Neuro-Cognitive Disorders

Annotations:

• Primary deficit in cognitive functions: LMC

1. Shifting principles

   Annotations:

   • Organic Mental Disorders Cognitive Disorders Neuro-cognitive Disorders

1. DSM 5

   Annotations:

   • Complex Attention Executive Function Language Perceptual motor problems Social Cognition
2. DSM 4

   Annotations:

   • Memory impairment Aphasia Apraxia Agnosia Executive Function

1. Major NCD (Dementia)

   Annotations:

   • Dementia Before for elderly after for younger people: HIV andTBI
   1. Diagnostic Criteria

      Annotations:

      • Severe Cognitive Decline Interfere with Independence Not due to 2
   2. Types

      Annotations:

      • 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
2. Mild NCD
   1. Diagnostic Criteria

      Annotations:

      • Moderate Cognitive Decline Do not interefere with independence
3. Delirium

   Annotations:

   • Absence of the criteria of delirium for Major/Minor NCD is called clear consciousness and can coexist.
   • Disruption of the homeostasis of the brain
   1. Diagnostic Criteria

      Annotations:

      • 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
   2. Risk factors

      Annotations:

      • Age, Cognitive/Sensory Impairment, Men, Severe illness, Hip fracture, Hyper/Hypo thermia, Hypotension, Malnutrition, Meds, Restraints, Metabolic (Hypo/Hyperglycemia, Azotemia), Depression, Alcoholism, and Pain
   3. Etiologies

      Annotations:

      • Organic 95% Multifactorial: Sensory Input, surroundings, and stressors DIMTOP
   4. Types
      1. Substance Intoxication
      2. Substance Withdrawal
      3. Medication Induced
      4. Due to another Medical Condition
      5. Due to multiple Etiologies
4. NCD (not specified)

1. Major NCD
   1. TBI

      Annotations:

      • Neuroimaging is required same as minor
   2. Parkinson
2. Minor NCD
   1. TBI

      Annotations:

      • Onset: known Loss of consciousnessDisorientationAmnesiaNeuroimaging not required
      • Recovery: Partial or complete Weeks to months
   2. S/M Induced
      1. Alcohol Abuse Abstinence 30-40%
      2. COSA 1/3
3. LBD

   Annotations:

   • Onset:Insidious Flactuating cognitiong alertness attention Visual hallucination Cognitive impairment-->1year-->Parkinsonian movements REM sleep disorder Neuroleptic sensitivity
   1. Parkinson

      Annotations:

      • 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
4. HIV

   Annotations:

   • Subcortical Pattern Impaired EF Slowing of processing speed Attention learning new info NO PROBLEM in recalling learned information 25-5%
5. Prion Disease

   Annotations:

   • Onset:Insidious Fatigue Anxiety Appetite/Sleep/concentration problems then after some weeks incoordenation, altered vision, abnormal gait, Rapidly progressive dementia, myoclonus, ataxia
   1. Creutzfeldt-Jakob

      Annotations:

      • 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
6. Huntington

   Annotations:

   • Onset:Insiduous EF (processing speed, organization, and planning) not learning and memory bradykinesia and chorea(kerking)
7. Vascular

   Annotations:

   • PR: above 65 second most common complex attention and EF
   • due to large vessel stroke small vessel ischemic disease white matter ischemia
8. AD

   Annotations:

   • 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
   1. Major

      Annotations:

      • 2 or more cognitive domains impaired IADLS
      1. Probable

         Annotations:

         • 1 of the following: Genetic mutation evidence or memory impairment  progressive gradual decline no other possible etiology
      2. Possible

         Annotations:

         • if none of probable occur
   2. Minor

      Annotations:

      • 1 or more cognitive domains IADLS intact
      1. Probable

         Annotations:

         • AD gene evidence
      2. Possible

         Annotations:

         • no evidence of AD gene but: Decline in memory progresive gradual decline in cognition no evidence of sources (Vascular, Lewy, Parkinson)

Annotations:

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