Neurocognitive disorders

• Delirium


  • Poor thinking skills (Cognitively impaired)
  • Poor Memory (Slow in recalling)
  • Disorientation – Difficulty in remembering personal information
  • Rambling words or nonsense speech
  • Trouble understanding speech
  • Difficulty in reading or writing
• Etiology of delirium


  • Occurs when the normal sending and receiving of signal in the brain become impaired
  • Certain medication
  • Alcohol and Drug intake or abuse
  • Medical Condition (Severe, Chronic, or Terminal Illness)
  • Metabolic imbalances
  • Exposure to toxin
  • Malnutrition
  • Sleep deprivation or severe emotional distress
• Assessing delirium


  • Confusion Assessment Method (CAM)
  • Delirium Symptom Interview (DSI)
  • Confusion Assessment Method for the Intensive Care Unit (CAM-ICU)
  • Intensive Care Delirium Screening Check-list (ICDSC)
  • Delirium Detection Scale (DDS)
  • Memorial Delirium Assessment Scale (MDAS)
• Treating delirium


  1. Subjected to Supportive Therapy and Pharmacologic Management

  2. Intake of fluids and nutrition are strictly monitored because of the high abuse of it

  3. Photos of family and events are used for reorientation techniques for patients
• Dementia


  • Deterioration of cognitive functions
  • Cognitive Deficits include – problems involving learning, memory, attention, language, recognition. Planning, decision making, problem solving, concentration, judgment, and perceptual motor activity (e.g., driving)
  • Cognitive deficits are Chronic - deficits may last longer (Months or years)
  • Cognitive deficits are Developed Slowly (Mainly through age)
  • Cognitive deficits are Irreversible - deficits do not improve through time
• Characterizing dementia


  • Major Neurocognitive Disorder - Involves significant cognitive decline and interference with daily activities
  • Mild Neurocognitive Disorder - Involves modest cognitive decline but without interference in daily activity. May progress to Major Neurocognitive Disorder
  • Senile Dementia - Refers to onset of dementia symptoms after the age of 65
  • Pre-Senile Dementia - Loss of mental ability with age. Preferably before the age of 65. Show severe symptoms that may lead to death. May cause aggressive course due to genetics
• Alzheimer's Disease


  • Most common form of Dementia ; Elders may have a high chance getting this disease
  • Shows slow and irreversible progression of dementia
  • Cognitive problems slowly develops and worsen over a period of 5 to 9 years
  • Effects on the parts of the brain such as the Cortex – Thinking and planning, Hippocampus – Recalling and forming new memories, Ventricles – Fluid Spaces in the brain (Growing Large)
  • Shows deficits in two or more cognitive areas
• Cognitive deficits in Alzheimer's Disease

  • Aphasia – impaired ability to use or comprehend spoken language
  • Apraxia - impaired voluntary movement despite adequate sensory and muscle functioning
  • Agnosia – inability to recognize people or common objects
  • Executive functioning deficits – includes impaired ability to plan and recognize daily activities
• Stages of Alzheimer's Disease

  • Early Stage (Mild Alzheimer's Disease) - Functions independently, but prone to memory lapses (Familiar words or locations). Trouble remembering names, Difficulty in performing task, Prone in losing and misplacing objects, Trouble in planning and organizing
  • Middle Stage (Moderate Stage) - Easily frustrated, irritated, and angry; suspicious, delusional, compulsive, does repetitive behavior. Trouble in recalling events; unable to recall address contact numbers; confusion in dates; problems in controlling bladder; restless nights
  • Last Stage (Severe Alzheimer's Disease) - Unable to respond, carry on with conversation, and control movement. Also, communication is difficult
• Types of Alzheimer's Disease

  • Early Onset Alzheimer's – 40s to 50s years old are commonly on this bracket. Mostly under 65 years old
  • Late Onset Alzheimer's – 65 and older are subjected in this type. Alzheimer's may not occur in family members when the diagnosed is in this type
  • Familial Alzheimer's disease (FAD) – Alzheimer's caused by genes. People with this gene starts to show symptoms and cognitive deficits as early as 40
• Vascular Dementia


  • History of stroke (cerebrovascular disease)
  • Abrupt symptoms of dementia, especially after stroke
  • Poor retention of overall cognitive functioning, even memory
  • Focal neurological signs – immediate indication of what side of the brain is affected
• Dementia with Lewy Bodies (DLB)

  • Very similar to Alzheimer's key features only with visual hallucinations, muscle tremors, and fluctuating course of symptoms: Fainting, loss of consciousness, autonomic dysfunction, hallucination (touch and hearing), difficulty in alertness and inattentive
  • A progressive dementia that leads to a decline in thinking, reasoning and independent function because of abnormal microscopic deposits that damage brain cells over time
• Parkinson's Disease


  • Progressive neurological disorder marked by abnormal movements
  • Dopamine starts to degenerate because of the clumps found within the brain
  • Shows Subcortical Dementia – problems in the cognitive area (Thinking and Recalling)
  • Difficulty in processing conversations, abstract thinking, and integrating visual information
  • Problems in language or conversation (monotone voice, slurred sentences, and recitative speech)
  • Inability to move and show emotions
  • May be diagnosed as early as 40 years old
• Abnormal movements in Parkinson's Disease

  • Resting tremors – "pill-rolling" behavior (unconscious shaking of hands even when idle)
  • Rigidity – difficulty in moving muscles
  • Bradykinesia – slow movement or trouble initiating movement
  • Hypokinesia and Akinesia – poor quality and lack of movement
  • Postural instability – difficulty in standing, staying in one position, standing erect, and maintaining balance
  • Hypomimia – lack of facial reaction
  • Other abnormal actions – inability to maintain eye movement, blink eye, and swing arms