Chapter 15 Neurocognitive Disorders

Description and Statistics
Neurocognitive Disorder Due to Alzheimer’s Disease
Vascular Neurocognitive Disorder
Other

Medical Conditions That Cause Neurocognitive Disorder
Substance/Medication-Induced Neurocognitive Disorder
Causes of Neurocognitive Disorder
Treatment and Prevention

image is on a penny?
Is he wearing a tie?

What five words besides “In God We Trust” appear on most U.S. coins?
When water goes down the drain, does it swirl clockwise or counterclockwise?
What letters, if any, are missing on a telephone dial?

image is on a penny? (Answer: Lincoln);
Is he wearing

a tie? (Answer: yes, a bow tie)
What five words besides “In God We Trust” appear on most U.S. coins? (Answer: United States of America and Liberty)
When water goes down the drain, does it swirl clockwise or counterclockwise? (Answer: counterclockwise in the Northern Hemisphere; clockwise in the Southern Hemisphere)
What letters, if any, are missing on a telephone dial? (Answer: Q, Z)
 

in life
Types of neurocognitive disorders
Delirium – temporary confusion and disorientation
Major

or mild neurocognitive disorder – broad cognitive deterioration affecting multiple domains
Amnestic – refers to problems with memory that may occur in neurocognitive disorders
Shifting DSM perspectives
From “organic” mental disorders to “cognitive” disorders
Broad impairments in cognitive functioning
Cause profound changes in behavior and personality
Thus, although some may consider these to be general medical conditions, often best treated by mental health professionals

and cognition
Develops rapidly over several hours or days
Appear confused, disoriented,

and inattentive
Marked memory and language deficits
Designer drugs such as Ecstasy, “Molly,” and “bath salts” can cause substance-induced delirium
Symptoms were written more than 2,400 years ago

in acute care facilities (e.g., ER)
More prevalent in certain

populations, including:
Older adults
Those undergoing medical procedures
AIDS patients and cancer patients
People in hospitals/critical care
Full recovery often occurs within several weeks

involve temporary delirium)
Drug intoxication, poisons, withdrawal from drugs
Infections
Head injury and

several forms of brain trauma
Sleep deprivation, immobility, and excessive stress

coping strategies, inclusion of patients in treatment decisions
Prevention
Address proper medical

care for illnesses, proper use, and adherence to therapeutic drugs

functioning
Deterioration in judgment and memory
Deterioration in language / advanced cognitive

processes
Has many causes and may be irreversible

new DSM-5 term for dementia
Individual is not able to function

independently
Mild neurocognitive disorder:
New DSM-5 classification for early stages of cognitive decline
Individual is able to function independently with some accommodations (e.g., reminders/lists)

that represent a decrease from previous functioning
complex attention,
executive function,

learning and memory,
language,
perceptual-motor,
social cognition
Interfere with daily independent activities

identified every 7 seconds
5% prevalence in adults 65+; 20%

prevalence in adults 85+
5 million people
Methodology for estimating number of those suffering from major neurocognitive disorder has resulted in diverging numbers
Dramatic rise in Alzheimer’s predicted through 2050; more people expected to live > 85 years

agnosia – inability to recognize familiar faces
Other symptoms
Delusions, apathy, depression,

agitation, aggression

Later stages
Cognitive functioning continues to deteriorate
Total support is needed to carry out day-to-day activities
Increased risk for early death due to inactivity and onset of other illnesses

Disease
Frontotemporal
Vascular
With Lewy bodies
Due to traumatic brain injury
Substance/medication induced
Due to HIV

infection
Due to prion disease
Due to Parkinson’s Disease

Due to Huntington’s disease
Due to another medical condition
Due to multiple etiologies
Unspecified

neurocognitive disorders
Clinical Features
Typically develop gradually and steadily
Memory, orientation, judgment, and

reasoning deficits
Additional symptoms may include
Agitation, confusion, or combativeness
Depression and/or anxiety

genes are involved in Alzheimer’s disease
Include genes on chromosomes 21,

19, 14, 12
Chromosome 14
Associated with early onset Alzheimer’s
Chromosome 19
Associated with late onset Alzheimer’s

3
Deterministic genes
Rare genes that inevitably lead to Alzheimer’s
Beta-amyloid precursor gene
Presenilin-1

and Presenilin-2 genes
Susceptibility genes
Make it more likely but not certain to develop Alzheimer’s

brains with Alzheimer’s disease
Neurofibrillary tangles (strandlike filaments)
Amyloid plaques (gummy deposits

between neurons)
Brains of Alzheimer’s patients tend to atrophy

with language
Apraxia – impaired motor functioning
Agnosia – failure to recognize

objects
Difficulties with
Planning, Organizing
Sequencing
Abstracting information

stages = slow
During middle stages = rapid
Post-diagnosis survival

= 8 years
Onset = 60s or 70s (“early onset” = 40s to 50s)
50% of the cases of neurocognitive disorder result from Alzheimer’s disease

damage, but the emphasis here is in the way the

brain uses its damaged resources. It could be defined as the ability to optimize or maximize performance through differential recruitment of brain networks and/or alternative cognitive strategies.

less educated individuals
More educated individuals decline more rapidly after onset;

this suggests that education provides a buffer period of better initial coping
Slightly more common in women
Possibly because women lose estrogen as they age; estrogen may be protective

of the disease
“Nun study” – analysis of nuns’ journal writing

over many years shows patterns of deterioration

leading cause of neurocognitive disorder after Alzheimer’s disease
Onset is often

sudden (e.g., stroke)
Patterns of impairment are variable
The symptoms relate to the area of the brain damaged.
Most require formal care in later stages

signs of brain tissue damage
Prevalence 1.5% in people 70 to

75 and 15% for people over 80
Risk slightly higher in men

leading cause of neurocognitive disorder after Alzheimer’s disease
Onset is often

sudden (e.g., stroke)
Patterns of impairment are variable
Most require formal care in later stages

medications
Control blood pressure, don’t smoke, and lead active social life
Other

targets of prevention efforts
Increasing safety behaviors to reduce head trauma
Reducing exposure to neurotoxins and use of drugs

protein deposits that damage brain over time
Symptoms onset gradually
Symptoms include

impaired attention and alertness, visual hallucinations, motor impairment

pathway damage
1 out of 1000 people are affected worldwide
Chief difficulty:

motor problems
Tremors, posture, walking, speech
Not all with PD will develop dementia
75% survive 10+ years after diagnosis

autosomal dominant disorder
Caused by a gene on chromosome 4
Manifests

initially as involuntary limb movements (chorea), usually later in life
Somewhere between 20% to 80% display neurocognitive disorder
Dementia follows a subcortical pattern

the brain that reproduce and cause damage
No known treatment, always

fatal
Can only be acquired through cannibalism or accidental transmission (e.g., contaminated blood transfusion)
Example: Creutzfeldt-Jakob disease
Affects one out of 1,000,000 persons
Linked to mad cow disease

attention, memory, language, and motor behavior
Causes include
Aging
Medical conditions
Abnormal

brain structures
Drug use
Environmental factors

attention, memory, language, and motor behavior
Causes include
Aging
Medical conditions
Abnormal

brain structures
Drug use
Environmental factors
Most result in progressive deterioration of functioning
Few treatments exist to reverse damage and deficits, but progression may be slowed