Masumura

NEUROCOGNITIVE DISORDERS Miraato

Pasco
DISCUSSION FLOW
Neurocognitive Disorders
 Various major and mild neurocognitive disorders and delirium.
MAJOR AND MILD NEUROCOGNITIVE
Types:
Neurocognitive Disorder due to
Alzheimer’s disease

DISORDERS Vascular Neurocognitive Disorder

Neurocognitive Disorders Associated
with Other Medical Condition
NEUROCOGNITIVE DISORDERS
major & mild NCD and delirium
disabilities that impair cognitive function due to changes
in the brain caused by trauma, injury and illness.
DSM-5
CRITERIA FOR MAJOR NEUROCOGNITIVE DISORDER
(NCD)
A. Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains
(complex attention, executive functioning, learning and memory, language, perceptual-motor, or social cognition)
based on:
1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a significant decline in cognitive
function; and
2. A substantial impairment in cognitive performance preferably documented by standardized neuropsychological testing or, in
its absence, another qualified clinical assessment.

B. The cognitive deficits interfere with independence in everyday activities (i.e., at a minimum, requiring assistance with
complex instrumental activities of daily living such as paying bills or managing medications).
C. The cognitive deficits do not occur exclusively in the context of delirium.
D. The cognitive deficits are not better explained by another mental disorder (e.g., major depressive disorder,
schizophrenia).
Note: NCDs are specified by their etiological subtypes, such as whether, for example, they are due to
Alzheimer’s disease, frontotemporal lobar degeneration, Lewy body disease, traumatic brain injury, or
substance/medication use.
NEUROCOGNITIVE DISORDER

Major Neurocognitive Disorder

Dementia
refers to older adults with degenerative disorders like Alzheimer/s disease.
Mild Neurocognitive Disorder
SYMPTOMS OF MAJOR NEUROCOGNITIVE DISORDER

major neurocognitive disorder is characterized by a

decline in cognitive functioning severe enough to
interfere with daily living
MAJOR NEUROCOGNITIVE DISORDER
Aphasia
deterioration of language
Palilalia (Echolalia)
repeating sounds or words over and over
Apraxia
impairment of the ability to execute common actions such as waving good-bye or putting on a
shirt

Agnosia
failure to recognize objects or people
Executive Functions

brain functions that involve the ability to plan, initiate, monitor,

and implement complex behaviors.
TYPES OF MAJOR AND MINOR
NEUROCOGNITIVE DISORDERS
NEUROCOGNITIVE DISORDER DUE TO
ALZHEIMER’S DISEASE

Alzheimer’s Disease
typically begins with mild memory loss, but as the disease
progresses the memory loss and disorientation quickly become
profound
 BRAIN ABNORMALITIES IN ALZHEIMER’S DISEASE
Alois Alzheimer (1906)
Observed severe memory loss and disorientation in a 51-
year old female patient.
Following her death at age 55, an autopsy revealed that
filaments within nerve cells in her brain were twisted and
tangled.

Neurofibrillary Tangles
Plaques are deposits of a class of protein,
beta-amyloid, that are neurotoxic and
accumulate in the spaces between the cells of the
cerebral cortex, hippocampus, amygdala, and
other brain structures critical to memory and
cognition.
CAUSES OF ALZHEIMER’S DISEASE
Apolipoprotein E gene (ApoE) (on chromosome 19)
 Regulates ApoE protein, involved in the transport of cholesterol through the
blood.
 ApoE gene has three alleles, or versions e2, e3, and e4.
 People who inherit an e4 allele from one parent have 2 to 4 times greater risk of developing AD, people
who inherit e4 alleles from both parents have an 8 to 12 times greater risk of developing the disorder
(Coon et al., 2007).

A defective gene on chromosome 21

 People with Down syndrome are more likely than people in the general
population to develop Alzheimer’s disease in late life.
 Researchers hypothesized: Alzheimer’s disease may be on chromosome 21 and
that people with Down syndrome are more prone to Alzheimer’s disease because
they have an extra chromosome 21.
CAUSES OF ALZHEIMER’S DISEASE

ACETYLCHOLINE
NOREPINEPHRINE
SEROTONIN
SOMASTOSTATIN
PEPTIDE Y
VASCULAR NEUROCOGNITIVE DISORDER
Most prominent cognitive symptoms are significant declines in
processing speed, in the ability to pay attention, and in the
executive functions.
Cerebrovascular Disease
occurs when the blood supply to areas of the brain is blocked, causing tissue damage in the
brain

Stroke
sudden damage to an area of the brain due to the blockage of blood flow or
to hemorrhaging (bleeding)
NEUROCOGNITIVE DISORDERS ASSOCIATED WITH
OTHER MEDICAL CONDITION

Lewy Body Disease

Parkinson’s Disease
Human Immunodeficiency Virus (HIV)
Huntington’s Disease
 NEUROCOGNITIVE DISORDERS ASSOCIATED WITH
OTHER MEDICAL CONDITION
Parkinson’s Disease
A degenerative brain disorder with the primary symptoms: tremors, muscle rigidity, and the inability to
initiate movement
Neurocognitive Disorder due to Lewy Body Disease
Second most common type of progressive neurocognitive disorder after AD characterized by changes in
attention and alertness, visual hallucinations, and symptoms of Parkinson’s disease.
Human Immunodeficiency Virus (HIV)
The virus that cause AIDS, can cause a mild or major NCD where memory and concentration become slowly
impaired
Huntington’s Disease
A rare genetic disorder wherein people eventually develop a major NCD and chorea – irregular jerks,
grimaces and twitches.
CAUSES OF MILD AND MAJOR NEUROCOGNITIVE
DISORDERS
Prion Disease (Creutzfeld-Jacob’s disease)
by brain tumors; by endocrine conditions, such as hypothyroidism; by nutritional conditions,
such as deficiencies of thiamine, niacin, and vitamin B12; by infections, such as syphilis; and
by other neurological diseases, such as multiple sclerosis.
Traumatic Brain Injury
Can result from penetrating injuries, such as those caused by gunshots, or closed head
injuries, typically caused by impact to the head and/or concussive forces such as caused by
motor vehicle accident, explosion or sports injury
Changes both in cognitive abilities and emotional and personality functioning
THE IMPACT OF GENDER, CULTURE, AND
EDUCATION ON NEUROCOGNITIVE DISORDER
There are more elderly women than elderly men with
neurocognitive disorder, particularly Alzheimer’s disease (Gatz,
2007).
Differences in people's level of education also may contribute to
differences in rates of neurocognitive disorder.
The likelihood that a person with neurocognitive disorder will be
institutionalized rather than cared for in the family is greater
among European Americans than among Asians or Hispanics and
Latinos (Chin et al., 2011; Mausbach et al., 2004;Torti et al.,
2004).
TREATMENTS FOR NEUROCOGNITIVE DISORDER
Cholinesterase Inhibitors
such as donepezil (Aricept), rivastigmine (Exelon), and galantamine (Reminyl)
help prevent the breakdown of the neurotransmitter acetylcholine, and randomized trials
show that they have modest positive effect or neurocognitive disorder symptoms
side effects: nausea, diarrhea and anorexia
Memantine
regulate the activity of the neurotransmitter glutamate, which plays and essential role in
learning and memory
TREATMENT FOR NEUROCOGNITIVE DISORDER
Antidepressants and antianxiety drugs
may be used to help control emotional symptoms
Antipsychotic drugs
may help control hallucinations, delusions, and agitation
Behavioral Therapies
may be helpful in controlling patients’ angry outbursts and emotional instability
Aerobic Exercise and Mental Activity
Reducing Risk Factors for Stroke
DELIRIUM
is characterized by disorientation, recent memory loss, and a
clouding of attention.
Sundowning “late-day confusion”
confusion and agitation becomes worse in the late afternoon or evening
Duration: short – rarely longer than a month
often are agitated and frightened; may also experience disrupted sleep-wake
cycles, incoherent speech, delusions, and hallucinations
DELIRIUM: SYMPTOMS

Early phase: mild symptoms such as fatigue, decreased

concentration, irritability, restlessness, or depression; may
experience mild cognitive impairments or perceptual
disturbances or even visual hallucinations.
As the delirium worsens, the person’s orientation becomes
disrupted.
DSM-5
CRITERIA FOR DELIRIUM
A. A disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention)
and orientation to the environment and awareness (reduced orientation to the
environment).
B. The disturbance develops over a short period of time (usually hours to a few days), and
represents a change from baseline attention and awareness, and tends to fluctuate in
severity during the course of a day.
C. An additional disturbance in cognition (e.g., memory deficit, disorientation, language,
visuospatial ability, or perception).
D. The 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. There is evidence from the history, physical examination, or laboratory findings that the
disturbance is a direct physiological consequence of another medical condition, substance
intoxication or withdrawal, or exposure to a toxin, or due to multiple etiologies.
CAUSES OF DELIRIUM
Neurocognitive disorder is the strongest predictor of delirium, increasing the risk
fivefold (Cole, 2004).
A wide range of medical disorders, including stroke, congestive heart failure,
infectious diseases, a high fever, and HIV infection, is associated with a risk for
delirium.
Intoxication with illicit drugs and withdrawal from these drugs or from prescription
medications also can lead to delirium.
Other possible causes include fluid and electrolyte imbalances, medication side
effects, and toxic substances.
Sensory isolation – a syndrome known as ICU/CCU psychosis occurs in intensive
care and cardiac care units (Mexmen & Ward, 1995).
TREATMENT OF DELIRIUM
Treatment for delirium is extremely important.
If a delirious person is not already hospitalized, immediate referral to a
physician should be made.
If another medical condition is associated with the delirium (e.g. stroke or
congestive heart failure), the first priority is to treat that condition (Cole,
2004).
Drugs that contribute to delirium must be discontinued.
Antipsychotic medications sometimes are used to treat the person’s
confusion.
Carefully watching people with delirium is a must.
THAT’S ALL FOLKS!

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