Neuro-Cognitive Disorders

Neuro-Cognitive Disorders

1. Overview

   • Primary deficit in cognitive functions: LMC
   • Shifting principles
     • Organic Mental Disorders Cognitive Disorders Neuro-cognitive Disorders

2. Cognitive Domains

   • DSM 5
     • Complex Attention Executive Function Language Perceptual motor problems Social Cognition
   • DSM 4
     • Memory impairment Aphasia Apraxia Agnosia Executive Function

3. Classes

   • Major NCD (Dementia)
     • Dementia Before for elderly after for younger people: HIV andTBI
     • Diagnostic Criteria
       • Severe Cognitive Decline Interfere with Independence Not due to 2
     • Types
       • Alzheimer's Disease Frontotemporal Lobar Degeneration  Lewy Body Disease Vascular Disease Traumatic Brain Injury Substance/Medication HIV infection Prion Disease Parkinson's Disease Huntington Disease
   • Mild NCD
     • Diagnostic Criteria
       • Moderate Cognitive Decline Do not interefere with independence
   • Delirium
     • Absence of the criteria of delirium for Major/Minor NCD is called clear consciousness and can coexist.
     • Disruption of the homeostasis of the brain
     • Diagnostic Criteria
       • Disturbance in attention (direct,focus,sustain,shift) and awareness(orientation) MAY INCLUDE COGNITION (One at least): Memory deficit, disorientation, language, visuospatial ability, or perceptionDue to something else May resolve Development Acute: hours to few daysPersistent: Weeks to months
       • Sleep/wake cycle changes Emotional State changes Worsening of behavioral problems in the evening
     • Risk factors
       • Age, Cognitive/Sensory Impairment, Men, Severe illness, Hip fracture, Hyper/Hypo thermia, Hypotension, Malnutrition, Meds, Restraints, Metabolic (Hypo/Hyperglycemia, Azotemia), Depression, Alcoholism, and Pain
     • Etiologies
       • Organic 95% Multifactorial: Sensory Input, surroundings, and stressors DIMTOP
     • Types
       • Substance Intoxication
       • Substance Withdrawal
       • Medication Induced
       • Due to another Medical Condition
       • Due to multiple Etiologies
   • NCD (not specified)

4. Types and Etiologies

   • Major NCD
     • TBI
       • Neuroimaging is required same as minor
     • Parkinson
   • Minor NCD
     • TBI
       • Onset: known Loss of consciousnessDisorientationAmnesiaNeuroimaging not required
       • Recovery: Partial or complete Weeks to months
     • S/M Induced
       • Alcohol Abuse Abstinence 30-40%
       • COSA 1/3
   • LBD
     • Onset:Insidious Flactuating cognitiong alertness attention Visual hallucination Cognitive impairment-->1year-->Parkinsonian movements REM sleep disorder Neuroleptic sensitivity
     • Parkinson
       • Onset: Insidious Tremor, rigidity, bradykinesia, shuffling of posture and gate Dementia happens later on
       • substantia nigra in the brain stem  pigmented lesions called lewy bodies no dopamine is produced Major NCD
   • HIV
     • Subcortical Pattern Impaired EF Slowing of processing speed Attention learning new info NO PROBLEM in recalling learned information 25-5%
   • Prion Disease
     • Onset:Insidious Fatigue Anxiety Appetite/Sleep/concentration problems then after some weeks incoordenation, altered vision, abnormal gait, Rapidly progressive dementia, myoclonus, ataxia
     • Creutzfeldt-Jakob
       • Transmitted by corneal grafts, injected crude of growth hormone derived from human pituitary, infected electrodes
       • prion agent spongiform encephalopathy vacuolization of nerve cells
       • Confusion Depression Altered Sensation then after weeks to months Dementia ataxia palsy cortical blindness
   • Huntington
     • Onset:Insiduous EF (processing speed, organization, and planning) not learning and memory bradykinesia and chorea(kerking)
   • Vascular
     • PR: above 65 second most common complex attention and EF
     • due to large vessel stroke small vessel ischemic disease white matter ischemia
   • AD
     • lower beta amyloid protein deposition Elevated tau or phosphorelated  Positron Emission Tomography These appear years before the onset of NCD symptoms
     • Duration 10 years 3-20 years
     • Major
       • 2 or more cognitive domains impaired IADLS
       • Probable
         • 1 of the following: Genetic mutation evidence or memory impairment  progressive gradual decline no other possible etiology
       • Possible
         • if none of probable occur
     • Minor
       • 1 or more cognitive domains IADLS intact
       • Probable
         • AD gene evidence
       • Possible
         • no evidence of AD gene but: Decline in memory progresive gradual decline in cognition no evidence of sources (Vascular, Lewy, Parkinson)

5. Delirium vs. Dementia

   • Onset attention/short term memory Flactuation during the day Visual hallucinations MMSE clock draw