Neurocognitive Disorders

Question 1

Disturbance in attention and awareness
Change in cognition that is not better accounted for by a preexisting, established, or evolving dementia
Disturbance develops over a short period (usually hours to days) and tends to fluctuate during the course of the day
There is evidence from the history, physical exam, or lab findings that the disturbance is caused by a direct physiologic consequence of a general medical condition, an intoxicating substance, medication use, or more than one cause

Answer 1

Delirium

Question 2

Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains based on concern of the individual, a knowledgeable informant or the clinician or a substantial impairment in documented cognitive performance
Cognitive deficits interfere with independence in everyday activities
Cognitive deficits do not occur exclusively in the context of delirium
Cognitive deficits are not better explained by another mental disorder

Answer 2

Neurocognitive Disorder

Question 3

Up to 25% of neurocognitive disorder cases
eosinophilic inclusion bodies are present in the cerebral cortex and brainstem
progressive cognitive impairment with early changes in complex attention and executive function rather than learning and memory
hallucinations, depression, delusions, REM sleep disorder, autonomic dysfunction, spontaneous parkinsonism
low striatal dopamine transporter uptake on SPECT or PET scan
significant sensitivity to antipsychotic drugs (caution)

Answer 3

Neurocognitive Disorder with Lewy Bodies

Question 4

Criteria is met for neurocognitive disorder
Insidious onset and gradual progression of impairment in one or more cognitive domain
Evidence of causative genetic mutation or family history
Decline in memory and learning and at least one other cognitive domain
Steadily progressive, gradual decline in cognition without extended plateaus
No evidence of mixed etiology
Disturbance is not better explained by cerebrovascular disease, another neurodegenerative disease, or the effects of another disorder or substance use

Answer 4

Neurocognitive Disorder due to Alzheimer’s Disease

Question 5

Second most common cause of neurocognitive (15-30% of cases)
Cerebrovascular disease is the primary pathology that accounts for the cognitive deficits (large vessel stroke or microvascular disease)
Personality and mood changes, loss of motivation, depression, emotional lability, psychomotor slowing, executive function deficits
Rapid onset and step-wise deterioration in patients in their 50s and 60s
Often associated with a history of high blood pressure or diabetes

Answer 5

Vascular Neurocognitive Disorder

Question 6

Relatively common cause of dementia in people under 65
Behavioral and language variants with distinct patterns of brain atrophy
Apathy, disinhibition (behavioral), aphasia (language)
Loss of interest in socialization, self-care, and personal responsibilities
Display of socially inappropriate behaviors, impaired insight
Relatively few deficits on formal neuropsychological testing in early stages
Gradually progressive with median survival 6-11 years after symptom onset and 3-4 years after diagnosis

Answer 6

Frontotemporal Neurocognitive Disorder / Pick’s Disease