Neurocognitive Disorders Alzheimer Type

Presence of dementia by PE, documentation of mental status,

Delirium confirmed by neuropsychological tests
Short-term confusion Declining memory/learning
4 sub-categories of causes: medical condition, substance induced, Steadily progressive and gradual decline
multiple causes, other. No evidence of mixed etiology
DSM-5 Criteria Genetic mutation/family hx
A. A disturbance in attention Epidemiology:
B. The disturbance develops in short time period, represents a Onset in 50s or 60s
change from baseline and fluctuates in severity Memory predominate early disease, but it affects
C. There is an additional disturbance in cognition cognition, mood, behavior
D. Disturbances in Criteria A & B (above) are not explained by other DSM-5 Criteria
neurocognitive disorder or coma A. Criteria met for major/mild neurocognitive disorder
E. There is evidence the disturbance is a direct physiologic B. Insidious onset w/gradual progression of impairment in 1
consequence of another medical condition cognitive domain (2 if major)
C. Major + Probable Alzheimer's- evidence of genetic mutation or all
Dementia three- evidence of decline of memory/learning, steady progressive
Major Neurocognitive Disorder decline in cognition w/o plateaus, no evidence of mixed etiology
Severe impairment in memory, judgment, orientation and cognition D. Mild + probable Alzheimer's- genetic mutation
Progressive cognitive impairment in clear consciousness E. Mild + possible Alzheimers (all three as above)
8 subcategories
Determining cause of dementia is critical Tx:
15% are reversible Prevent disease in asymptomatic individuals
Therefore screening labs are essential Exercise, health diet, treatment of comorbidities
CBC, ESR Enhance cognition and memory
Electrolytes, Glucose Prognosis
BUN SCr, LFTs Survival up to 20 years after diagnosis
Ca PO4 Usually about 8 years
TSH, Protein, B12, folate Final stages: pt is mute and unable to comprehend, death
All drug levels: digoxin from pneumonia, etc.
UA
Pregnancy test if childbearing age Amnestic Disorders
ECG, LP, EEG Major neurocognitive disorders caused by other medical
Epidemiology conditions
5% general population older than 65 Medical conditions (ex: hypoxia)
20-40% older than 85 Toxins/medications
AD is most common type Unknown causes
Diagnosed by the inability to learn new information or inability to recall
DSM-5 Criteria for Major Neurocognitive Disorder previously learned information leading to impairment in functioning, and
A. Evidence of significant cognitive decline from previous level in is caused by general medical condition
one or more cognitive domains based on: Treatment centered around tx underlying cause
1. Concern by the pt, a knowledgeable informant or Major or minor neurocognitive disorders due to another medical
clinician condition
2. A substantial impairment in cognitive performance that May be transient lasting hours to days, or chronic lasting weeks to
is documented months
B. Cognitive deficits interfere with independence of everyday Subtypes:
activities Cerebrovascular disease
C. Cognitive deficits do no occur exclusively in context of delirium MS
D. The cognitive deficits are not better explained by other mental Korsakoff
disorders Alcoholic black outs
Electroconvulsive therapy
Head injury
Transient global amnesia