10.22 Elderly Psychiatric Disorders

Question 1

What is a major neurocognitive disorder?
According to the DSM-V

Answer 1

1. Evidence of significant cognitive decline
2. Relative to previous level of functioning
3. In one or more cognitive domains
4. These deficits interfere with independence in everyday activities

Question 2

Neurocognitive domains

Answer 2

• complex attention
• executive function
• learning and memory
• language
• perceptual-motor
• social cognition (social awareness as humans)

Question 3

What is a mild neurocognitive disorder?

Answer 3

1. Evidence of modest cognitive decline
2. Relative to previous level of functioning
3. In one or more cognitive domains
4. These deficits does not interfere with independence in everyday activities but require more effort or compensatory strategies

Question 4

Types of Dementia / Major neurocognitive disorders

Answer 4

1. Frontotemporal lobar degeneration (front part of brain shrink -> personality change)
2. Vascular (vessel wall thickening) -> stroke
3. Lewy body (little alpha-synclein) -> location in brain
4. Alzheimer’s (inflammation)
5. Parkinson’s with dementia

Question 5

Risk factors in major/mild neurocognitive disorders

Answer 5

1. Psychosocial (environment)
- education
- smoking
- physical inactivity
- social isolation

2. Biological
- neurotransmitters
- abnormal protein formation
- brain atrophy
- vascular abnormalities
- genetic / epigenetic

3. Other
- vascular risk factor control (diabetes, hypercholesterolemia, hypertention)
- depression
- hearing loss

Question 6

Biological abnormalities in major/mild neurocognitive disorders

Answer 6

Genetic and epigenetic variation
- Apo E4 variants
- Autosomal dominant mutations

Neurotransmitter abnormalities
- Dopaminergic systems (parkinson’s, fronto-temporal lobar)
- Acetylcholine (Ach) {Alzheimer’s and Lewy body}
- Glutamatergic (Vascular MNCD)

Vascular abnormalities
- Cerebral ischemia

Abnormal proteins
- Amyloid plaque (beta-amyloid 42)
- Abnormal Tau proteins (neurofibrillary tangles)
- Alpha-synclein

Brain atropy
- Loss of connective relationship
- loss of delicate balance

Question 7

Risk factors for demetia based on life stages

Answer 7

Birth
- ApoE 4 allele

Early life
- less education

Midlife
- hearing loss
- hypertension
- obesity

Late life
- smoking
- depression
- physical inactivity
- social isolation
- diabetes

Question 8

The neuroanatomical changes associated with Major/mild Neurocognitive Disorders

Answer 8

COMPLEX ATTENTION - Pre-frontal complex
PERCEPTUAL MOTOR - Occipital lobe
LANGUAGE - Frontal/Temporal and parietal lobe helps to formulate what you want to say, and the motor cortex enables you to articulate the words
LEARNING AND MEMORY - Hippocampus (limbic system next to the medial temporal lobe)
EXECUTIVE FUNCTION - Prefrontal regions of the frontal lobe
SOCIAL COGNITION - Pre-frontal cortex