1. PSY 6670 Diagnosis & Treatment Planning Lecture 2: Neurocognitive Disorders Treatment Planning
Joel Fairbanks, Ph.D.

2. Epidemiology 35 million Americans over 65 with dementia.
Prevalence rate 15% after age 65.
Incident rate rises between 70 – 80 years.
Prevalence rate 25 % for those 65 – 74 years.
Prevalence rate 45 % for those over 80.
Over half of all hospitalized elderly mental patients have dementia.

3. 2016 Study of Prevalence Rate for Dementia
Rate for Dementia fell from 12 % of the elder population in 2000 to 9% in 2014.
That equates to a reduction of 1 Million cases reported per year in 2014.

15. DSM – IV Diagnoses for Dementia
Dementia, Uncomplicated
Dementia, with Depression
Dementia, with Delusions
Dementia, with Delirium

16. DSM-5 Diagnosis Criteria for Dementia
Neurocognitive Disorders (Dementia) is a syndrome due to disease of the brain in which there is a disturbance of multiple higher cortical functions, including Memory, Thinking, Orientation, Comprehension, Calculation, Learning Capacity, Language, and Judgment.

17. Diagnosis Criteria for Dementia
The decline of higher cortical functions interferes with personal activities of Daily Living; such as washing, dressing, eating, personal hygiene, excretory and toilet activities.
How such a decline manifests itself will depend largely on the social and cultural setting in which the patient lives.

18. Types of Dementia Symptoms and presentation
Alzheimer’s Type
Lewy Bodies
Vascular Disease (CVA)
Neurological Disorders (e.g. Parkinson’s Dx.)
Drug/Alcohol Abuse (Korsakoff’s Dx.)
Traumatic Brain Injury (TBI)

20. Mild vs. Major Neurocognitive Disorder
According to the DSM-5, Mild Neurological Disorders differ from Major N.D. in that the cognitive decline and deficits in one or more cognitive domains are modest and Do Not sufficiently interfere with personal activities so as to lose the capacity for independence.

23. Additional Treatment Concerns
Most of these patients will also have significant other medical problems, conditions, or physical disabilities that will challenge their independence and treatment.
Substance Use (especially alcohol or prescription medications) is a common comorbid condition that will also need to be addressed.

24. Differential Diagnosis
Delirium (infections or poisons/heavy metals)
Autoimmune Diseases
Metabolic Disorders
Vitamin B1, B12, Niacin, Folic Acid Deficiencies
Neoplasms (tumors)
Mechanical Disorders (hydrocephalus or hematoma)
Psychosis
Pseudo-Dementia
Normal Aging

25. Psychosocial Interventions
Patient Care: The primary goal is to make the patient as comfortable as possible. The environment should be kept simple and helpful. Clocks, calendars, labels, lists, familiar routines, short-term tasks, brief walks and simple exercise.
Family Counseling: Supportive and help to develop Behavioral Interventions for the patient in the home.

26. Safety Awareness and Planning
Removable of risk conditions such as: alcohol use, poor nutrition, exposure to toxins (cleaners), falls, wandering, stoves/ovens, self medication/over medication, and “noncompliance” with medications.

29. Cognitive Medications
Donepezil (Aricept 5 and10 mg)
Galantamine (Razadyne 8 – 24 mg)
Memantine (Namenda XR 5 – 28 mg)
Rivastigmine (Exelon patch 6 – 12 mg)

30. Pseudobulbar Affect Disorder (PBA)
Symptoms include frequent and often inappropriate, excessive, and uncontrollable, crying or laughing outbursts.
Nuedexta 20/10 (dextromethorphan 20 mg/
quinidine 10 mg)

31. Case Study
Video : Vivian

32. Impairments in functioning Treatment Needs
Vivian Case Study
What are Vivian’s
Symptoms
Impairments in functioning
Treatment Needs
Possible Goals for Treatment

33. What are Vivian’s “Strengths” and available Resources ?

34. Who else would you consult regarding the care and treatment of Vivian ?
Primary Care Physician
In-Home medical/nursing services
Social Worker or Case Manager
Council on Aging
State Senior Services Department
Meals on Wheels
Community Transportation
Family or neighbors

35. If the goal is to maintain Vivian living “independently” in her own home, what would be 3 Objectives (or short-term goals) for at this time ? 1. 2. 3.

36. Goal 1: Create a safe environment to maintain the patient in the home, living “independently” with her spouse for the next 6 months.
1. Conduct a Home Safety Check (2 weeks)
2. Patient will be complaint with the taking of her daily medications as prescribed by her PHC (6 months)
3. Refer the patient to neurologist to assess her ability to safely operate a motor vehicle (1 month).

37. What Interventions would you employ?

38. What Safety Concerns need to be included into her Treatment Plan ?

39. How would monitor and assess the effectiveness of this Treatment Plan?