What percentage of individuals over the age of 85 have a neurocognitive disorder Quizlet

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Neurocognitive Disorders
*primary clinical deficit is in cognitive function
A. Major Neurocognitive Disorder, due to...
i. Significant decline in functioning...
ii. Dementia: marked cognitive decline, due to...
B. Mild Neurocognitive Disorder, due to...
i. Mild or subtle decline in functioning...
ii. Often precedes Major Neurocognitive Disorder
C. Delirium, due to...
i. Acute, rapid onset, obvious confusion/disorientation
ii. Reversible, time limited, treatable
iii. Disorientation: impaired awareness, attention;
disturbed perception/sensory inputs
2
Dementia
• Dementia:
- Decline in cognitive mental function and ADLs
- Examples of affected areas:
• memory, problem solving, language, mood, and
impulse control; behavior; personality
- Gradual onset and continuing cognitive decline
• Age is strongest risk factor for dementia
- Afflicts 15% of those over age 70
- Prominent feature of many MNDs
- Not a standalone diagnosis
Major and Mild Neurocognitive Disorders (MNDs)
Diagnosing with DSM 5
a) Specify: "Possible" or "Probable" designation
- e.g., "MND probably due to vascular disease"
b) Specify due to: (Etiology/Cause)
- Alzheimer's disease, Frontotemporal lobar degeneration, Lewy
body disease, Vascular disease, Traumatic brain injury (TBI),
Substance or medication use/abuse, HIV infection, Prion
disease, Parkinson's disease, Huntington's disease, Another
medical condition, Multiple etiologies, Unspecified
c) Specify: behavioral disturbance,
- With or without behavioral disturbance.
d) Specify current severity:
- Mild, Moderate, Severe. This specifier applies only to major
neurocognitive disorders (including probable and possible).
3
Importance of Specifiers
MND due to
_____
Parkinson's
Disease
Alzheimer's
Disease
Dementia with
Lewy bodies
Huntington's
Disease
Frontotemporal
lobar
degeneration
(Pick's)
Prion Disease
(CreutzfeldtJakob)
Vascular
Disease
Substance Use
AIDS-related
Dementia
TBI
Unknown
Assessment
Assessment of Major/Mild Neurocognitive Disorder:
1. Gather extensive background information in clinical
interview
2. Evaluate overall mental functioning, personality
characteristics, and coping skills
3. Attempt to rule out sensory conditions, medical, or
emotional factors
4. Test to pinpoint areas of cognitive difficulty or
deficits (see MMSE or MoCA posted online)
5. If possible: Imaging (PET, CT, MRI, EEG)
6. Invite input from others (with permission) who have
observed the decline in patients' cognitive function
(collateral information; corroborative baseline data)

A. Major Neurocognitive Disorder
For a diagnosis, a person must show significant
decline in:
1. One or more cognitive areas
• Attention and focus; decision-making and judgment;
language, learning and memory; visual perception; or social
understanding (deficits in multiple areas are common)
-and-
2. Ability to independently meet daily living
demands (ADLs - 6 domains)
• eating, bathing, dressing, toileting, mobility and continence
B. Mild Neurocognitive Disorder
For diagnosis, one must show mild/subtle decline in:
1. at least one major cognitive area
• Attention and focus; decision-making and
judgment; language, learning and memory; visual
perception; or social understanding
Individuals are able to participate in normal activities;
May require extra time to complete tasks
Overall independent functioning not compromised
- Often undiagnosed; difficult to distinguish from
normal aging
Early detection can allow individual to plan for future
care before the disorder progresses
• Sometimes a major ND is downgraded to a mild one
As a result of recovery from stroke or TBI
6
Normal Aging or Neurocognitive Disorder?

C. Delirium
• Acute onset; state of confusion
characterized by disorientation and impaired
attentional skills
- Abrupt onset
• Develops over a period of several hours or days
- Symptoms can be mild to severe
- Transient psychotic symptoms may be present
- Treatment: identify underlying cause treat
- Hospitalized individuals and the elderly at
increased risk
- Resolved relatively easily; temporary condition
7
Etiology of Neurocognitive Disorders
MNDs result from WIDE variety of medical conditions
• Specific injury events, for example:
• Stroke ("cerebrovascular accident" - CVA)
• Head injury (TBI)
- Some become worse over time; others recover
• Neurodegeneration
- Progressive brain damage involving death or destruction of
brain cells; often cause unknown or difficult to verify (ALZ)
• decline, never improvement
But Neurogenesis Does Occur!
- Stimulation of new neural cell growth; hope for future cure
stem cell research
- Very limited in adult brain (hippocampus; olfactory bulb)
Importance of Specifiers
MND due to
_____
Vascular
Disease
TBI
Substance
Abuse
8
Specifiers: Neurodegenerative Disorders
(the "due to_____" part)
-TIA Vascular
Neurocognitive Disorder due to:
Cerebrovascular Events
Can result from a one-time CVA or from unnoticed,
ongoing disruptions to vascular system
• Often begin with atherosclerosis; plaque buildup
• Correlates: Smoking; stress; poor diet; depression
Cerebrovascular Accident (CVA) "Stroke":
Obstruction of blood flow to or within the brain,
leading to loss of brain function
o Hemorrhagic: Involves leakage of blood into the brain
o Ischemic: Caused by a clot or severe narrowing of the
arteries supplying blood to the brain (87%)
o Transient ischemic attack (TIA): "Mini-stroke"
resulting from temporary blockage of arteries
o Symptoms often precede ischemic stroke
9
Neurocognitive Disorder due to:
Traumatic Brain Injury (TBI)
• Traumatic brain injury (TBI; mTBI)
- Can result from bump, jolt, blow, blast, or physical
wound to the head
- Mild, Moderate, Severe (based on initial injury)
• Most are mild (mTBI) 75-95%
• But every single case is different
- 2 TYPES:
• Penetrating (e.g., GSW; shrapnel; Phineas Gage...)
• Closed Head (stroke; blast, bump, hypoxic/anoxic injuries)
- 1.7 million people per year receive emergency care for
traumatic brain injury (does not include military #s)
• Most effects are temporary; but can be permanent
• Most with mTBI recover function (weeks to months)
- BUT: repeated TBIs, make recovery more complicated
Neurocognitive Disorder due to:
Substance Abuse
• Use of drugs or alcohol
- Can result in delirium, temporary cognitive
impairment, or chronic brain dysfunction
(Korsakoff's)
• Mild neurocognitive disorder common with
history of heavy substance use
- Symptoms continue with initial abstinence but
can improve over time
- Possibility of treating (e.g., thiamine deficiency
treated with massive vitamin dose - alcoholics)
10
Importance of Specifiers
MND due to
_____
Alzheimer's
Disease
Parkinson's
Disease
Dementia with
Lewy bodies
Huntington's
Disease
Frontotemporal
lobar
degeneration
AIDS-related
Dementia
Unknown
Specifiers: Neurodegenerative Disorders
("due to_____")
11
Neurocognitive Disorder due to:
Alzheimer's Disease
#1 -Most prevalent neurodegenerative disorder
- Affects more than 5 million Americans
• Involves progressive cognitive decline
- Early symptoms
• Memory dysfunction, irritability, and cognitive
impairment
- Other symptoms that often appear
• Social withdrawal, depression, apathy, delusions,
impulsive behaviors, neglect of personal hygiene
• Age a major risk factor
• Clear physiological indicators required to
predict whether patients with mild memory
impairment will likely develop AD
• No cure
Alzheimer's Disease and the Brain
• Shrinkage of brain tissue (cell death due to tau &
plaques)
• Abnormal structures
1. Neurofibrillary tangles (tau)
• Twisted fibers of tau found inside nerve cells
2. Beta-amyloid plaques
• Beta-amyloid proteins aggregate in spaces between neurons;
sticky; prevent communication
• Brain changes appear years before dementia appears
• Influenced by hereditary and environmental factors
- APOE-e4 allele of the APOE gene increases risk for AD
- Link between sleep and amount of beta-amyloid in the
brain
- Same factors that elevate risk for CVD (diet; smoking;
sedentary; depression; sleep; stress)
12
Senile Plaques and Neurofibrillary Tangles
Alzheimer's Disease Progression (8-10yrs)
Mild memory
problems, lapses of
attention, and mild
difficulties in
language and
communication
Trouble completing
complicated tasks
and remembering
important
appointments
Difficulty with
simple tasks,
distant memories,
and changes in
personality become
noticeable
Less and less
awareness of
limitations shown;
can be angry,
irritable, confused,
violent
Eventually fully
dependent with no
knowledge of past
and failure to
recognize familiar
faces
Usually in good
physical health until
later stages of
disease
Death typically from
infection
(pneumonia)

Can we predict Alzheimer's disease?
• Most cases of Alzheimer's disease can be
diagnosed with certainty only after death, when an
autopsy is performed
• Brain scans, which reveal structural abnormalities
in the brain, now are commonly viewed as
assessment tools
- PET scans (Mosconi and colleagues)
- Overall, the PET scans, administered years before
the onset of symptoms, predicted mild neurocognitive
impairment with an accuracy rate of 71% and major
neurocognitive impairment with an accuracy rate of
83%
15
Assessing and Predicting Alzheimer's
Disease
• Most effective interventions
- Prevention and Early intervention
- Diet
- Exercise
- Social Support
- Optimism
- Healthy lifestyle
- Education (yay, you!)
What Biochemical Changes in the Brain
Relate to Alzheimer's Disease?
• Certain biochemical activities seem to be
especially important in memory
- For new information to be acquired and stored,
certain proteins must be produced in key brain
cells
- Several chemicals are responsible for the
production of these memory-linked proteins;
research suggests that abnormal activity by these
various chemicals may contribute to the
symptoms of Alzheimer's disease
• Acetylcholine, glutamate, RNA (ribonucleic acid), and
calcium
16
Other Explanations of Alzheimer's Disease
• Explanations
- Zinc
- Environmental
toxin lead
- Autoimmune
theory
- Viral theory
Slipping away
Neurocognitive Disorder due to:
Parkinson's Disease
2
nd most common neurodegenerative disorder
• 4 symptoms: psychomotor primarily
- Tremor of the hands, arms, legs, jaw, or face
- Rigidity of the limbs and trunk
- Slowness in initiating movement
- Drooping posture, or impaired balance and coordination
- Motor sx evident at least 1yr prior to cognitive decline
** Only mild cognitive disorder - 27% of those with PD
• Later stages of PD similar to those of DLB
• More common in Northern Midwest and the
Northeast in urban settings
- Raises questions about environmental toxins
17
Neurocognitive Disorder due to:
Dementia with Lewy Bodies
• 2nd most common cause of dementia in NDs
• Characteristics
- Progressive cognitive decline
- Unusual movements seen in Parkinson's disease;
Significant fluctuations in attention and alertness;
Hallucinations; Impaired mobility; Sleep disturbance
• Lewy bodies
- Brain cell irregularities
- Result from the buildup of abnormal proteins in the
nuclei of neurons
- Also present in Parkinson's disease
- When present in the cortex
• Deplete the neurotransmitter acetylcholine
- When present in the brain stem
• Deplete dopamine
Neurocognitive Disorder due to:
Huntington's Disease
• Rare, genetically-transmitted degenerative
disorder
• Symptoms
- Involuntary twitching movements
- Eventual dementia and death
• Early symptoms
- Difficulty in executive functioning (frontal
lobes); memory; problem-solving; decision
making; emotion/behavioral control
• No effective treatment; No cure
• Death occurs 15-20 years after symptom
onset
18
Neurocognitive Disorder due to:
Frontotemporal Lobar Degeneration (Pick's)
• 4th leading cause of dementia
• Degeneration/atrophy in the frontal (behavior)
and temporal (communication) lobes
• 40% have hx of neurodegenerative disorders in
the family
• Symptoms
- Changes in behavior, personality, and social skills
- Difficulty with fluent speech or word meaning
- Muscle weakness
- Average age of onset is between 45 and 64 yrs
Neurocognitive Disorder due to:
PRION DISEASE (CREUTZFELDT-JAKOB DISEASE)
• Early onset: 60yrs;
• extremely rare (1/1,000,000);
• rapid development of dementia; spasms
• Theories:
- slow-acting virus that may lie dormant for
decades (majority), or
- familial transmission (rare)
- Contamination by virii (very rare)
• 75% mortality in 6mos; 90% dead in 1yr.
• No cure; impossible to kill

Neurocognitive Disorder due to:
HIV- AIDS
• Cognitive impairment sometimes the first
sign of untreated HIV-AIDS
- Slower mental processing; difficulty
concentrating; memory problems "fuzzy thinking"
• AIDS dementia complex (ADC)
- HIV becomes active in the brain
• Antiretroviral therapies can prevent or delay
onset (but not cure)
- Brain changes still occur in half of those taking
antiretroviral medications
Neurocognitive Disorder due to:
VASCULAR DISORDER
• follows a cerebrovascular accident, or
stroke, during which blood flow to specific
areas of the brain was cut off, with resultant
damage
• This disorder is progressive but its symptoms
begin suddenly, rather than gradually
• Cognitive functioning may continue to be normal
in the areas of the brain not affected by the
stroke
20
Who Cares for Them?
Home care by relatives
- Caregiving can take a heavy toll on the close
relatives of people with Alzheimer's disease
and other types of neurocognitive disorders.
• Almost 90% of all people with Alzheimer's disease
are cared for by their relatives.
• One of the most frequent reasons for the
institutionalization of people suffering from
Alzheimer's is that overwhelmed caregivers can no
longer cope with the difficulties of keeping them at
home.
Sociocultural approaches including day-care
and assisted-living facilities
What Treatments Are Currently Available?
• Treatments and approaches
• Drug therapy
• Vitamin therapy
• Cognitive techniques
• Behavioral interventions
• Lifestyle changes
• Support for caregivers
• Sociocultural approaches
21
Treatment: Neurocognitive Disorders
Treatment approaches vary widely due to
different causes, symptoms, and dysfunctions
Major interventions
1. Rehabilitative services
2. Biological interventions
3. Cognitive and behavioral treatment
4. Lifestyle changes
5. Environmental support
Rehabilitation Services
• Must be comprehensive and sustained
• Physical, occupational, speech, and
language therapy
- Individual's commitment and participation in
therapy plays an important role
- Depression, pessimism, and anxiety can stall
progress
• Constraint-induced therapy
- Repeated and intensive use of affected side of
the body
22
Biological & Lifestyle Treatment
• Medication (e.g., Alzheimer's)
- Levodopa increases dopamine availability
- High doses of vitamin E can slow AD progression;
high dose of thiamine for deficient alcoholics (with
cognitive sxs)
- Antidepressants; antipsychotics; anxiolytics
- Early stages of research into deep brain
stimulation
• Importance of lifestyle "treatment":
sufficient sleep; healthy diet; exercise
(oxygen!); weight loss; smoking cessation;
hypertension; social support; optimism;
meditation; mindfulness; keeping cognitively
active (learn something!)
Cognitive and Behavioral Treatment
• Psychotherapy
- Enhance coping and participation in rehabilitation
efforts
- Reduce frequency and severity of problem
behaviors
- Teach coping strategies to deal with changes
• Meditation and mindfulness-based stress
reduction (early stages)
- Reduced brain atrophy
- Slow down progression of disease
23
Environmental Support
• MNDs involving dementia are: irreversible; best
managed with supportive people and environment
• Exposure to bright lighting
- Improve sleep and decrease agitation and depression
• Family visits; encourage recall of past happy times
• Labeling family photos
• Make memory notes; put post-its around to aid
• Remove anything that seems disturbing
**Remember to support caregivers: extremely high
levels of "caregiver exhaustion/burnout" with MNDs
** Assisted living/care for final stages
Still Alice......
• The word she was
searching for was
"pariah." Alzheimer's
is like cancer used
to be. People don't
understand it,
they're afraid of it.
• But when you ask
people over 65 what
disease they're most
concerned about --
it's Alzheimer's.
Alice: "You know, I'd rather have cancer. Because then I wouldn't be such a

Cost of Living Longer.......
• In 2014, the cost of caring for those with
Alzheimer's was an estimated $214 billion,
according to the Alzheimer's Association.
• By 2050, unless better treatments are found,
it will cost around $1.2 trillion.
To compare: $4.8 trillion - cost of all efforts for all
wars fought since 2001 (Iraq, Afghanistan,
Pakistan), and ongoing/future care of veterans