NEUROCOGNITIVE DISORDERS Behavioral Changes: Patients may exhibit

Neurocognitive disorders, formerly referred to changes in mood, personality, and behavior,

as dementia, constitute a group of conditions which can be challenging for caregivers.
characterized by a decline in cognitive functioning Language Problems: Difficulties in language
that significantly impairs an individual's ability to comprehension, expression, and naming objects
perform daily activities. These disorders are are common in many neurocognitive disorders.
among the most challenging and prevalent issues Motor Symptoms: Some disorders, like
in geriatric medicine and psychiatry, affecting Parkinson's disease dementia and progressive
millions of individuals worldwide. supranuclear palsy, present with motor symptoms
Etiology: such as tremors and rigidity.
Genetic Predisposition: A family history of
neurocognitive disorders increases the risk. Diagnosis:
Age: Advanced age is the primary risk factor for ● Clinical Evaluation
most neurocognitive disorders. ● Cognitive Testing (Mini-Mental State
Cardiovascular Health: Conditions like Examination (MMSE) and Montreal
hypertension, diabetes, and high cholesterol can Cognitive Assessment (MoCA))
increase the risk of vascular neurocognitive ● Neuroimaging (MRI and PET Scans)
disorder. ● Blood Tests
Head Injury: Repeated head injuries, as seen in Treatment:
some athletes and military personnel, may While there is no cure for most neurocognitive
contribute to the development of neurocognitive disorders, several strategies can help manage
disorders. symptoms and improve the quality of life for
Environmental Toxins: Exposure to certain patients:
toxins, like heavy metals, has been linked to Medications: Depending on the specific disorder,
cognitive decline. medications may be prescribed to manage
Lifestyle Factors: A sedentary lifestyle, poor cognitive symptoms, depression, or agitation. For
diet, smoking, and excessive alcohol example, cholinesterase inhibitors like Donepezil
consumption can also increase the risk. are used in Alzheimer's treatment.
Psychosocial Interventions: Cognitive
Clinical Presentation: rehabilitation and psychotherapy can help
The clinical presentation of neurocognitive patients and their caregivers cope with the
disorders varies depending on the underlying emotional and practical challenges associated
cause. However, some common symptoms with neurocognitive disorders.
include: Lifestyle Modifications: A healthy diet, regular
Memory Impairment: Most neurocognitive physical activity, and cognitive stimulation can
disorders involve some degree of memory loss, slow the progression of cognitive decline.
especially in the early stages. Supportive Care: Patients often require
Cognitive Decline: Impaired thinking, reasoning, assistance with daily activities, and support from
and problem-solving abilities are hallmarks of family members or professional caregivers is
these disorders. essential.
 Clinical Presentation:
DELIRIUM ● Fluctuating Mental Status: Delirium
Delirium, often referred to as acute confusional often fluctuates throughout the day, with
state, is a complex and serious medical condition periods of lucidity followed by confusion.
characterized by a sudden and fluctuating ● Inattention: Patients with delirium
disturbance in cognitive function, attention, and struggle to focus on tasks or
awareness. conversations and are easily distracted.
Diagnostic Criteria: ● Disorientation: They may not know
❖ Disturbance in Attention and where they are or what time it is.
Awareness: A hallmark feature of ● Memory Impairment: Short-term memory
delirium is a fluctuating course with a is often particularly affected.
reduced ability to direct, focus, sustain, ● Language Problems: Speech may be
and shift attention. disorganized or nonsensical.
❖ Additional Cognitive Deficits: In addition ● Hallucinations and Delusions: Patients
to attention and awareness disturbances, may experience visual or auditory
delirium often involves other cognitive hallucinations and hold false beliefs.
deficits, such as memory impairment,
disorientation, language problems, and MAJOR & MILD NEUROCOGNITIVE
perceptual disturbances. DISORDERS
❖ Acute Onset and Fluctuating Course: Neurocognitive Disorders (NCDs) encompass a
Delirium typically has an acute onset, group of conditions characterized by cognitive
occurring over hours to days, and its decline significant enough to impact daily
severity tends to fluctuate throughout the functioning. Two key classifications within this
day. group are Major NCD (formerly dementia) and
❖ Etiological Attribution: The symptoms of Mild NCD (formerly mild cognitive impairment).
delirium should not be better explained by MAJOR NEUROCOGNITIVE DISORDER
another neurocognitive disorder, like Major NCD, commonly referred to as dementia,
dementia, and should be due to a medical represents a severe cognitive impairment
condition, substance intoxication or disorder. It involves significant cognitive decline
withdrawal, exposure to a toxin, or from a prior level of functioning, leading to
multiple etiologies. marked interference with daily activities.
❖ Evidence from History, Physical Diagnostic Criteria:
Examination, or Laboratory Findings: ● Cognitive Decline: There must be
To establish the diagnosis, there must be evidence of a significant cognitive decline
evidence from clinical assessment or from a previous level of functioning in one
laboratory investigations that the delirium or more cognitive domains. These
is a direct result of a medical condition or domains include memory, language,
substance use. attention, executive function, and complex
motor skills.
 ● Impact on Daily Life: The cognitive
decline should be severe enough to
interfere with an individual's ability to
independently perform daily activities,
such as managing finances, preparing
meals, or maintaining personal hygiene.
● Progressive Course: Major NCD is
typically characterized by a progressive
and irreversible course, where cognitive
deficits worsen over time.
● Etiology: While cognitive decline can
result from various underlying causes,
Major NCD itself is not due to a medical
condition, substance use, or another
mental disorder. It is diagnosed based on
the cognitive and functional impairments
observed.
● Severity Staging: Major NCD can be
staged based on its severity, from mild to
moderate and severe. The stage is
determined by the extent of cognitive
impairment and its impact on daily life.
MILD NEUROCOGNITIVE DISORDER
Mild NCD is a less severe form of cognitive
impairment than Major NCD, sometimes
considered a transitional stage between normal
age-related cognitive changes and more severe
impairment.
Diagnostic Criteria:
Cognitive Decline: There must be evidence of
mild cognitive decline from a previous level of
functioning in one or more cognitive domains.
These cognitive domains are the same as those
for Major NCD.
Minimal Impairment in Daily Life: Unlike Major
NCD, the cognitive deficits observed in Mild NCD
do not significantly interfere with a person's ability
to independently perform everyday tasks.
Non-Severe Course: Mild NCD typically has a
stable or slowly progressive course, and
individuals may remain in this stage for extended
periods.
Etiology: As with Major NCD, the primary cause
of Mild NCD should not be due to another medical
condition, substance use, or another mental
disorder. It is primarily diagnosed based on the
cognitive impairments noted.
Comparative Overview:
Severity: The primary distinction between Major
NCD and Mild NCD is the severity of cognitive
impairment and its impact on daily functioning.
Major NCD represents severe cognitive decline
with marked interference in daily life, while Mild
NCD involves mild cognitive decline with minimal
functional impairment.
Progression: Major NCD typically follows a
progressive course with worsening cognitive
deficits. In contrast, Mild NCD often remains
stable or slowly progresses.
Clinical Implications: Major NCD often
necessitates significant caregiving and support
due to the profound impact on daily functioning.
Mild NCD may not require the same level of
assistance, and some individuals with Mild NCD
may remain stable for years.
Risk: Mild NCD may increase the risk of
progressing to Major NCD, although not all
individuals with Mild NCD will develop the severe
form of the disorder.
Major Neurocognitive Disorder (Major NCD) and
Mild Neurocognitive Disorder (Mild NCD)
represent different levels of cognitive impairment,
with Major NCD involving severe decline and
marked functional impairment, while Mild NCD
signifies milder cognitive deficits with minimal
interference in daily life. Both conditions are
significant in terms of their impact on individuals Severity Staging: NCD due to Alzheimer's
and caregivers, and early recognition and Disease can be categorized into different stages
appropriate management are essential to provide based on the severity of cognitive impairment,
the best possible care and support. ranging from mild to moderate and severe. The
stage is determined by the extent of cognitive
NCD DUE TO ALZHEIMER'S DISEASE deficits and their impact on daily life.
Alzheimer's Disease is a chronic, irreversible
brain disorder characterized by the progressive FRONTOTEMPORAL NCD
degeneration of brain cells, leading to cognitive Frontotemporal Neurocognitive Disorder is a
impairment, memory loss, and the inability to subtype of NCD characterized by progressive
perform everyday activities. It is the most changes in behavior, personality, language, and
common cause of dementia among older adults. executive function. It is caused by the
degeneration of nerve cells in the frontal and
AD-NCD is a neurocognitive disorder marked by temporal lobes of the brain.
substantial cognitive decline from a previous level
of performance, particularly in the cognitive Diagnostic Criteria:
domains of memory, language, and executive Significant Behavioral or Language
function. This decline is severe enough to Impairment: There should be evidence of either
interfere with an individual's ability to significant behavioral changes, personality
independently perform daily activities. changes, or prominent language deficits.
Interference with Daily Life: These behavioral
Diagnostic Criteria: or language deficits should be severe enough to
Evidence of Significant Cognitive Decline: interfere with an individual's ability to
There must be evidence of a significant decline in independently perform everyday activities.
cognitive functioning from a previous level in one Frontotemporal Brain Atrophy: Neuroimaging
or more cognitive domains. This decline can studies, such as MRI, should reveal atrophy in the
manifest as deficits in memory, language, frontal and/or temporal lobes of the brain, which is
executive function, or other cognitive areas. characteristic of Frontotemporal NCD.
Interference with Daily Functioning: The Exclusion of Other Conditions: The symptoms
cognitive decline should be severe enough to observed should not be better explained by
interfere with an individual's ability to another neurocognitive disorder, medical
independently perform everyday activities, such condition, substance use, or another mental
as managing finances, preparing meals, or disorder.
maintaining personal hygiene.
Alzheimer's Disease as the Underlying Cause: Primary Variants:
The cognitive decline is attributed to the Frontotemporal NCD presents in two primary
underlying pathology of Alzheimer's disease. This variants:
attribution is often based on clinical evaluation, Behavioral Variant Frontotemporal NCD
neuroimaging, and the exclusion of other potential (bvFTD): This variant is characterized by
causes of cognitive impairment. prominent behavioral changes and personality
alterations. Key features include disinhibition, NCD WITH LEWY BODIES
apathy, social inappropriateness, compulsive NCD with Lewy Bodies is a neurocognitive
behaviors, and a lack of empathy. Individuals may disorder characterized by cognitive decline and
engage in socially inappropriate actions and may the presence of Lewy bodies, which are abnormal
appear selfish or insensitive. protein deposits, in the brain. These deposits can
Primary Progressive Aphasia (PPA): cause a range of cognitive, motor, and psychiatric
a. Non-fluent/Agrammatic Variant symptoms.
(nfvPPA): Individuals with nfvPPA
experience difficulty with speech fluency, Diagnostic Criteria:
grammar, and word finding. They may Significant Cognitive Decline: There should be
struggle to form grammatically correct evidence of a significant decline in cognitive
sentences and may have limited functioning from a previous level, which includes
vocabulary. deficits in attention, executive function,
b. Semantic Variant (svPPA): svPPA visuospatial ability, and memory.
primarily affects word comprehension and Fluctuating Cognitive Symptoms: Symptoms
vocabulary. Individuals have difficulty should fluctuate in severity and alertness over
understanding the meaning of words and time, often within the same day.
may lose the ability to recognize familiar Spontaneous Motor Features of
faces or objects. Parkinsonism: Individuals should exhibit at least
c. Logopenic Variant (lvPPA): lvPPA two of the following: bradykinesia (slowness of
involves word-finding difficulties, movement), resting tremor, or rigidity.
hesitations in speech, and problems with Visual Hallucinations: Recurrent complex visual
repetition. Individuals with lvPPA often hallucinations that are well-formed and detailed
exhibit slow and effortful speech. are often present. These hallucinations are
typically seen by the individual, not others.
Clinical Features: REM Sleep Behavior Disorder: A history of
The clinical presentation of Frontotemporal NCD REM (rapid eye movement) sleep behavior
varies depending on the variant but generally disorder, where individuals physically act out their
includes: dreams during sleep, is a common feature.
Behavioral Variant (bvFTD): Prominent Sensitivity to Antipsychotic Medications:
behavioral changes, apathy, disinhibition, and Individuals with NCD with Lewy Bodies may
social inappropriateness. experience severe sensitivity or adverse reactions
Primary Progressive Aphasia (PPA): Language to antipsychotic medications.
deficits specific to the subtype, such as speech Exclusion of Other Causes: The symptoms
fluency issues (nfvPPA), word comprehension should not be better explained by another
problems (svPPA), or word-finding difficulties neurocognitive disorder, medical condition,
(lvPPA). substance use, or another mental disorder.
VASCULAR NEUROCOGNITIVE DISORDER
Vascular NCD is a neurocognitive disorder Diagnostic Criteria:
characterized by cognitive impairment primarily Evidence of a Traumatic Brain Injury: There
related to cerebrovascular disease. It often should be documented evidence of a traumatic
presents as a stepwise decline in cognitive brain injury. This evidence can come from
function due to the cumulative effect of multiple medical records, imaging studies, or clinical
strokes or other vascular brain injuries. evaluation.
Cognitive Deficits: There must be evidence of a
Diagnostic Criteria: significant decline in cognitive functioning in one
Evidence of Cognitive Decline: There should be or more cognitive domains. These cognitive
evidence of a significant decline in cognitive deficits can manifest as problems with memory,
functioning from a previous level. This decline can attention, executive function, language, or
manifest as deficits in memory, executive visuospatial abilities.
function, language, or other cognitive domains. Relationship Between TBI and Cognitive
Cerebrovascular Disease as the Underlying Decline: The cognitive decline must be attributed
Cause: The cognitive decline should be primarily to the traumatic brain injury. This attribution is
attributed to cerebrovascular disease. This often based on the temporal relationship between
attribution is often based on clinical evaluation, the injury and the onset of cognitive symptoms,
neuroimaging, and the temporal relationship as well as the exclusion of other potential causes
between cognitive decline and vascular events. of cognitive impairment.
Cognitive Deficits Corresponding to Vascular Interference with Daily Functioning: The
Brain Injury: The cognitive deficits observed cognitive decline should be severe enough to
should correspond to the location and extent of interfere with an individual's ability to
vascular brain injury, as revealed by independently perform everyday activities, such
neuroimaging. as managing finances, preparing meals, or
Exclusion of Other Causes: The cognitive maintaining personal hygiene.
decline should not be better explained by another Exclusion of Other Causes: The cognitive
neurocognitive disorder, medical condition, deficits should not be better explained by another
substance use, or another mental disorder. neurocognitive disorder, medical condition,
substance use, or another mental disorder.
NCD DUE TO TRAUMATIC BRAIN INJURY Etiology:
NCD due to Traumatic Brain Injury is a Concussions: Mild TBIs often referred to as
neurocognitive disorder characterized by a concussions can result from sports injuries, falls,
significant cognitive decline in one or more or accidents.
cognitive domains (e.g., memory, attention, Moderate to Severe TBIs: More severe injuries
executive function) that is severe enough to can occur from automobile accidents, falls from
impair daily functioning. This decline is attributed heights, or other high-impact events.
to a traumatic brain injury, which can result from Blast Injuries: Military personnel are at risk of
head trauma due to accidents, falls, sports TBIs due to blast injuries from explosions.
injuries, or other causes.
Penetrating Head Injuries: Gunshot wounds or
other penetrating injuries can also cause TBIs.
The severity of cognitive impairment can vary
depending on the extent and location of brain
injury, with more severe injuries typically resulting
in more pronounced cognitive deficits.
NCD DUE TO HIV INFECTION
NCD due to HIV infection is a neurocognitive
disorder characterized by cognitive impairment
that can range from mild to severe and is
attributed to the effects of HIV on the central
nervous system.
Diagnostic Criteria:
Evidence of Cognitive Decline: There should be
evidence of a significant decline in cognitive
functioning from a previous level. This decline can
manifest as deficits in memory, attention,
executive function, language, or other cognitive
domains.
HIV Infection: The individual must be confirmed
to be HIV-positive through appropriate testing.
Relationship Between HIV and Cognitive
Decline: The cognitive decline must be attributed
to HIV infection. This is typically based on the
temporal relationship between the onset of
cognitive symptoms and the presence of HIV
infection, as well as the exclusion of other
potential causes of cognitive impairment.
Interference with Daily Functioning:
cognitive decline should be severe enough to
interfere with an individual's ability
independently perform everyday activities, such
as managing finances, preparing meals, or
maintaining personal hygiene.
Exclusion of Other Causes: The cognitive
deficits should not be better explained by another
neurocognitive disorder, medical condition,
substance use, or another mental disorder.
Etiology:
The primary cause of NCD due to HIV infection is
the presence of the HIV virus in the central
nervous system. HIV can cross the blood-brain
barrier and directly affect brain cells, leading to
inflammation, neuronal damage, and cognitive
impairment. Contributing factors may include the
viral strain, the effectiveness of antiretroviral
therapy (ART), and the individual's immune
response.
NCD DUE TO PRION DISEASE
Prion diseases, also known as transmissible
spongiform encephalopathies (TSEs), are a group
of rare and fatal neurodegenerative disorders that
affect humans and animals. These diseases are
characterized by the accumulation of abnormal,
misfolded proteins in the brain, which can lead to
severe neurological dysfunction. Prion diseases
are unique in that they can be transmitted from
one individual to another, and they have no
known cure.
NCD due to prion disease is a neurocognitive
disorder characterized by a significant and rapid
decline in cognitive functioning, often
accompanied by neurological symptoms, caused
by prion diseases.
The
Diagnostic Criteria:
to Evidence of Cognitive Decline: There should be
evidence of a significant and rapid decline in
cognitive functioning from a previous level. This
decline can manifest as deficits in memory,
attention, executive function, language, or other
cognitive domains.
Neurological Symptoms: Prion diseases independently perform everyday activities, such
typically present with neurological symptoms, as managing finances, preparing meals, or
which can include muscle stiffness, twitching, maintaining personal hygiene.
weakness, and changes in gait. Exclusion of Other Causes: The cognitive
Temporal Relationship to Prion Disease: The deficits should not be better explained by another
cognitive decline must be attributed to prion neurocognitive disorder, medical condition,
disease. This attribution is based on the temporal substance use, or another mental disorder.
relationship between the onset of cognitive
symptoms and the presence of prion disease, as Etiology:
well as the exclusion of other potential causes of Parkinson's Disease is primarily characterized by
cognitive impairment. the degeneration of dopamine-producing neurons
Exclusion of Other Causes: The cognitive in the brain. However, the cognitive impairment
deficits should not be better explained by another seen in NCD due to Parkinson's Disease is
neurocognitive disorder, medical condition, thought to result from the involvement of broader
substance use, or another mental disorder. brain networks beyond just the dopaminergic
system. Factors contributing to cognitive
NCD DUE TO PARKINSON'S DISEASE impairment may include the accumulation of
Parkinson's disease is a chronic, progressive abnormal protein aggregates (such as alpha-
neurological disorder that primarily affects synuclein), cerebrovascular changes, and
movement. It belongs to a group of conditions neurotransmitter imbalances.
known as "movement disorders" and is
characterized by the degeneration of specific SUBSTANCE/MEDICATION-INDUCED NCD
brain cells that produce dopamine, a Substance/Medication-Induced NCD is a
neurotransmitter essential for smooth and neurocognitive disorder characterized by
coordinated muscle movements. cognitive impairment resulting from the use or
exposure to substances or medications. This
Diagnostic Criteria: impairment can affect various cognitive domains,
Presence of Parkinson's Disease: The such as memory, attention, executive function,
individual must have a confirmed diagnosis of language, or visuospatial abilities.
Parkinson's disease based on clinical evaluation
and, in some cases, neuroimaging. Diagnostic Criteria:
Significant Cognitive Decline: There should be Evidence of Cognitive Decline: There should be
evidence of a significant decline in cognitive evidence of a significant decline in cognitive
functioning from a previous level. This decline can functioning from a previous level. This decline can
manifest as deficits in memory, attention, manifest as deficits in memory, attention,
executive function, language, or other cognitive executive function, language, or other cognitive
domains. domains.
Interference with Daily Functioning: The Temporal Relationship: The cognitive decline
cognitive decline should be severe enough to should have a temporal relationship with the use
interfere with an individual's ability to or exposure to a substance or medication. In
other words, the cognitive impairment should cognitive impairment that results from the genetic
develop during or shortly after the period of mutation responsible for Huntington's disease.
substance use or exposure. This mutation leads to progressive
Interference with Daily Functioning: The neurodegeneration, primarily affecting the basal
cognitive decline should be severe enough to ganglia and cerebral cortex.
interfere with an individual's ability to
independently perform everyday activities, such Diagnostic Criteria:
as managing finances, preparing meals, or Genetic Mutation: There should be confirmed
maintaining personal hygiene. evidence of the presence of the mutated HTT
Exclusion of Other Causes: The cognitive gene, which is responsible for Huntington's
deficits should not be better explained by another disease.
neurocognitive disorder, medical condition, or Cognitive Decline: There should be evidence of
mental disorder unrelated to substance use or a significant decline in cognitive functioning from
exposure. a previous level. This decline can manifest as
deficits in memory, attention, executive function,
Common Substances and Medications language, or other cognitive domains.
Involved: Interference with Daily Functioning: The
Alcohol: Chronic alcohol abuse can lead to cognitive decline should be severe enough to
Wernicke-Korsakoff syndrome, a condition interfere with an individual's ability to
characterized by severe memory impairment and independently perform everyday activities, such
cognitive deficits. as managing finances, preparing meals, or
Prescription Medications: Some medications, maintaining personal hygiene.
such as benzodiazepines, opioids, anticholinergic Exclusion of Other Causes: The cognitive
drugs, and certain sleep medications, can lead to deficits should not be better explained by another
cognitive impairment when misused or taken neurocognitive disorder, medical condition, or
inappropriately. mental disorder unrelated to Huntington's
Illicit Drugs: The use of illicit drugs like cocaine, disease.
amphetamines, and cannabis can affect cognitive
function, particularly with chronic or heavy use. Etiology:
Inhalants: The abuse of inhalants like paint Huntington's disease is an autosomal dominant
thinners or solvents can result in significant genetic disorder caused by a mutation in the HTT
cognitive deficits. gene. This mutation leads to the production of a
Environmental Toxins: Exposure to faulty form of the huntingtin protein, which
environmental toxins, such as lead or certain accumulates in brain cells, causing progressive
heavy metals, can lead to cognitive impairment. neurodegeneration. The basal ganglia,
responsible for motor control, and the cerebral
NCD DUE TO HUNTINGTON'S DISEASE cortex, involved in cognition, are particularly
NCD due to Huntington's Disease is a affected.
neurocognitive disorder characterized by
 Major Neurocognitive Disorder Mild Neurocognitive Disorder (Minor
Aspect (Major NCD) NCD)

Severe cognitive decline that impairs Mild cognitive decline that does not
Definition
daily functioning. significantly impair daily functioning.

Significant cognitive decline Noticeable cognitive decline

Diagnostic Impairment in daily functioning Minimal impairment in daily functioning
Criteria Evidence in medical history, Evidence in medical history,
examination, or cognitive testing. examination, or cognitive testing.

Mild to moderate cognitive deficits that

Cognitive Severe cognitive deficits across
may be isolated or involve multiple
Impairment multiple domains.
domains.

Substantial interference with daily Some interference with daily activities but
Daily Functioning
activities. generally independent.

More severe and advanced stage of Less severe, earlier stage of cognitive
Severity
cognitive decline. decline.

Alzheimer's disease, frontotemporal Alzheimer's disease, vascular cognitive

Typical Causes dementia, Lewy body dementia, impairment, mild cognitive impairment,
vascular dementia, etc. etc.

Typically a more rapid and relentless Progression is slower and less

Progression
progression. aggressive.

Focused on symptom management Focused on symptom management and

Treatment
and support, no cure. support, no cure.

Generally associated with a poorer Generally associated with a relatively

Prognosis
long-term prognosis. better long-term prognosis.

Diagnostic Major NCD often requires more Minor NCD individuals may be more
Considerations intensive care and assistance. independent and self-sufficient.

Clinical
Easier to maintain a higher degree of
Implications for Greater caregiving needs and
independence, but support and
Individuals and challenges.
monitoring may still be necessary.
Caregivers
 Parkinso
Vascular Traumatic Substance/ HIV n's Huntington's
Alzheimer's Frontotempora Lewy (Stroke) Brain Injury Medication- Infection- Prion Disease Disease
Aspect Disease l NCD Bodies NCD NCD NCD Induced NCD Related NCD Disease NCD NCD NCD

Dopamin
Alzheimer's Presence of
Frontotemporal Vascular Physical e HTT gene
pathology in Lewy bodies Caused by the
lobar brain injury to the Related to deficienc mutation and
Underlyi the brain, (alpha- use or Prion proteins
degeneration, damage due brain, often HIV infection y and accumulation
ng including synuclein exposure to are misfolding
distinct frontal to stroke or as a result of and its effects basal of mutant
Etiology amyloid protein substances or in the brain.
and temporal cerebrovasc trauma or on the brain. ganglia huntingtin
plaques and aggregates) medications.
lobe atrophy. ular disease. accidents. dysfuncti protein.
tau tangles. in brain cells.
on.

Typically
late
Typically late Early onset Varies, adulthoo
Late Varies but Varies, can Varies based
adulthood, (often before Can occur at typically d, Typically mid-
Onset adulthood, often occurs happen at on substance
although age 65) and any age after occurs in although adulthood,
Age often in the in older any age due or medication
early-onset late-onset HIV infection. older early- but can vary.
50s or 60s. adulthood. to injury. use.
forms exist. forms. adulthood. onset
forms
exist.

Commonly Prominent Prominen

Motor deficits
Not a presents with motor May have t motor Prominent
may result Commonly
prominent motor symptoms, motor deficits symptom motor
from stroke, presents with Variable,
Motor feature in symptoms, like if related to Rare motor s such as symptoms
such as motor depends on
Sympto early stages. including parkinsonism HIV- symptoms, if bradykin including
hemiparesis impairments the substance
ms May occur in muscle (tremors, associated any. esia, chorea
(weakness due to brain or medication.
advanced weakness and stiffness, brain tremors, (involuntary
on one side injury.
stages. coordination bradykinesia) damage. and movements).
of the body).
problems. . rigidity.

Early memory Early and Fluctuating Variable Depends on Rapid Predomin

Cognitive Progressive
Cognitiv impairment, prominent cognitive based on Variable the substance cognitive antly
decline, often cognitive
e followed by changes in abilities, stroke depending on or medication decline with a affects
affecting decline
Impairm deficits in behavior, including location but the location involved. May focus on executive
memory and across
ent multiple personality, and attention, can affect and extent of involve memory and function,
executive multiple
Pattern cognitive language. visuospatial, multiple brain injury. memory, visuospatial attention,
function. domains.
domains. Memory deficits & executive cognitive attention, or skills. and
 function.
visuospat
Hallucination
occur later. domains. other domains. ial
& delusion
abilities.
are common.

Common,
often Not typically Variable, may May involve Not typically Psychiatric
Hallucin Uncommon in
Common, involving associated Variable, may involve psychosis associated symptoms,
ations early stages, Not a
especially in visual with occur after psychosis and with including
and more likely in prominen
behavioral hallucination hallucination traumatic depending on hallucinations hallucinations irritability and
Delusion advanced t feature.
variants. s and s and brain injury. the substance related to HIV and impulsivity,
s stages.
paranoid delusions. or medication. infection. delusions. are common.
delusions.

Variable,
may occur Variable, Rapid decline
Variable but Variable, can
Gradual, slow suddenly or Variable, depends on Variable, can in prion Progressi Gradual,
Progres often slower fluctuate, but
progression gradually depending on the substance progress diseases like ve, progressive
sion progression generally
over years to depending the extent of or medication slowly over Creutzfeldt- gradual decline over
Rate compared to slower than
decades. on the brain injury. and level of years. Jakob decline. years.
Alzheimer's. Alzheimer's.
stroke's use. disease.
severity.

Medicatio
Limited ns for
Rehabilitatio
treatment Rehabilitation Cessation or No cure, motor
Medications Medications n after Antiretroviral
Treatme options, , cognitive withdrawal treatment symptom Symptomatic
for symptom for motor and stroke, therapy to
nt focusing on therapy, and from the focuses on s and treatment, no
management. cognitive medications manage HIV
Options symptom supportive substance or symptom supportiv cure.
No cure. symptoms. to manage infection.
management care. medication. management. e
risk factors.
and support. therapies
.

Genetic
Genetic
predispo
testing can Some Generally not Not genetic Some forms Highly
Some forms are Not genetic, sition can
identify genetic genetic, unless it's are genetic, genetic,
Genetic genetic, with caused by Not genetic, influence
familial forms, such linked to related to a linked to autosomal
Compon mutations in substance or results from age of
Alzheimer's as familial cerebrovasc genetic mutations in dominant
ent genes like medication HIV infection. onset
cases, but it's Lewy body ular risk predisposition prion protein inheritance
C9orf72. use. and
not always dementia. factors. before injury. gene (PRNP). pattern.
symptom
genetic.
s.
 Dopamin
Causativ Alpha-
Tau protein Physical HIV infection- e HTT gene
e synuclein Brain Substance or
Amyloid abnormalities in trauma to the related Abnormal deficienc mutation,
Agent/U protein damage due medication use
plaques and some forms; brain, may damage to folding of y and accumulation
nderlyin aggregates to leads to
tau tangles in TDP-43 involve brain cells prion proteins basal of mutant
g (Lewy cerebrovasc cognitive
the brain. abnormalities in diffuse axonal and in the brain. ganglia huntingtin
Patholo bodies) in ular events. impairment.
others. injury. structures. dysfuncti protein.
gy brain cells.
on.

Variable,
Life Variable, Variable, may Variable, Variable,
Variable, Improved Rapid decline, can live Variable,
Expecta typically live for several often several Variable, depends on
depends on with often leading for many several years
ncy several years years to a years after depending on the substance
stroke antiretroviral to death years to a couple of
After to a couple of couple of diagnosis, the extent of or medication
severity and therapy, but within a year after decades from
Diagnosi decades from decades post- but shorter in brain injury. use and
risk factors. variable. or two. diagnosis diagnosis.
s diagnosis. diagnosis. some cases. cessation.
.