Diagnoses of different types of “neurocognitive disorders” include:
Most often occurring in elderly adults, delirium is an impairment of consciousness, marked by a disturbance in attention and awareness. A life-threatening yet potentially reversible disorder of the central nervous system (CNS), delirium often involves perceptual disturbances, abnormal psychomotor activity, ad sleep cycle impairment. The condition develops over a short period of time (usually hours to a few days)and tends to fluctuate in severity during the course of a day. Cognition is also impaired, which can include memory problems, disorientation, language difficulties, or impairment of visuospatial ability and perception. The symptoms are not better explained by another preexisting or evolving neurocognitive disorder. Major causes of delirium include CNS disease (e.g., epilepsy), systemic disease (e.g., cardiac failure), and either intoxication or withdrawal from pharmacological or toxic agents.
Substance intoxication delirium may be caused by alcohol, cannabis, phencyclidine, opioids, inhalants, sedatives, hypnotics, anxiolytic drugs, amphetamines, cocaine, or other substances.
A diagnosis of “major neurocognitive disorder”, also known as dementia, is given when there is evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains: complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition. The diagnosis is based on:
The cognitive deficits interfere with the individual’s independence in everyday activities, at a minimum, requiring assistance with activities of daily living such as paying bills or managing medications. The cognitive impairment does not occur exclusively in the context of delirium and is not better explained by another mental disorder (e.g., major depressive disorder, schizophrenia).
Major neurocognitive disorder may be due to:
Symptoms of major neurocognitive disorder may occur in any of the following cognitive domains.
Complex Attention
This category applies to attention and processing speed. Examples:
Executive Function
This category applies to decision making, working memory, responding to feedback/error correction, overriding habits/inhibition, mental flexibility. Examples:
Learning and Memory
This category applies to immediate and recent memory (including free recall, cued recall, and recognition memory), very long-term memory, and implicit learning. Examples:
Language
This category applies to using language, including naming, word finding, fluency, grammar and syntax, and comprehension. Examples:
Perceptual-Motor
This category applies to visual perception and recognition, hand-eye coordination, and carrying out learned movements. Examples:
Social Cognition
This category applies to recognition of emotions, social behavior and sensitivity toward others. Examples:
There are a number of psychiatric and neurological changes that can occur with major neurocognitive disorder (dementia). These include:
“Mild neurocognitive disorder” is the term for individuals who fall between the cognitive changes of aging and early dementia.
A diagnosis of mild neurocognitive disorder is given when there is evidence of modest cognitive decline from a previous level of performance in one or more cognitive domains: complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition. The diagnosis is based on:
The cognitive deficits do not interfere with the individual’s independence in everyday activities, such as paying bills or managing medications, but greater effort, compensatory strategies, or accommodation may be required. The cognitive impairment does not occur exclusively in the context of delirium and is not better explained by another mental disorder (e.g., major depressive disorder, schizophrenia). Some minor impairment in memory may accompany normal aging.
Mild neurocognitive disorder may be due to:
Symptoms of mild neurocognitive disorder may occur in any of the following cognitive domains.
Complex Attention
This category applies to attention and processing speed. Examples:
Executive Function
This category applies to decision making, working memory, responding to feedback/error correction, overriding habits/inhibition, mental flexibility. Examples:
Learning and Memory
This category applies to immediate and recent memory (including free recall, cued recall, and recognition memory), very long-term memory, and implicit learning. Examples:
Language
This category applies to using language, including naming, word finding, fluency, grammar and syntax, and comprehension. Examples:
Perceptual-Motor
This category applies to visual perception and recognition, hand-eye coordination, and carrying out learned movements. Examples:
Social Cognition
This category applies to recognition of emotions, social behavior and sensitivity toward others. Examples:
Some studies have indicated that as many as 40 percent of Alzheimer’s patients have a family history of Alzheimer’s type of dementia; therefore, genetic factors are presumed to play a part in the development of the disorder, at least in some cases. Alzheimer’s type dementia has shown linkage to chromosomes 1, 14, and 21.
“Pseudodementia” occurs in depressed people who complain of impaired memory but, in fact, have a depressive disorder. When the depression is treated, the cognitive defects disappear.
Pseudodementia typically involves three cognitive components: memory issues, deficits in executive functioning, and deficits in speech and language. Specific cognitive symptoms might include trouble recalling words or remembering things in general, decreased attention and concentration, difficulty completing tasks or making decisions, decreased speed and fluency of speech, and impaired processing speed.
Most types of dementia cannot be cured, but there are ways to manage symptoms and to slow down the progression of dementia.
Pharmacotherapy
Doneprezil (Aricept), rivastigmine (Excelon), and galantamine (Reminyl) are cholinesterase inhibitors used to treat mild to moderate cognitive impairment in Alzheimer’s disease. Memantine (Namenda)protects neurons from excessive amounts of glutamate, which may be neurotoxic. The drug is sometimes combined with donepezil. It has been known to improve dementia.
Other drugs being tested for cognitive-enhancing activity include general cerebral metabolic enhancers, calcium channel inhibitors, and serotonergic agents. Some studies have shown that selegiline (Elderpryl), a selective type B monoamine oxidase inhibitor, may slow the advance of dementia.
Estrogen replacement therapy may reduce the risk of cognitive decline in postmenopausal women; however, more studies are needed to confirm this effect. Several epidemiological studies indicate a reduced risk of dementia in persons taking antihypertensive medications, cholesterol-lowering drugs, antioxidants, and anti-inflammatory drugs. However, no randomized controlled trials verify these data.
Psychosocial Therapies
Patients facing a progression of dementia often benefit from supportive and educational psychotherapy in which the nature and course of their illness are clearly explained. They may also benefit from assistance in grieving and accepting the extent of their disability.
Psychotherapy and counseling for family members of patients with dementia may also be of great value. A common problem that develops among caregivers involves their self-sacrifice in caring for a patient. A gradually developing resentment is often suppressed because of the feelings of guiltit produces. Therapists can help caregivers understand the complex mixture of feelings associated with seeing a loved one decline and can provide caregivers permission to express these feelings.
Preventive Lifestyle Factors
Exercise is reported to delay the onset of cognitive deterioration in general. Other factors associated with a reduced risk of cognitive impairment and dementia later in life include high education and socioeconomic status in early life, high work complexity, rich social network, social engagement, mentally stimulating activity, nonsmoking, and living with a partner during mid-life. Following a healthy diet, such as adherence to a Mediterranean diet, and intake of antioxidants and polyunsaturated fatty acids are also associated with a decreased dementia risk.
Risk factors for dementia include high blood pressure, obesity, high cholesterol, diabetes, and smoking.