1. NEUROCOGNITIVE DISORDERS
Chapter 13
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2. Characteristics of Neurocognitive Disorders
These disorders involve cognitive decline acquired in life in one or more domains of cognition.
Based upon concerns of the client or someone who knows the client well, and performance on objective assessment measures.
The DSM-5 provides descriptions to help clinicians provide a diagnosis that indicates both the fact that the individual has a neurocognitive disorder and, where known, the possible cause.
Brain’s functioning affects our abilities to think, remember, and pay attention.
In DSM-IV-TR, this set of disorders is titled delirium, dementia, amnestic, and other cognitive disorders.
Symptoms:
Mood disorders
Personality disorders
Injuries to the brain including brain trauma, disease, or exposure to toxic substances including drugs.
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3. neurocognitive disorders
In DSM-5, the term neurocognitive disorder replaces dementia
Refers to a form of cognitive impairment in which individuals undergo progressive loss of cognitive functions severe enough to interfere with their normal daily activities and social relationships.
Clinicians still use the term “dementia,” and the DSM-5 work group considered dementia to be useful in settings where medical personnel are familiar with the term.
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4. Delirium
A neurocognitive disorder that is temporary in nature involving disturbances in attention or awareness.
A temporary state in which individuals experience a clouding of consciousness
Unaware of what is happening around them
Unable to focus or pay attention
The symptoms tend to appear abruptly and fluctuate over the course of the time that they have the disorder
Core of the disorder involves an acute state of confusion, impairment in cognitive processing that affects memory, orientation, executive functioning, ability to use language, visual perception, and learning.
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5. Delirium Develops for a variety of reasons Substance intoxication
Substance withdrawal
Head injury
High fever
Vitamin deficiency
People of any age can experience delirium, common among medically or psychiatrically hospitalized older adult patients.
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6. Delirium Causes Tests and treatment Infection
Central nervous system disorder
Metabolic disorders
Tests and treatment
Delirium Rating Scale-Revised
Pharmacological approach
Haloperidol and respiridone
Apart from the cognitive symptoms of inattention and memory loss, individuals experiencing delirium have hallucinations, delusions, abnormalities in sleep-wake cycles, changes in mood, and movement abnormalities.
The advantage of using Delirium Rating Scale-Revised is that although designed for psychiatrists, other professionals and researchers can also use it.
Pharmacological approach administers antipsychotics.
Standard approach uses haloperidol, but clinicians may use “off-label” antipsychotics such as respiridone.
This combination appears to help resolve symptoms in as many as 84 percent of cases over a period of 4 to 7 days
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7. Neurocognitive Disorder due to Alzheimer’s Disease
This is a neurocognitive disorder associated with progressive, gradual declines in memory, learning, and at least one other cognitive domain.
Progressive and gradual cognitive deficits due to severe cerebral atrophy
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8. Diagnostic Criteria for Neurocognitive Disorder due to Alzheimer’s Disease
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9. FIGURE 13.1 - Changes in the Brain Associated with Alzheimer’s Disease
Mild cognitive impairment (MCI): A condition in which an individual suffers some memory problems but does not show symptoms of dementia.
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10. Stages of Alzheimer’s Disease
Not Alzheimer
Early-stage
Middle-stage
Late-stage
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11. Stages of Alzheimer’s Disease
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12. Diagnosis of Alzheimer’s Disease
Brain imaging techniques
Neuropsychological testing
NINCDS/ADRDA guidelines
Mini-Mental State Examination
The diagnosis of Alzheimer’s disease based on the NINCDS/ADRDA criteria involves thorough medical and neuropsychological screenings.
Continued improvement of MRI has resulted in a virtual explosion of studies on the diagnosis of Alzheimer’s disease through brain imaging.
Clinicians convened to revise the 1984 NINCDS/ADRDA Guidelines.
Goal was to develop diagnostic criteria not dependent on the expensive and potentially invasive brain scans used in research.
The clinical tool that clinicians most commonly use for diagnosing Alzheimer’s disease is a specialized form of the mental status examination, which we call the Mini-Mental State Examination.
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13. Pseudodementia
False dementia, symptoms caused by depression that mimic those apparent in early stages of Alzheimer's
People with depression are anxious, have difficulty sleeping, show disturbed appetite patterns, and experience suicidal thoughts, low self-esteem, guilt, and lack of motivation.
People with pseudodementia are likely to have a history of prior depressive episodes that may have been undiagnosed.
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14. Theories and Treatment of Alzheimer’s Disease
All theories regarding the cause of Alzheimer’s disease focus on biological abnormalities involving the nervous system.
Neurofibrillary tangles
Tau
Amyloid plaques
Secretases
Neurofibrillary tangles- A characteristic of Alzheimer’s disease in which the material within the cell bodies of neurons becomes filled with densely packed, twisted protein microfibrils, or tiny strands.
Amyloid plaques- A characteristic of Alzheimer’s disease in which clusters of dead or dying neurons become mixed together with fragments of protein molecules.
Secretases trim the part of APP remaining outside the neuron so that it is flush with the neuron’s outer membrane
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15. Figure 13.3 - Neurofibrillary Tangle
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16. figure 13.4 - Development of Amyloid Plaques
Secretases: Enzymes that trim part of the APP remaining outside the neuron so that it is flush with the neuron’s outer membrane.
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17. Risk factors for Alzheimer's disease
Cigarette smoking
Obesity
Lack of physical exercise
Neurofibrillary tangles: Material within the cell bodies of neurons becomes filled with densely packed, twisted protein microfibrils, or tiny strands.
Tau: A protein that normally helps maintain the internal support structure of the axons.
Amyloid plaques: Clusters of dead or dying neurons become mixed together with fragments of protein molecules.
Two main implications of research documenting the behavioral risk factors for Alzheimer’s disease:
People can reduce their risk of Alzheimer’s disease by taking advantage of behaviors that contribute to its development.
Risk factors increase the likelihood of an individual developing cerebrovascular disease, depression, and other causes of dementia.
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18. Mechanism of Action and Side Effects of Alzheimer’s Medications
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19. Behavioral strategies
Behavioral psychologists are developing strategies to maximize the daily functioning of people with Alzheimer’s disease.
Target both patient and caregiver to:
Increase patient independence
Eliminate wandering and aggression
Provide social support for caregivers
Caregivers are often targeted since they suffer adverse effects from the constant demands of caregiving.
Strategies that can promote the patient’s independence and reduce his or her distressing behaviors.
Support groups
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20. Neurocognitive Disorders due to Neurological Disorders Other than Alzheimer’s Disease
causes that include degenerative
neurological conditions other than Alzheimer’s disease
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21. Neurocognitive Disorders due to Neurological Disorders Other than Alzheimer’s Disease
Fronto-temporal neurocognitive disorder- Neurocognitive disorder that involves the fronto-temporal area of the brain.
Symptoms are reflected in personality changes:
Apathy, lack of inhibition, obsessiveness, and loss of judgment.
Neglect of personal habits and loss of the ability to communicate eventually occurs.
The onset of the disorder is slow and insidious.
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22. Neurocognitive disorder with Lewy bodies
A form of neurocognitive disorder with progressive loss of:
Memory
Language
Calculation
Reasoning and higher mental functions
Results from the accumulation of abnormalities called Lewy bodies throughout the brain.
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23. Vascular neurocognitive disorder A form of neurocognitive disorder resulting from a vascular disease that causes deprivation of the blood supply to the brain.
multi-infarct dementia (MID), caused by transient attacks in which blood flow to the brain is interrupted by a clogged or burst artery.
Although each infarct is too small to be noticed at first, over time the progressive damage caused by the infarcts leads the individual to lose cognitive abilities
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24. Pick’s disease
A relatively rare progressive degenerative disease that affects the cerebral cortex’s frontal and temporal lobes.
It is caused by the accumulation in neurons of unusual protein deposits
In addition to memory problems, people with this disorder become socially disinhibited, acting either inappropriately and impulsively or appearing apathetic and unmotivated.
Unlike Alzheimer’s Disease, personality alterations occur before memory problems.
Pick’s disease is a relatively rare progressive degenerative disease that affects the cerebral cortex’s frontal and temporal lobes. It is caused by the accumulation in neurons of unusual protein deposits called Pick bodies. In addition to having memory problems, people with this disorder become socially disinhibited, acting either inappropriately and impulsively or appearing apathetic and unmotivated. In contrast to the sequence of changes that people with Alzheimer’s disease show, people with Pick’s disease undergo personality alterations before they begin to have memory problems.
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25. neurocognitive disorder due to Parkinson’s disease
A neurocognitive disorder that involves degeneration of neurons in the subcortical structures that control motor movements.
At rest, hands, ankles, or head may shake involuntarily
Akinesia: Muscular rigidity, difficulty initiating movement
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26. Parkinson’s Disease Symptoms
Bradykinesia: General slowing of motor activity
Loss of fine motor coordination
Slowed, shuffling gait
Difficulty starting or stopping movement like walking
Signs of cognitive deterioration
Expressionless and speech becomes stilted
Many cognitive functions, such as attention, concentration, and immediate memory, remain intact.
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27. additional Neurocognitive disorders
Huntington’s disease
Creutzfeldt-Jakob disease
Lewy body dementia: Similar to Alzheimer's disease with progressive loss of memory, language, calculation, and reasoning, as well as other higher mental functions.
Diagnosed when Lewy bodies are found more diffusely throughout the brain.
Frontotemporal dementias: Involve the frontotemporal area of the brain.
Reflected in personality changes such as apathy, lack of inhibition, obsessiveness, or loss of judgment.
Motivation and communication are lost.
Huntington's disease: Hereditary condition causing dementia that involves a widespread deterioration of the subcortical brain structures and parts of the frontal cortex that control motor movements.
Creutzfeldt-Jakob disease: A neurological disease transmitted from animals to humans that leads to dementia and death resulting from abnormal protein accumulations in the brain.
Vascular dementia: Resulting from a vascular disease that causes deprivation of the blood supply to the brain.
Multi-infarct dementia: Caused by transient attacks in which blood flow to the brain is interrupted by a clogged or burst artery.
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28. Figure 13.6 - Other Diseases That Can Cause Deterioration in Cognitive Function
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29. Neurocognitive Disorder Due to Traumatic Brain Injury
Traumatic Brain Injury (TBI)- Damage to the brain caused by exposure to trauma.
Post-concussion syndrome: Constellation of physical, emotional, and cognitive symptoms persists from weeks to years
Trauma to the head that results in an alteration or loss of consciousness, or post- traumatic
amnesia is called traumatic brain injury, or TBI. Th e diagnostic criteria for neurocognitive disorder due to traumatic brain injury require evidence of impact to the head along with loss of consciousness, amnesia following the trauma, disorientation and confusion, and neurological abnormalities such as seizures. Th e symptoms must occur imm ediately aft er the trauma or aft er recovering consciousness, and past the acute postinjury period.
According to the Centers for
In older adults, falls are the most common cause of TBIs.
People undergoing mild TBI may experience a related condition known as post-concussion syndrome (PCS).
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30. Neurocognitive Disorders due to Another General Medical Condition
Previously referred to as amnesia
Amnesia is the inability to recall information that was previously learned or to register new memories.
Can result from a wide variety of medical problems, including:
Head trauma
Loss of oxygen
herpes simplex
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31. Substance-Induced neurocognitive disorder
Medications
Illicit drugs
Lead
Mercury
Insecticides
Industrial solvents
The most common cause:
Chronic alcohol use
Memory loss must persist over time for the clinician to assign the diagnosis of amnestic disorder.
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32. Biopsychosocial Perspective
No viable treatment for Alzheimer’s disease
Computer networks - Innovative, high-technology methods for reducing the stress placed on caregivers
Traditional approach – Emotional support
Cognitive-behavioral
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33. For more information on material covered in this chapter, visit our Web site:
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