
• Symptoms become
more disabling,
additional care will be
needed
• Delusions,
compulsions, repetitive
behavior, needs help
getting dressed,
problems with reading
and writing
• Loss of track of time
• Sleep disturbances
• Symptoms
become significant
and apparent
• Significant
personality and
behavioral
changes
• Difficulty moving,
speaking, eating
and swallowing
• Lack of awareness
of surrounding
• Susceptible to
infections
• Mild Neurocognitive Disorder: Alzheimer’s Disease
o Criteria for major cognitive disorder are not met.
o Insidious onset or gradual progression of impairment in one or more
cognitive domains
o Criteria are met for either probable or possible Alzheimer's disease as
follows:
▪ Probable diagnosed when (otherwise it is possible):
▪ Evidence of causative Alzheimer’s disease genetic
mutation
▪ All 3 of the following are present:
▪ Clear evidence of decline in memory and
learning, and at least one other cognitive domain
▪ Steadily progressive, gradual decline in cognition,
without extended plateaus
Document Summary
Inattention: caused by, cns disease, drugs, metabolic insufficiency, alcohol withdrawal syndrome, deficiency disease, electrolyte imbalance, postoperative states, trauma. Impairments in attention, alertness, orientation: agitated or depressed behaviors, disorganized thoughts, usually insidious, slow decline, months to years, attention, alertness, orientation are mostly intact (impaired only later on) Covid, viral infection: can cause select cognitive deficits. Impairment in ability to plan or organize, engage in abstract system. Agnosia: impaired voluntary movement despite adequate sensory and muscle functioning, difficulty to use or comprehend spoken language, difficulty speaking, can"t understand what is being said to them, 3 stages. Impaired ability to recognize people or common objects: failed to recognize loved ones or basic items. Insidious onset and gradual progression of impairment: major or mild neurocognitive disorder probably due to. Parkinon"s disease is diagnosed if 1 and 2 both are met. Major or mild neurocognitive disorder possibly due to parkinson"s disease should be diagnosed if 1 or two are met:
