T14: Neurocognitive Disorders and Disorders Related to Aging

• Delirium is an often-temporary condition displayed as confusion and disorientation. People with this appear confused, disoriented, and out of touch with their surroundings. They cannot focus and sustain their attention on even the simplest tasks. There are marked impairments in memory and language.
• Major neurocognitive disorder (previously labeled dementia) is a gradual deterioration of brain functioning that affects memory, judgment, language, and other advanced cognitive processes.
• Mild neurocognitive disorder focuses on the early stages of cognitive decline. Here the person has modest impairments in cognitive abilities but can, with some accommodations (for example, making extensive lists of things to do or creating elaborate schedules), continue to function independently.
• Agnosia, the inability to recognize and name objects, is one of the most familiar symptoms of neurocognitive disorders.
• Facial agnosia, one of the most the most familiar symptom of neurocognitive disorder is the inability to recognize even familiar faces and can be extremely distressing to family members.
• DSM-5 identifies classes of neurocognitive disorder based on etiology:

  1. Alzheimer's Disease
  2. Vascular Injury
  3. Frontotemporal Degeneration
  4. Traumatic Brain Injury
  5. Lewy Body Disease
  6. Parkinson's Disease
  7. HIV Infection
  8. Substance Use
  9. Huntington's Disease
  10. Prion Disease
  11. Another medical condition
• The DSM-5 diagnostic criteria for neurocognitive disorder due to Alzheimer’s disease include multiple cognitive deficits that develop gradually and steadily. Predominant are impairment of memory, orientation, judgment, and reasoning. The inability to integrate new information results in failure to learn new associations.
• Sundowner syndrome is a behavior experienced by people with neurocognitive disorder due to Alzheimer's disease in which their interest in nonroutine activities narrows. They tend to lose interest in others and, as a result, become more socially isolated. As the disorder progresses, they can become agitated, confused, depressed, anxious, or even combative.
• People with neurocognitive disorder due to Alzheimer’s disease also display one or more other cognitive disturbances, including aphasia (difficulty with language), apraxia (impaired motor functioning), agnosia (failure to recognize objects), or difficulty with activities such as planning, organizing, sequencing, or abstracting information.
• Vascular Neurocognitive Disorder refers to blood vessels when the blood vessels in the brain are blocked or damaged and no longer carry oxygen and other nutrients to certain areas of brain tissue, damage results.
• Chronic Traumatic Encephalopathy (CTE) also known as dementia pugilistica (which suggested that it was restricted to boxers or pugilists) is caused by repetitive head trauma that can provoke distinctive neurodegeneration.
• Frontotemporal neurocognitive disorder is an overarching term used to categorize a variety of brain disorders that damage the frontal or temporal regions of the brain—areas that affect personality, language, and behavior. It identifies two variants—through declines in appropriate behavior (e.g., socially inappropriate actions, apathy, making poor judgments) or language (e.g., problems with speech, finding the right word, naming objects).
• Pick's Disease is a specific type of frontotemporal neurocognitive disorder that is a rare condition occurring in about 5% of those people with neurocognitive impairment—that produces symptoms similar to that of Alzheimer’s disease. It lasts from 5 to 10 years and appears to have a genetic component and occurs relatively early in life—during a person’s 40s or 50s—and is therefore considered an example of early onset neurocognitive disorder.
• Neurocognitive disorder due to traumatic brain injury includes symptoms that persist for at least a week following the trauma, including executive dysfunction (e.g., difficulty planning complex activities) and problems with learning and memory. The greater risks are teens and young adults accompanied by alcohol abuse or lower socio-economic class.
• Lewy bodies are microscopic deposits of a protein that damage brain cells over time. The signs of this disorder come on gradually and include impairment in alertness and attention, vivid visual hallucinations, and motor impairment as seen in Parkinson’s disease.
• Parkinson’s disease is a degenerative brain disorder that has a problem with motor functioning resulting to stooped posture, slow body movements (called bradykinesia), tremors, and jerkiness in walking. It is due to the result of damage to dopamine pathways.
• The human immunodeficiency virus type 1 (HIV-1), which causes AIDS, can also cause neurocognitive disorder. Early symptoms are cognitive slowness, impaired attention, and forgetfulness. They also tend to be clumsy and shows repetitive movements such as tremors and leg weakness, and to become apathetic and socially withdrawn. It is also sometimes referred as cortical dementia like other neurocognitive disorder, because it affects primarily the inner areas of the brain, below the outer layer called the cortex.
• Huntington’s disease is a genetic disorder that initially affects motor movements, typically in the form of chorea, involuntary limb movements. The main cause typically points to multiple gene (polygenic) influences.
• Neurocognitive disorder due to prion disease is a rare progressive neurodegenerative disorder caused by proteins that can reproduce themselves and cause damage to brain cells leading to neurocognitive decline. It is thought by some to have no DNA or RNA that can be destroyed by chemicals or radiation. As a result, there is no known treatment for the disease.
• Substance/Medication-Induced Neurocognitive Disorder is a neurocognitive disorder caused by prolonged use of drugs, especially combined with poor diet leading to brain damage. To meet the criteria, it is the same as many of the other forms of neurocognitive disorder that is experiencing aphasia, apraxia, agnosia, and disturbance in executive functioning.