neurocognitive disorders

• Delirium

  A disturbance of attention or awareness that is accompanied by a change in baseline cognition that cannot be better explained by a preexisting or evolving disorder
• Delirium


  1. Develops over a short period of time, usually hours to a few days

  2. Tends to fluctuate during the day, often with worsening in the evening and night when external orienting stimuli decrease
• There is evidence from the history, physical examination, or laboratory findings that the disturbance is a physiological consequence of an underlying medical condition, substance intoxication or withdrawal, use of a medication, or a toxin exposure, or a combination of these factors
• Major Neurocognitive Disorder


  A gradual deterioration of brain functioning that affects memory, judgment, language, and other advanced cognitive processes
• Mild Neurocognitive Disorder


  A new DSM-5 disorder that was created to focus attention on the early stages of cognitive decline. Here the person has modest impairments in cognitive abilities but can, with some accommodations continue to function independently
• Neuropsychological testing, with performance compared with norms appropriate to the patient's age, educational attainment, and cultural background, is part of the standard evaluation of NCD
• NCD due to Alzheimer's Disease


  Predominant are impairment of memory, orientation, judgment, and reasoning. The inability to integrate new information results in failure to learn new associations. Individuals with Alzheimer's disease forget important events and lose objects
• Evidence of a causative Alzheimer's disease genetic mutation from family history or genetic testing
• Evidence of decline in memory and learning
• Steadily progressive, gradual decline in cognition, without extended plateaus
• Social cognition tends to be preserved until late in the course of the disease
• Frontotemporal NCD


  Comprises a number of syndromic variants characterized by the progressive development of behavioral and personality change and/or language impairment. The behavioral variant and three language variants (semantic, agrammatic/nonfluent, and logopenic) exhibit distinct patterns of brain atrophy and some distinctive neuropathology. The criteria must be met for either the behavioral or the language variant to make the diagnosis, but many individuals present with features of both
• Frontotemporal NCD


  May lose interest in socialization, self-care, and personal responsibilities, or display socially inappropriate behaviors
• NCD with Lewy Bodies


  Includes not only progressive cognitive impairment but also recurrent complex visual hallucinations; and concurrent symptoms of rapid eye movement (REM) sleep behavior disorder; as well as hallucinations in other sensory modalities, depression, and delusions
• The symptoms fluctuate in a pattern that can resemble a delirium, but no adequate underlying cause can be found
• The use of assessment scales specifically designed to assess fluctuation may aid in diagnosis
• May frequently experience repeated falls and syncope and transient episodes of unexplained loss of consciousness
• Vascular NCD


  Clinical features are consistent with a vascular etiology, as suggested by either of the following: Onset of the cognitive deficits is temporally related to one or more cerebrovascular events, or Evidence for decline is prominent in complex attention (including processing speed) and frontal-executive function
• Evidence of the presence of cerebrovascular disease from history, physical examination, and/or neuroimaging considered sufficient to account for the neurocognitive deficits
• NCD due to Traumatic Brain Injury


  Caused by an impact to the head, or other mechanisms of rapid movement or displacement of the brain within the skull, as can happen with blast injuries
• Traumatic brain injury is defined as brain trauma with specific characteristics that include at least one of the following: loss of consciousness, post-traumatic amnesia, disorientation and confusion, or, in more severe cases, neurological signs
• Must present either immediately after the brain injury occurs or immediately after the individual recovers consciousness after the injury and persist past the acute post-injury period
• Substance/Medication-Induced NCD


  Impairments that persist beyond the usual duration of intoxication and acute withdrawal
• The given substance and its use must be known to be capable of causing the observed impairments
• Can be caused by sedative, hypnotic, or anxiolytic drugs which could also affect memory
• Alcohol frequently manifests with a combination of impairments in executive-function and memory and learning domain
• Methamphetamine use can also be associated with evidence of vascular injury
• NCD due to HIV Infection

  Acquired through exposure to bodily fluids of an infected person through injection drug use, unprotected sexual contact, or accidental or iatrogenic exposure
• Infection affects the "T-helper" (CD4) lymphocytes, resulting in severe immunocompromise, often leading to opportunistic infections and neoplasms
• Impaired executive function, slowing of processing speed, problems with more demanding attentional tasks, and difficulty in learning new information, but fewer problems with recall of learned information
• NCD due to Prion Disease

  Due to a group of subacute spongiform encephalopathies caused by transmissible agents known as prions
• Prion Diseases


  • Creutzfeldt-Jakob disease, variant Creutzfeldt-Jakob disease (mad cow disease), kuru (due to cannibalism), Gerstmann-Sträussler-Scheinker syndrome, and fatal insomnia
• Individuals with CJD present with neurocognitive deficits, ataxia, and abnormal movements such as myoclonus, chorea, or dystonia; a startle reflex is also common
• Prions are 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 prion disease, and the course of this disorder is always fatal
• NCD due to Parkinson's Disease


  Motor problems are characteristic among people with Parkinson's disease, who tend to have stooped posture, slow body movements (called bradykinesia), tremors, and jerkiness in walking
• For NCD to be attributed to Parkinson's disease, the motor and other symptoms of Parkinson's disease must be present well before (by convention, at least 1 year prior) cognitive decline has reached the level of major NCD
• Afflicted individuals speak in a soft monotone
• NCD due to Huntington's Disease


  A genetic disorder that initially affects motor movements, typically in the form of chorea, involuntary limb movements
• Early symptoms of Huntington's disease may include instability of mood, irritability, or compulsive behaviors that may suggest another mental disorder. Genetic testing or the development of motor symptoms will distinguish the presence of Huntington's disease
• As the disease progresses, disability from problems such as impaired gait, dysarthria, and impulsive or irritable behaviors may substantially add to the level of impairment and daily care needs, over and above the care needs attributable to the cognitive decline