Neurocognitive Disorders

Question 1

Changes DSM4 to 5

Answer 1

DSM-5 introduces the chapter on the neurocognitive disorders previously entitled “Delirium, Dementia, and Amnestic and Other Cognitive Disorders” in the DSM–IV
Core features are cognitive
Characterized by the syndromes of delirium, and major or mild neurocognitive disorders including their etiological subtypes

All are caused by either a general medical condition, substance use (both prescribed and illicit, and including alcohol), or a combination of these factors

Question 2

Delirium (p. 596)

Answer 2

Characterized as a temporary condition that often follows a short and fluctuating course seen by symptoms of:

Impaired awareness and attention

Transient nature (i.e., it can occur and then resolve itself quickly)

Disturbance in cognition

Not better explained by a preexisting or evolving neurocognitive disorder
Etiology should be specified according to: substance intoxication or withdrawal, medication-induced, due to another condition, or due to multiple etiologies
Tendencies towards restlessness, agitation, constant moving around without purpose

Question 3

The Neurocognitive Disorders (NCD)

Answer 3

The NCDs are characterized by cognitive decline from a previous level of performance and do not occur within the context of delirium seen by:

Evidence of decline in one or more of the following cognitive domains interfering with daily activities:
Complex attention – The ability to sustain focus
Executive function – The ability to think abstractly and to plan initiate, sequence, monitor, and stop complex behavior
Learning and memory – The process in which information is encoded, stored, and retrieved
Language - In particular, expressive language or one’s ability to communicate with others using language or how one expresses his or her wants and needs
Perceptual-motor – The ability to receive, interpret, and respond successfully to sensory information
Social Cognition – Focuses on how people process, store, and apply information about others and social situations

Question 4

Neurocognitive Disorders Subtypes

Answer 4

Alzheimer’s disease
Frontotemporal lobar degeneration (FTD) 
Lewy bodies 
Vascular Disease
Traumatic Brain Injury
Substance/medication use
HIV infection
Prion disease
Parkinson’s disease
Huntington’s disease
Another medical condition
Multiple etiologies
Unspecified

Question 5

Distinguishing Major and Minor NCD

Answer 5

relies heavily on observable behavior but can also be tested by a cognitive assessment, such as a neuropsychological test battery
Mild NCD requires a “modest” cognitive decline to the extent that it does not interfere with the person’s independence in everyday activities; specify with or without behavioral disturbance
Cognitive decline in major NCD meets criteria when there is “significant” impairment that is evident or reported by those who know the individual and interferes with independence to the extent that assistance is required; specify behavioral disturbance and severity (mild to severe)
Distinguish between a probable and a possible diagnosis

Question 6

Delirium Subtypes

Answer 6

Substance Intoxication / Withdrawal
Medication Induced
Delirium due to another medical condition