NEUROCOGNITIVE DISORDERS

Presentation By: Sarthak Kumar Singh

Presentation On: 07th March 2019
 Neurological disorders or Neurocognitive disorders
are diseases of the central and peripheral nervous
system.
 In other words, the brain, spinal cord, cranial nerves,
peripheral nerves, nerve roots, autonomic nervous
system, neuro-muscular junction, and muscles.
 Referred to in DSM-IV as "Dementia, Delirium,
Amnestic, and Other Cognitive Disorders"
 Epilepsy,
 Alzheimer disease and other Dementias,
 Cerebrovascular diseases including stroke, migraine and other
headache disorders,
 Multiple sclerosis,
 Parkinson's disease,
 Neuroinfectious,
 Brain tumours,
 Traumatic disorders of the nervous system due to head trauma,
 Neurological disorders as a result of malnutrition.
 The word "dementia" is related to a Latin word for “mad,” or
“insane”.
 Introduction of the term neurocognitive disorder attempts
to help reduce the stigma associated with both the word
dementia and the conditions that it refers to.
 Dementia is a chronic organic mental disorder,
characterized by, impairment of intellectual functions.
 Dementia is a descriptive term for the deterioration of
cognitive abilities where functioning becomes impaired.
 Impairments of memory predominantly of recent
memory, especially in early stages.
 Causing interference with day-to-day activities and
interpersonal relationships.
 As the dementia progresses, a parent is unable to
remember the name of a daughter or son and later may
not even recall that he or she has children or recognize
them when they come to visit.
 People with dementia also may get lost, even in familiar
surroundings.
 1. Emotional lability (marked variation in emotional expression).
 2. Catastrophic reaction (when confronted with an assignment which is beyond the
residual intellectual capacity, patient may go into a sudden rage).
 3. Thought abnormalities, e.g. perseveration, delusions.
 4. Urinary and faecal incontinence may develop in later stages.
 5. Disorientation in time; disorientation in place and person may also develop in
later stages.
 6. Neurological signs may or may not be present, depending on the underlying
cause.
 Evidence of significant cognitive decline from a previous level of performance in
one or more cognitive domains.
 The cognitive deficits interfere with independence in everyday activities.
 The cognitive deficits do not occur exclusively in the context of a delirium.
 The cognitive deficits are not better explained by another mental disorder (e.g.,
major depressive disorder, schizophrenia)
 Evidence of modest cognitive decline from a previous level of
performance in one or more cognitive domains.
 The cognitive deficits do not interfere with capacity for
independence in everyday activities.
 The cognitive deficits do not occur exclusively in the context of
a delirium.
 The cognitive deficits are not better explained by another
mental disorder (e.g., major depressive disorder,
schizophrenia).
 Alzheimer's disease is a primary degenerative cerebral disease
of unknown etiology(cause).
 Usually insidious in onset and develops slowly but steadily over
a period of years.
 The onset can be in middle adult life or even earlier.
 Dementia in Alzheimer's disease with early onset (F00.0):
Dementia in Alzheimer's disease beginning before the age of
65.
 Dementia in Alzheimer's disease with late onset(F00.1):
Dementia in Alzheimer’s disease where the clinically
observable onset is after the age of 65 years and usually in the
late 70s or thereafter.
 Dementia in Alzheimer's disease, atypical or mixed type
(F00.2): Dementias that do not fit the descriptions and
guidelines for either F00.0 or F00.1 should be classified here,
mixed Alzheimer's and vascular dementias are also included
here.
 Dementia in Alzheimer's disease, unspecified (F00.9).
 The prevalence of overall dementia (major NCD) rises steeply
with age.
 In high-income countries, it ranges from 5% to 10% in the
seventh decade to at least 25% thereafter.
 The percentage of dementias attributable to Alzheimer's
disease ranges from about 60% to over 90%, depending on the
setting and diagnostic criteria.
 Environmental: Traumatic brain injury increases risk for major
or mild NCD due to Alzheimer's disease.
 Genetic and physiological: Age is the strongest risk factor for
Alzheimer's disease.
 The genetic susceptibility polymorphism apolipoprotein E4
increases risk and decreases age at onset, particularly in
homozygous individuals.
 Multiple vascular risk factors influence risk for Alzheimer's
disease and may act by increasing cerebrovascular pathology
or also through direct effects on Alzheimer pathology.
 Presence of a dementia.
 Insidious onset with slow deterioration.
 Absence of clinical evidence, or findings from special
investigations, to suggest that the mental state may be due to
other systemic or brain disease which can induce a dementia.
 Major and mild NCDs due to other neurodegenerative
processes (e.g., Lewy body disease, frontotemporal lobar
degeneration) share the insidious onset and gradual decline
caused by Alzheimer's disease but have distinctive core
features of their own.
 In major or mild vascular NCD, there is typically history of
stroke temporally related to the onset of cognitive impairment,
and infarcts or white matter hyperintensities are judged
sufficient to account for the clinical picture.
 Particularly when there is no clear history of stepwise decline,
major or mild vascular NCD can share many clinical features
with Alzheimer's disease.
 Other concurrent, active neurological or systemic illness: At the
mild NCD level, it may be difficult to distinguish an Alzheimer's
disease etiology from that of another medical condition (e.g.,
thyroid disorders, vitamin B12 deficiency).
 Major depressive disorder: Particularly at the mild NCD level,
the differential diagnosis also includes major depression.
Presence of depression may be associated with reduced daily
functioning and poor concentration that may resemble an NCD.
 Most individuals with Alzheimer's disease are elderly and have
multiple medical conditions that can complicate diagnosis and
influence the clinical course.
 Major or mild NCD due to Alzheimer's disease commonly co-
occurs with cerebrovascular disease.
 When a comorbid condition contributes to the NCD in an
individual with Alzheimer's disease, then NCD due to multiple
etiologies should be diagnosed.
 The prominence of memory loss can cause significant
difficulties relatively early in the course. Social cognition (and
thus social functioning) and procedural memory (e.g., dancing,
playing musical instruments) may be relatively preserved for
extended periods.
 Neurodegeneration is the most common biological cause of
dementia and often leads to Alzheimer’s disease.
 Neurodegeneration is the process where brain cells (neurons)
break down and die.
 The disease causes a protein build up in the brain that slowly
destroys brain cells.
 While there is no cure for Alzheimer’s disease or a way to stop
or slow its progression.
 There are drug and non-drug options that may help treat
symptoms.
 Understanding available options can help individuals living
with the disease and their caregivers to cope with symptoms
and improve quality of life.
 Antidepressants
 Antidepressants may sometimes be given if depression is
suspected as an underlying cause of anxiety.

 Other Medications
 If coping strategies do not work, a consultant psychiatrist can
prescribe risperidone or haloperidol, antipsychotic medicines,
for those showing persistent aggression or extreme distress.
 Cognitive stimulation therapy: Cognitive stimulation therapy
(CST) involves taking part in group activities and exercises
designed to improve memory and problem-solving skills.
 Cognitive rehabilitation: Cognitive rehabilitation works by
getting you to use the parts of your brain that are working to
help the parts that are not.
 Reminiscence and life story work: Reminiscence work
involves talking about things and events from your past. It
usually involves using props such as photos, favourite
possessions or music.
 Vascular (formerly arteriosclerotic) dementia, which includes
multi-infarct dementia, is distinguished from dementia in
Alzheimer's disease by its history of onset clinical features, and
subsequent course.
 History of transient ischaemic attacks (a brief episode of
neurological dysfunction caused by loss of blood flow
(ischemia) in the brain, spinal cord, or retina, without tissue
death (infarction).) with brief impairment of consciousness,
fleeting pareses, or visual loss.
 Some impairment of memory and thinking then becomes
apparent. Onset, which is usually in later life, can be abrupt,
following one particular ischaemic episode, or there may be
more gradual emergence.
 This dementia is usually the result of infarction of the brain due
to vascular diseases, including hypertensive cerebrovascular
disease.
 The infarcts are usually small but cumulative in their effect.
 F01.0 Vascular dementia of acute onset: Usually develops
rapidly after a succession of strokes from cerebrovascular
thrombosis, embolism, or haemorrhage, in rare cases, a single
large infarction may be the cause.
 F01.1 Multi-infarct dementia: This is more gradual in onset
than the acute form, following a number of minor ischaemic
episodes which produce an accumulation of infarcts in the
cerebral parenchyma.
 F01.2 Subcortical vascular dementia: There may be a history
of hypertension and focal point of ischaemic destruction in the
deep white matter of the cerebral hemispheres, which can be
suspected on clinical grounds and demonstrated on
computerized axial tomography scans.
 F01.3 Mixed cortical and subcortical vascular dementia:
Mixed cortical and subcortical components of the vascular
dementia may be suspected from the clinical features, the
results of investigations (including autopsy), or both.
 F01.8 Other vascular dementia
 F01.9 Vascular dementia, unspecified
 Major or mild vascular NCD is the second most common cause
of NCD after Alzheimer's disease.
 In the United States, population prevalence estimates for
vascular dementia range from 0.2% in the 65-70 years age
group to 16% in individuals 80 years and older.
 Within 3 months following stroke, 20%-30% of individuals are
diagnosed with dementia.
 In neuropathology series, the prevalence of vascular dementia
increases from 13% at age 70 years to 44.6% at age 90 years or
older, in comparison with Alzheimer's disease (23.6%-51%) and
combined vascular dementia and Alzheimer's disease (2%-
46.4%).
 Higher prevalence has been reported in African Americans
compared with Caucasians, and in East Asian countries (e.g.,
Japan, China).
 Prevalence is higher in males than in females.
 Environmental: The neurocognitive outcomes of vascular brain
injury are influenced by neuroplasticity factors such as
education, physical exercise, and mental activity.

 Genetic and physiological: The major risk factors for major or

mild vascular NCD are the same as those for cerebrovascular
disease.
 A. The criteria are met for major or mild neurocognitive
disorder.
 B. There is insidious onset and gradual progression of
impairment in one or more cognitive domains (for major
neurocognitive disorder, at least two domains must be
impaired).
 C. The disturbance is not better explained by cerebrovascular
disease, another neurodegenerative disease, the effects of a
substance, or another mental, neurological, or systemic
disorder.
 Other neurocognitive disorders: Since incidental brain
infarctions and white matter lesions are common in older
individuals, it is important to consider other possible etiologies
when an NCD is present.
 Other medical conditions: A diagnosis of major or mild
vascular NCD is not made if other diseases (e.g., brain tumour,
multiple sclerosis, encephalitis, toxic or metabolic disorders)
are present and are of sufficient severity to account for the
cognitive impairment.
 Other mental disorders: A diagnosis of major or mild vascular
NCD is inappropriate if the symptoms can be entirely attributed
to delirium, although delirium may sometimes be
superimposed on a pre-existing major or mild vascular NCD, in
which case both diagnoses can be made.
 Major or mild NCD due to Alzheimer's disease commonly co-
occurs with major or mild vascular NCD, in which case both
diagnoses should be made. Major or mild vascular NCD and
depression frequently co-occur.
 Major or mild vascular NCD is commonly associated with
physical deficits that cause additional disability.
 Vascular dementia is the result of damaged nerve cells in the
brain, and based on the part of the brain that is damaged,
individuals with dementia are affected differently.
 Damage to blood vessels in the brain, or cerebrovascular
damage, by way of haemorrhage, malformation, or blockage, is
a common biological cause of dementia.
 It is most often caused by strokes, heart disease, and/or
hardening of the blood vessels supplying the brain
(atherosclerosis).
 The type of dementia that results from cerebrovascular disease
is Vascular or Multi-Infarct Dementia.
 Vascular dementia is the second most common cause of
dementia and is usually caused by one major stroke, or many
small “mini strokes”. This type of dementia occurs as a result of
an interruption of blood supply to the brain
 Treatment can help prevent further damage to the brain in
people with vascular dementia and may slow down in
progression. There’s currently no cure for the condition or a way
to reverse the damage that’s already occurred.
 Lifestyle changes: Eating healthy, for example, you may be
advised to follow a low salt-diet to manage high blood pressure,
losing weight if you’re overweight.
 Medication: Medication may also be offered to treat the
underlying cause of vascular dementia and help stop it getting
worse. These include:
 Medication for high blood pressure
 Statins to treat high cholesterol
 Medicines such as aspirin or clopidogrel to reduce the risk of
blood clots and further strokes
 Medication for diabetes
 An antipsychotic medicine, such as haloperidol, maybe given to
those showing persistent aggression or extreme distress where
there’s a risk of harm to themselves or others.
Support and Other Therapies:
 Occupational therapy to identify problem areas in everyday life,
such as getting dressed, and help with working out practical
solutions.
 Physiotherapy to help with movement difficulties.
 Psychological therapies, such as cognitive stimulation (activities
and exercise designed to improve memory, problem-solving
skills and language ability).
 Relaxation techniques, such as massage and music or dance
therapy.
 Social interactions, leisure activities and other dementia
activities.
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Disorders. United States: American Psychiatric Association. Retrieved Jan
01, 2019
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https://www.amboss.com/us/knowledge/Major_neurocognitive_disorder
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https://www.theravive.com/therapedia/mild-neurocognitive-disorder-
dsm--5-331.83-(g31.84)-or-799.59-(r41.9)-for-unspecified
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