Neurocognitive Disorders

I. Neurocognitive Disorders: disorders diagnosed on the basis of deficits in cognitive functioning that represent a marked change from the individual’s prior level of functioning.

Neurocognitive disorders are not psychologically based; they are caused by biological problems or medical diseases, or drug use/withdrawal that affect the functioning of the brain.

People who suffer from neurocognitive disorders may become completely dependent on others to meet basic needs in feeding, toileting, and grooming.

A. Amnesia: loss of memory due usually to brain injury, shock, fatigue, repression, illness, disease, drug use, or a major surgical operation.

1) Retrograde Amnesia: loss of memory of past events and personal information.

2) Anterograde Amnesia: inability or difficulty forming or storing new memories.

3) The Case of H.M.

II. Delirium: a state of extreme mental confusion in which people have difficulty focusing their attention, speaking clearly and coherently, and orienting themselves to the environment.

As a person’s focus becomes less clear, he or she has great difficulty concentrating and thinking in an organized way.

This leads to misinterpretations, illusions, and, on occasion, hallucinations.

This state of massive confusion typically develops over a short period of time, usually hours or days.

Fever, certain diseases and infections, poor nutrition, head injuries, strokes, stress (including the trauma of surgery), and intoxication by certain substances may all cause delirium.

The prevalence of delirium is estimated at about 1% to 2% in the general population, but rises to 14% among people over the age of 85.

III. Major Neurocognitive Disorder: a profound decline or deterioration in mental functioning characterized by significant impairment of memory, thinking processes, attention, judgment, and by specific cognitive deficits (a.k.a. Dementia).

A. Senile Dementias: forms of dementia that begin after age 65.

B. Presenile Dementias: forms of dementia that begin at or before age 65.

C. Happy and Sad Stroke Victims

D. The Man Who Mistook His Wife For A Hat

IV. Alzheimer’s Disease: a progressive, degenerative brain disease characterized by irreversible deterioration in memory, intelligence, communication, awareness, and control of bodily functions, eventually leading to death.The disease affects about 1 in 8 people age 65 or older and more than 1 in 3 people over the age of 85. It is the most common cause of dementia.

The time between onset and death is typically 8 to 10 years, although some people may survive for as many as 20 years.

A. Symptoms

It usually begins with mild memory problems, lapses of attention, and difficulties in language and communication.

In moderately severe Alzheimer’s Disease, people require assistance in managing everyday tasks.

In advanced Alzheimer’s Disease, sufferers also have difficulty with simple tasks, distant memories are forgotten, and changes in personality often become very noticeable.

End stage Alzheimer’s Disease is marked by the inability to walk, speak, control one’s bladder, eat, etc., followed by seizures, coma, and death.

B. Causal Factors

It appears that Alzheimer’s Disease often has a genetic basis.

1) Early-Onset vs Late-Onset

Researchers have identified a number of brain abnormalities seen in Alzheimer’s Disease.

Beta-amyloid protein plaques form in the spaces between cells in the hippocampus, cerebral cortex, and certain other brain regions.

Neurofibrillary tangles are twisted protein fibers found within the cells of the hippocampus.

C. Treatment and Prevention

Presently available drugs for Alzheimer’s Disease offer some benefits in slowing cognitive decline and boosting cognitive functioning.

Engaging in stimulating cognitive activities can help boost cognitive performance in people with mild to moderate Alzheimer’s Disease.

Some research suggests that lifestyle factors such as maintaining a regular exercise program and following a healthy diet low in animal fat and rich in vegetables and fish can reduce the risk of Alzheimer’s Disease.

V. Parkinson’s Disease: a progressive disease characterized by uncontrollable shaking or tremors, rigidity, disturbances in posture (leaning forward), and lack of control over body movements.

The disease affects men and women about equally and most often strikes between the ages of 50 and 69, affecting over 1% of the population over the age of 65.

Dementia occurs in perhaps 80% of Parkinson’s patients over the course of the illness.

Parkinson’s Disease is characterized by destruction or impairment of dopamine producing nerve cells in an area of the brain that helps regulate body movement.

The drug L-dopa, which increases dopamine levels, brought hope to Parkinson’s patients when it was introduced in the 1970s.

VI. Huntington’s Disease: an inherited degenerative disease that is characterized by jerking and twisting movements, mental deterioration, and unstable moods (anxiety and depression).

It typically develops between the ages of 30 to 45 with death occurring 15 to 20 years after onset. Only 1 in 10,000 people develop the disease.

It’s due to a defective gene that produces abnormal protein deposits in nerve cells in the brain.

VII. Frontotemporal Neurocognitive Disorder: a disorder characterized by the deterioration (thinning or shrinkage) of brain tissue in the frontal and temporal lobes of the cerebral cortex (a.k.a. Pick’s Disease).Symptoms include memory loss, and interestingly, social inappropriateness, such as a loss of modesty or the display of flagrant sexual behavior.

VIII. Neurocognitive Disorder With Lewy Bodies

A. Lewy bodies: abnormal protein deposits that form within the nucleus of cells in parts of the brain, disrupting brain processes that control memory and motor control.

It accounts for about 10% of dementias in older adults and has features of both Alzheimer’s Disease and Parkinson’s Disease.

The distinguishing features of the disorder, in addition to profound cognitive decline, is the appearance of fluctuating alertness and attention, marked by frequent periods of drowsiness and staring into space, as well as recurrent visual hallucinations, rigid body movements, and stiff muscles typical of Parkinson’s Disease.

IX. Foreign Accent Syndrome: a rare neurological condition in which patients develop what appears to be a foreign accent.

People with foreign accent syndrome acquire neither a specific foreign accent nor any additional fluency in a foreign language.

A. Pareidolia: the imagined perception of a pattern or meaning where it does not actually exist.