Problem 7 – Hooley and Butcher 17th ed. & Davey 2nd ed.
Some of the first signs of neurocognitive disorders are deficits in basic cognitive functions such as
perception, learning, memory, attention, language, visuospatial skills and also executive skills (problem-
solving, planning etc.). Cognitive disorders also affect disposition and personality, they may display radical
changes in personality and behavior. These are managed and treated by rehabilitation programs.
Learning and memory deficits: Amnesia is a common feature including the inability to learn new
information and failure to recall past events, especially recent past. Antegrade amnesia is when the person
is unable to recall anything from the moment of a head injury and to retain memories of recent events.
Deficits in attention and arousal: people show signs of lack of attention, being easily distracted, performing
well-known activities slower.
Language deficits: these are collectively known as aphasias. Language impairment can take many forms
including inability to understand speech or repeat it correctly, production of incoherent, jumbled speech
(fluent aphasia), inability to initiate speech or respond to speech with anything other than simple words
(non-fluent aphasia). Distinctions can be made between Broca’s aphasia (impairment in ability to speak)
and Wernicke’s aphasia (impairment in understanding speech).
Deficits in visual-perceptual functioning: agnosia is the loss of ability to recognize objects, persons, sounds,
shapes or smells. It can affect a variety of functions such as face perception (prosopagnosia) to musical
discrimination (amusia).
Motor skills deficits: impairments in motor performance and coordination. E.g. inability to move a limb,
difficulty in coordination movement. This is known as apraxia.
Deficits in executive functioning: these functions are normally associated with the prefrontal cortex.
Inability to effectively plan, initiate, monitor or exhibit complex behaviors.
Neurocognitive disorders:
- Delirium
- Major neurocognitive disorder (former diagnosis of dementia, involves Alzheimer’s)
- Mild neurocognitive disorder
Delirium: state of acute brain failure that between normal wakefulness and stupor/coma. It’s
characterized by confusion, disturbed concentration and cognitive dysfunction.
- ‘disturbance in awareness’
- It involves impairments in memory and attention, as well as disorganized thinking.
- Hallucinations and delusions are quite common.
- It often includes abnormal psychomotor activities such as wild lashing or disturbance of sleep cycle.
- The person is unable to carry out purposeful mental activity of any kind.
- The individual may also exhibit emotional disturbances: anxiety, fear, depression, anger, euphoria
- Delirium is treated as a distinct disorder because it can fluctuate quickly in severity.
- It can also coexist with a major or mild neurocognitive disorder.
- Can occur in a person of any age but old people are more at risk perhaps because the brain changes
by normal aging lead to reduced brain reserve.
- It’s common in the elderly especially after they’ve had surgery. 10 to 51% of patients who have had
surgery will experience delirium.
- At the other end of the spectrum, children are also at high risk, perhaps because their brains are
not yet fully developed.
, - Other risk factors are dementia, depression and tobacco use.
- Delirium is correlated with cognitive decline, longer hospital stays, more health problems and
increased mortality: 25% of old patients with delirium die within the following 6 months.
- It can be caused by head injury, infection, malnutrition, sleep loss, surgery, psychological stress in
general. But the most common cause of delirium is drug intoxication or withdrawal.
Treatment
- Most cases are reversible, expect when it’s caused by a terminal illness or severe brain trauma.
- Treatment involves medication, environmental manipulations, and family support.
- The medications are neuroleptics, same drugs used to treat schizophrenia.
- For delirium caused by drug withdrawal or alcohol, benzodiazepines (also used in anxiety disorders)
are used.
- Environmental manipulations that help them stay oriented include good lighting, easily visible
calendars, clocks and signs.
- Elder patients may still have some orientation problems like sleeping problems etc.
Major neurocognitive disorder: The broad diagnostic category for dementia has been renamed. One
reason is to reduce stigma, and also because dementia is accepted for elders but nor younger adults.
- Major neurocognitive disorders are those that involve marked deficits in cognitive abilities.
- These deficits are apparent in attention, executive ability, learning and memory, language,
perception, and social cognition.
- There is a decline from previously attained level of functioning.
Some of the first signs of neurocognitive disorders are deficits in basic cognitive functions such as
perception, learning, memory, attention, language, visuospatial skills and also executive skills (problem-
solving, planning etc.). Cognitive disorders also affect disposition and personality, they may display radical
changes in personality and behavior. These are managed and treated by rehabilitation programs.
Learning and memory deficits: Amnesia is a common feature including the inability to learn new
information and failure to recall past events, especially recent past. Antegrade amnesia is when the person
is unable to recall anything from the moment of a head injury and to retain memories of recent events.
Deficits in attention and arousal: people show signs of lack of attention, being easily distracted, performing
well-known activities slower.
Language deficits: these are collectively known as aphasias. Language impairment can take many forms
including inability to understand speech or repeat it correctly, production of incoherent, jumbled speech
(fluent aphasia), inability to initiate speech or respond to speech with anything other than simple words
(non-fluent aphasia). Distinctions can be made between Broca’s aphasia (impairment in ability to speak)
and Wernicke’s aphasia (impairment in understanding speech).
Deficits in visual-perceptual functioning: agnosia is the loss of ability to recognize objects, persons, sounds,
shapes or smells. It can affect a variety of functions such as face perception (prosopagnosia) to musical
discrimination (amusia).
Motor skills deficits: impairments in motor performance and coordination. E.g. inability to move a limb,
difficulty in coordination movement. This is known as apraxia.
Deficits in executive functioning: these functions are normally associated with the prefrontal cortex.
Inability to effectively plan, initiate, monitor or exhibit complex behaviors.
Neurocognitive disorders:
- Delirium
- Major neurocognitive disorder (former diagnosis of dementia, involves Alzheimer’s)
- Mild neurocognitive disorder
Delirium: state of acute brain failure that between normal wakefulness and stupor/coma. It’s
characterized by confusion, disturbed concentration and cognitive dysfunction.
- ‘disturbance in awareness’
- It involves impairments in memory and attention, as well as disorganized thinking.
- Hallucinations and delusions are quite common.
- It often includes abnormal psychomotor activities such as wild lashing or disturbance of sleep cycle.
- The person is unable to carry out purposeful mental activity of any kind.
- The individual may also exhibit emotional disturbances: anxiety, fear, depression, anger, euphoria
- Delirium is treated as a distinct disorder because it can fluctuate quickly in severity.
- It can also coexist with a major or mild neurocognitive disorder.
- Can occur in a person of any age but old people are more at risk perhaps because the brain changes
by normal aging lead to reduced brain reserve.
- It’s common in the elderly especially after they’ve had surgery. 10 to 51% of patients who have had
surgery will experience delirium.
- At the other end of the spectrum, children are also at high risk, perhaps because their brains are
not yet fully developed.
, - Other risk factors are dementia, depression and tobacco use.
- Delirium is correlated with cognitive decline, longer hospital stays, more health problems and
increased mortality: 25% of old patients with delirium die within the following 6 months.
- It can be caused by head injury, infection, malnutrition, sleep loss, surgery, psychological stress in
general. But the most common cause of delirium is drug intoxication or withdrawal.
Treatment
- Most cases are reversible, expect when it’s caused by a terminal illness or severe brain trauma.
- Treatment involves medication, environmental manipulations, and family support.
- The medications are neuroleptics, same drugs used to treat schizophrenia.
- For delirium caused by drug withdrawal or alcohol, benzodiazepines (also used in anxiety disorders)
are used.
- Environmental manipulations that help them stay oriented include good lighting, easily visible
calendars, clocks and signs.
- Elder patients may still have some orientation problems like sleeping problems etc.
Major neurocognitive disorder: The broad diagnostic category for dementia has been renamed. One
reason is to reduce stigma, and also because dementia is accepted for elders but nor younger adults.
- Major neurocognitive disorders are those that involve marked deficits in cognitive abilities.
- These deficits are apparent in attention, executive ability, learning and memory, language,
perception, and social cognition.
- There is a decline from previously attained level of functioning.
