Neurocognitive Disorders I

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Overview – Neurocognitive Disorders, Part 1

Neurocognitive Disorders are a category of disorders that primarily affect cognitive abilities. They are not developmental conditions but are acquired conditions representing underlying brain pathology that results in a decline in functioning from a previously attained level of cognitive (mental) functioning. Diagnosis requires that symptoms must be associated with a medical condition and not another mental health problem, and there cannot be evidence of delirium, which is a separate, temporary disorder with similar symptoms. 

Two categories are recognized: Mild and Major. They exist on a spectrum of cognitive and functional impairment. At the Mild Neurocognitive Disorders level, the individual is likely to describe their everyday tasks as being more difficult or as requiring extra time or effort or compensatory strategies. Neurocognitive deficits in mild neurocognitive disorder do not interfere with the capacity for independence in everyday activities, although the individual usually functions at a suboptimal level, with the tasks becoming more fatiguing. A Mild Neurocognitive Disorders may or may not progress to a major neurocognitive disorder. A Major Neurocognitive Disorders shows a serious decline from a previous level of cognitive performance, interfering with independence in everyday activities, and requiring more assistance with complex activities. Some activities may need to be abandoned altogether.

Neurocognitive Disorders involve six areas of cognitive function including: 

  • Executive function – difficulties with planning
  • Learning and memory – inability to make decisions
  • Perceptual-motor function – trouble focusing on tasks
  • Language – inability to remember names of objects and people
  • Complex attention – struggling to perform daily tasks
  • Social cognition – speaking or behaving in socially unacceptable ways.

Neurocognitive Disorders, Part 1, presents information about four types of Neurocognitive Disorders, one type each day for four days. These are:  

Neurocognitive Disorder due to Traumatic Brain Injury

A Neurocognitive Disorder due to Traumatic Brain Injury is an intracranial injury that occurs when an external force injures the brain, usually from a bump, jolt, blow, or other head injury as in a vehicle accident, fall, stroke, sports, or athletic injuries. It causes temporary or permanent damage in the brain. It can result in long term complications up to and including death. TBI has historically been a military complication, but it is now recognized as a major civilian problem, on account of vehicular accidents, falls, and the increasing recognition of brain concussion in athletic injuries and some sports. 

Neurocognitive Disorder Due to HIV Infection

A Neurocognitive Disorder due to HIV Infection occurs because of an infection with the Human Immunodeficiency Virus (HIV) that attacks the brain. It is diagnosed when criteria for either mild or major Neurocognitive Disorder have been met and the individual has been diagnosed with HIV infection. The symptoms should not be attributable to any other medical condition and should not be explained by another mental disorder. 

HIV Infection Neurocognitive Disorder is more common in individuals testing HIV positive who have had prior episodes of severe immunosuppression, high viral loads in the cerebrospinal fluid, anemia, and hypoalbuminemia.

  • HIV Infection Mild Neurocognitive Disorder is diagnosed when there is some modest impairment compared to prior performance but does not necessarily interfere with activities of daily living, although more effort is required to accomplish these activities.
  • HIV Infection Major Neurocognitive Disorder is diagnosed when there is a significant decline in prior performance, substantial enough to interfere with complex activities of daily living, such as paying bills, holding a job, managing medications, etc. 
Neurocognitive Disorder Due to Prion Disease

Neurocognitive Disorder Due to Prion Disease involves fatal disorders that are in a unique category of mental illness in that the underlying pathology, and frequently the etiology as well, can potentially be determined. They encompass the group of disorders in which the primary clinical deficit of impaired cognitive function is acquired rather than developmental. Two categories are recognized: mild neurocognitive disorders and major neurocognitive disorders (formerly referred to as dementia). 

The causative agents are believed to be proteinaceous infectious particles or prions, a type of protein. These pathogenic agents are able to induce abnormal folding of The These causative agents are believed to be proteinaceous infectious particles or prions, a type of protein. specific normal-cellular proteins called prion proteins that are found most abundantly in the brain. The functions of these normal-prion proteins are still not completely understood. The abnormal folding of the prion proteins leads to brain damage and the characteristic signs and symptoms of the disease. Prion diseases are usually rapidly progressive and always fatal. Prions kill neurons by shortening the dendritic spines on neurons that pull information into the cells, which they use to transmit signals to each other. 

Prion diseases are transmissible to both humans and animals and are sometimes spread to humans by infected meat products. Scrapie is a type of disease seen in animals. Several types have been identified in humans including Creutzfeldt-Jakob Disease (CJD) and Variant Creutzfeldt-Jakob Disease (vCJD), Bovine Spongiform Encephalopathy (BSE) or Mad Cow Disease, and Chronic Wasting Disease (CWD). 

Frontotemporal Neurocognitive Disorder

Frontotemporal Neurocognitive Disorder is a progressive mental condition with frontal and temporal lobe degeneration that is diagnosed when there is either a progressive behavioral problem or a progressive language problem. Patients may present with both the behavioral and the language variant of frontotemporal lobar degeneration concurrently. It is the 3rd most common dementia after Alzheimer’s and Lewy body dementia, and the most common causes of dementia in adults younger than 60 years. 

A progressive language problem includes a prominent decline in language ability, speech production, word-finding, grammar, or word-comprehension. The language variant of Frontotemporal Neurocognitive Disorder comprises three types: 

  • Semantic – difficulty understanding the meaning of a word, phrase, sentence, or text.
  • Agrammatic/non-fluent – slowing of speech production, grammar difficulties, and muteness.
  • Logopenic – difficulty making or understanding speech 

The disease is gradually progressive, with a median survival of 5-10 years after symptom onset and 4 years after diagnosis.

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