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Neurocognitive Disorders

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Neurocognitive Disorders
Neurocognitive disorders in DSM 5 include
Delirium and followed by syndromes of
Major Neurocognitive Disorder (NCD) and
Mild Neurocognitive disorder.

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Neurocognitive Disorders
Both types of NCD have subtypes

NCD due to Alzheimer’s disease,


Vasculsar NCD
NCD with Lewy bodies
NCD due to parkinson’s disease
Frontotemporal NCD
NCD due to traumatic brain injury
NCD due to HIV infection
Substance/medication induced NCD

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Neurocognitive Disorders

NCD due to Huntington’s Disease


NCD due to
Prion’s disease
NCD due to another medical condition
NCD due to multiple etiologies
Unspecified NCD

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Neurocognitive Disorders
• Cognitive deficits
are present in many
mental disorders
but only disorders
whose core
features are
cognitive are
included in the
NCD category.
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COGNITIVE DOMAIN
• 1. Perceptual and
motor ...

• Eg. Visual
perception,
• Perceptual-motor
• Praxis and gnosis

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COGNITIVE DOMAIN
• 2. social cognition

• Social recog...
• theory of mind

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COGNITIVE DOMAIN
• 3.Complex
attention

• Sustained atttention
• Selective attentiuon
• Divided attentiuon

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COGNITIVE DOMAIN
• 4. executive function

• Planning
• Decision making
• Working memory
• Feedback/ error utilization
• Overriding habits/inhibition
• Mental/cognitive flexibility
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YELLOW
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BLACK
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GREEN
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VIOLET
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Neurocognitive Disorders
Delirium
. A disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift
attention) and awareness (reduced orientation to the environment).

The disturbance develops over a short period of time (usually hours to a few days),
represents a change from baseline attention

C. An additional disturbance in cognition (e.g., memory deficit, disorientation, •


language, visuospatial ability, or perception).

D. The disturbances in Criteria A and C are not better explained by another •


preexisting, established, or evolving neurocognitive disorder and do not occur in the
context of a severely reduced level of arousal, such as coma.

E. There is evidence from the history, physical examination, or laboratory findings that •
the disturbance is a direct physiological consequence of another medical condition,
substance intoxication or withdrawal (i.e., due to a drug of abuse or to a medication),
or exposure to a toxin, or is due to multiple etiologies.
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Neurocognitive Disorders
Delirium

Clinical features
The cardinal feature is disturbed
consciousness as drowsiness,
decreased awareness of the
surroundings, disorientation and
distractibility
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Neurocognitive Disorders
Delirium
Clinical features cont

Thinking is slow and muddled .


Ideas of reference, persecutory
delusions which are transient and
poorly elaborated.
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Neurocognitive Disorders
Delirium

Causes of delirium:
• Drugs & alcohol intoxication,
withdrawal and delirium tremens,
opiates, prescribed drugs,
Antiochinergics, sedatives, digoxin,
diuretics, lithium, and steroids.

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Neurocognitive Disorders
Delirium
Causes of delirium: cont

• Neurological conditions, epileptic


seizures or post
ictal, head injury, space occupying
lesions, encephalitis,cerebral
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hemorrhage
Neurocognitive Disorders
Delirium
Management of delirium

It is a medical emergency
o The underlying cause must be
treated
drugs must suspected as a
common cause
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Neurocognitive Disorders
Delirium
Management of delirium cont

Drug treatment
Used to treat the underlying cause,
control agitation and distress and allow
adequate sleep.
Haloperidol is used and some cases
are treated with atypical
antipsychotics. 23
Neurocognitive Disorders
Delirium
Outcome

Many cases recover rapidly


The outcome is worse in the elderly, preexisting
dementia or physical illness.
Delirium in the elderly increases the risk of death in
the next two years, institutionalization and risk of
dementia.

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Neurocognitive Disorders
amnesia and amnesic syndromes
Amnesia Is Loss Of Memory For
Episodic Memory As
Anterograde Amnesia And
Retrograde Amnesia.

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Neurocognitive Disorders
amnesia and amnesic syndromes
Causes of amnesia:
Transient
Transient global amnesia
Transient epileptic amnesia
Head injury

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Neurocognitive Disorders
amnesia and amnesic syndromes

Causes of amnesia:
persistent

Korsakov syndrome---B1 (THIAMINE)

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Neurocognitive Disorders
amnesia and amnesic syndromes

Clinical features
Profound deficit in episodic
memory
Disorientation for time
Loss of autobiographical
information
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Neurocognitive Disorders
amnesia and amnesic syndromes

Korsakov syndrome
also called
Wernicke Korsakov Syndrome
A syndrome that follows
Wernicke’s encephalopathy
Delirium, ataxia, pupillary
abnormalities, ophthalmoplegia,
nystagmus, and peripheral
neuropathy

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Neurocognitive Disorders
amnesia and amnesic syndromes
Korsakov syndrome
also called
Wernicke Korsakov Syndrome
 It is due to thiamine deficiency caused by
alcohol abuse, hyperemesis gravidarum,
severe malnutrition, or due to infarction,
tumors or infection

There is neuronal loss, gliosis and


microhemorrhages in the periaqueductal and
periventricular gray matter 30
Neurocognitive Disorders
amnesia and amnesic syndromes

Korsakov syndrome
also called
Wernicke Korsakov Syndrome
It is regarded as a medical emergency
And diagnosed by decreased red cell
transketolase level and increased MRI signal
in midline structures

Treatment is by replacing the thiamine before


administering glucose 31
Neurocognitive Disorders
amnesia and amnesic syndromes

Korsakov syndrome
also called
Wernicke Korsakov Syndrome

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Neurocognitive Disorders
amnesia and amnesic syndromes
Transient global Amnesia

Occurs in middle or late life

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Dementia

Is an acquired global impairment of


intellect, memory, and personality
without impairment of
consciousness.

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Dementia

 It is often
precipitated
by intercurrent
illness or
change in
social
circumstances 35
Dementia

 Loss of flexibility and adaptability and if


you press the patient who lost this
flexibility, there will be sudden explosions
of anger or grief(catastrophic reaction).

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Dementia

 Aimless behavior

 Slow thinking with perseveration

 False ideas, mostly persecutory

 Speech becomes incoherent or mute.


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Dementia

 Behavioral, affective, and


psychotic features accompany the
cognitive deficits.
 Insight is retained at first but
gradually lost.

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Dementia

 there are special tools to screen for cognitive


impairment such as MMSE (Mini-Mental State
Examination).
 Diagnosis and finding the cause requires the
following investigations:

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Dementia

Risk assessment include:

 Self neglect, poor judgment,


wandering, abuse, disinhibition

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Dementia

Alzheimer’s disease

60% of dementia is due to


Alzheimer disease

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Dementia
Alzheimer’s disease

clinical features
Amnesia, gradual and progressive
Aphasia-unable to understand/ express
speech
Apraxia-unable to perform
task/movement even he understands it

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Dementia
Alzheimer’s disease
Neuropathology
The brain is shrunken, widened sulci,
enlarged ventricles, brain weight is
reduced.

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Dementia
Alzheimer’s disease
etiology
Genes.
Most of the cases are not genetically
inherited but in rare cases it is familial and
causative mutations were identified in three
genes, APP(amyloid precursor protein,
presenilin1 and presenilin 2.

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Dementia
Alzheimer’s disease

Other theories include cholinergic


hypothesis based on the loss of
acetylcholine in the cerebral cortex.

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Dementia
vascular dementia

Is the second commonest cause of dementia.


More in men than women, more in Japan, China
and Russia.\

Clinical features: •
It appears in the late sixties or seventies. •
Emotional and personality changes appear first •
followed by impairment of memory and intellect.

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Dementia
vascular dementia
Depression, emotional liability and confusion

Behavioral retardation and anxiety

Transient Ischemic attacks or mild strokes •


are common.
The course is stepwise with periods of •
deterioration and partial recovery.
They have shorter survival than Alzheimer 49•
patients.
Dementia
vascular dementia
They have signs of hypertension,
arteriosclerosis in the peripheral
and retinal vessels and signs of
focal neurological deficits.

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Dementia
Dementia with Lewy Bodies
Is the second or third most frequent cause
of dementia
The cardinal feature is Lewy bodies in the
cerebral cortex.

LEWY BODY-ABNORMAL PROTEIN


AGREGATES

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Dementia
Dementia with Lewy Bodies

Neuropathology
Presence of Lewy bodies in the cerebral
cortex
They are seen in the substantial nigra
Presence of α-synuclein and ubiquitin
proteins.

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Dementia
Frontotemporal Dementias
Is the second most common form of
presenile dementia.
Presentation is usually between 45&70
years of age.
Prominence of behavioral rather than
cognitive features.

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Dementia
Frontotemporal Dementias
The frontal form present with behavioral
and personality change and the temporal
form with language disorder.

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Dementia
Frontotemporal Dementias

Subtypes include :

Pick’s disease.
Semantic dementia

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Dementia
Frontotemporal Dementias
On neuroimaging there is focal and
asymmetrical atrophy of the temporal and
frontal poles.
EEG is usually normal unlike the diffuse
slowing in Alzheimer's disease.
Acetylcholine and dopamine are not
affected but serotonin markers are
reduced.

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