neurocognitive disorders

Question 1

Important DSM-5 changes

Answer 1

Dementia and amnestic disorder are now rolled into Neurocognitive Disorder (NCD)-Major
Criteria and specific diseases are similar
New to DSM-5 is NCD-Minor
The term “dementia” is retained and still may be used in certain settings; however the move is to use the term NCD

Question 2

Delirium

Answer 2

Reduced awareness of environment and attention disturbance Lack of focus, can’t sustain focus)
Questions get repeated, attention wanders, give delayed answers, engagement difficult
Disorientation, Recent memory loss, Language disturbance, Disturbance in sleep-wake cycle
Sudden change in behavior and fluctuating lucid intervals
Usually memory impairment, disorientated, language disturbance
Many specifiers required: various substance intoxication or withdrawal, medication, medical condition, acute, persistent, activity level

Question 3

Delirium- prevalence, treatment course

Answer 3

Usually in elderly and hospitals
Usually sudden in onset, but if prolonged further evaluation is needed
Early identification is important as death or brain damage is possible
Causes: medical (i.e. disease), substance, trauma, sensory isolation
Drugs and hospitalization needed for treatment

Question 4

Delirium diagnostic tips

Answer 4

Visual hallucinations more likely to be delirium than psychotic disorder
Perceptual disturbances: illusions, hallucinations, mistaken auditory
Usually signals urgent and dangerous medical emergency
Seek medical consultation, investigate medical/substance causes
Investigate the patterns: sudden onset, duration, when more present
Attempt to orient client quickly or as often as possible with pictures, light, etc.

Question 5

neurocognitive disorders

Answer 5

Major:
Significant cognitive decline (i.e. learning, memory, language)
Substantial impairments in everyday livingDeficits occur outside of delirium
Treatment: medical intervention, patient care strategies (comfort, simple tasks, reduce stress)
Typically: Alzheimer’s, Parkinson’s, etc.

Minor:
Similar physical issues as major
Severity less
Limited interference with everyday living

Question 6

Basic info on the NCD’s

Answer 6

Alzheimer’s: clear decline in memory

Frontotemporal: decline in activity, language, social connection, planning, poor judgment. Many others (hoarding)

Lewy bodies: decline in cognition with visual hallucinations and sleep behavior problems

Vascular: stroke related issues that could be progressive or acute

TBI: loss of consciousness, amnesia, disorientation, confusion.

Prion Disease: related to transmissible agents (Mad Cow Disease). Progression from fatigue and sleeping/eating issues to worsening dementia related issues

Huntington: Impairments in executive functioning (organization and planning), not language and memory