neuro-cognitive disorders

1. NEUROCOGNITIV
E DISORDERS
Presented by: Rabia Javed Iqbal

2. NEURO-COGNITIVE
DISORDERS
• Delirium
• Neuro cognitive disorder due to Lewy bodies
• Neurocognitive disorder due to Alzheimer disease.
• Frontotemporal neurocognitive disorder
• Vascular neurocognitive disorder
• Neurocognitive disorder due to traumatic brain injury

3. DELIRIU
M
• Clouding state of consciousness in which a person has great
difficulty in concentrating, focusing, keeping attention and a
straightforward stream of thought.
• Delirium can often be traced to one or more contributing
factors, such as a
• severe or chronic medical illness,
• changes in your metabolic balance (such as low sodium),
• medication, infection, surgery, or alcohol or drug withdrawal.

4. SIGNS AND
SYMPTOMS
• Disturbance of attention often manifested by reduced
ability to focus, direct, sustain and shift attention.
• Repetition of questions.
• Easily distracted by irrelevant stimuli.
• Disturbance of awareness manifested by reduced
orientation to environment and time.

5. • Signs and symptoms of delirium usually begin over a few
hours or a few days.
• They often fluctuate throughout the day, and there may be
periods of no symptoms.
• Symptoms tend to be worse during the night when it's dark
and things look less familiar.

6. • Reduced awareness of environment;
• Cognitive Impairment (Poor Thinking Skills)
• Emotional Disturbances
• Behavioral Changes

7. TYPES OF
DELIRIUM
• Hyperactive Or Hyper Alert Delirium
• The patient is hyperactive, aggressive, argumentative and
uncooperative.
• May appear to be responding to internal stimuli
• Frequently the people suffering come to our attention because they
are difficult to care for.

8. TYPES OF
DELIRIUM
Hypoactive or hypo-alert
• Person appears to be napping on and off throughout the day
• Unable to sustain attention when awakened, quickly fallingback
asleep
• Misses meals, medications, appointments
• Does not ask for care or attention
• This type is easy to miss because caring for these patients is not
problematic to staff

9. TYPES OF
DELIRIUM
Mixed Delirium
• This includes both hyperactive and hypoactive symptoms.
• The person may quickly switch back and forth from
hyperactive to hypoactive states.
• The most common types are hypoactive and mixed
accounting for approximately 80% of delirium cases

10. CAUSES OF
DELIRIUM
• Delirium occurs when the normal sending and receiving of
signals in the brain become impaired.
• This impairment is most likely caused by a combination of
factors that make the brain vulnerable and trigger a
malfunction in brain activity.
• Delirium may have a single cause or more than one cause,
such as a medical condition and medication toxicity.
Sometimes no cause can be identified.

11. CAUSES OF
DELIRIUM
• In a study of delirium in elderly patients, Francis and
colleagues
• identified five leading causes of delirium.
1. Fluid/electrolyte disturbance
2. Infection
3. Medication toxicity
4. Metabolic derangement

12. DEMENTIA VS.
DELIRIUM
• Dementia has an deceptive onset, chronic memory
and executive function disturbance, tends not to
fluctuate.
• In delirium cognitive changes develop acutely and
fluctuate.
• Dementia has intact alertness and attention but
broken speech and thinking.
• In delirium speech can be confused or disorganized.
• Alertness and attention wax and wane.

13. TREATMENTS
• First and foremost treat the underlying cause.
• Environmental interventions
• cues for orientation must be used e.g. (calendar, clock, family
pictures, windows),
• frequently reorient the patient,
• have family or friends visit frequently making sure they
introduce themselves,
• minimize staff switching.

14. NEUROCOGNITIVE
DISORDER DUE TO LEWY
BODIES
• Lewy bodies = microscopic protein deposits that damage brain
over time
• NCDLB is the newest dementia diagnosis with an incidence of
7 per 1,000 individuals among those aged 65 and older.
• Individuals with NCDLB are often misdiagnosed with NCD due
to Parkinson’s Disease.
• Both show similar motor and cognitive clinical symptoms.

15. • There are intense neurotransmitter deficits along the
dopaminergic and cholinergic pathways.
• In The cholinergic deficit, acetylcholine is responsible
for cognitive dysfunction
• whereas the dopamine deficit is responsible for motor
dysfunction.

16. CONTINUE..
• NCDLB can be differentiated from NCD due to
Parkinson’s Disease based on the chronological onset
of symptoms.
• Individuals with NCDLB will exhibit cognitive symptoms
before the onset of motor symptoms

17. CAUSE
S
• NCDLB results in a collection of proteins, called Lewy
bodies, that progress through the neuronal synapses.
• The functional deficits seen with NCDLB are greater
than NCD with Alzheimer Disease as a result of the
effects on motor and involuntary nervous systems.

18. TREATMEN
T
• When developing a plan for individuals with NCDLB, it is
important to modify care by having the patient or
caregiver rank the cognitive, emotional, and motor
difficulties by level of subjective distress.
effective with many symptoms
cognition, hallucinations, and
• The medications are
including fluctuating
mood disorders.

19. NEUROCOGNITIVE
DISORDER CAUSED BY
ALZHEIMER DISEASE
• Neurocognitive disorder caused by Alzheimer Disease (NCD due
to AD) is a slow developing non-reversible brain disorder that
results in a permanent loss of neurons and neuronal synapses.
• The loss of neurons is prevalent in the areas of the brain
responsible for memory, function, and cognition.
• Neuronal destruction comes from extracellular neurotic plaque
and neurofibrillary tangles inside neurons.
• Acetylcholine, which enables learning and memory, is also
decreased.

20. RISK
FACTORS
• NCD due to AD is gender neutral i.e. occurrence rate is equal
both in males and females.
• Family history and age increase the risk of developing NCD
due to AD.
• The risk for an individual with a parent or sibling with NCD
due to AD increases as much as 30% with each afflicted family
member

21. TREATMEN
T
• Pharmacologic treatment of NCD due to AD includes 2
classes of pharmacologic treatment:
• cholinesterase inhibitors (CEIs)
• N-methyl-D-aspartic acid receptor antagonists.
• Although CEIs do not stop the disease trajectory, they
may slow the decline.

22. FRONTOTEMPORAL
NEUROCOGNITIVE DISORDER
• It is a mental health condition characterized by abnormal
shrinkage in two parts of the brain, called the frontal and
temporal anterior lobes.
• This condition replaces an essentially equivalent illness,
known as Frontotemporal dementia, in DSM 5.

23. • The brain’s frontal and temporal lobes play a primary role in
maintaining brain function such as the ability to use language,
the ability to regulate behavior.
• The specific manifestation of the disorder depends upon the
particular portions of the frontal and temporal lobes that
undergo shrinkage, as well as the degree of shrinkage that
occurs at any given point in time.

24. SYMPTOM
S
• Loss of the normal ability to make appropriate decisions or
control impulsive urges.
• loss of the ability to show empathy with others or develop
personal motivation
• changes in self grooming or eating habits.

25. SYMPTOM
S
• Language- or speaking-related difficulties associated with the
disorder include:
• aphasia (loss of the ability to use or understand words).
• difficulties with normal body movement such as rigid or
trembling muscles, loss of the ability to coordinate the activity
of different muscles, unusually weak muscles, or swallowing
problems (rare occurrence of these symptoms)

26. TREATMEN
T
• Frontotemporal neurocognitive disorder is both incurable and
progressive.
• Gets worse over time.
• Doctors can potentially manage the effects of Frontotemporal
dysfunction through the use of medications i.e. types of
antidepressants.

27. VASCULAR
NEUROCOGNITIV
E DISORDER
• vascular neurocognitive disorder is a condition
characterized by disruptions in the brain’s blood supply
that lead to impairment of one or more aspects of a
person’s conscious brain functions.
• The DSM includes this as a replacement for a condition
previously identified as vascular dementia.

28. • The term “vascular” in vascular neurocognitive disorder
refers to the body’s system of blood vessels, known
medically as the vascular system or circulatory system.
• The disorder is named so because the impairments it
produces originate from some sort of reduction or
blockage in the supply of blood that normally passes
through the blood vessels called arteries and into the
brain’s tissues.

29. CAUSE
S
 Stroke – a condition that occurs when a brain artery either gets
blocked or springs a leak of blood
Ongoing health problems that either decrease a blood vessel’s
general health or produce abnormal narrowing in a blood
vessel’s interior diameter.
Conditions that can trigger these damaging blood vessel
changes include
atherosclerosis (hardened arteries),
hypertension (high blood pressure)
diabetes
effects of the normal aging process.

30. TREATMEN
T
• Vascular dementia is incurable and inevitably shortens the
lives of affected individuals.
the disorder’s
from growing
• However, doctors can potentially slow
progression or even stop its effects
substantially worse over time
• treated with the help of certain medications originally
developed to treat Alzheimer’s disease. Examples of these
medications include a group of drugs known collectively as
cholinesterase inhibitors and a single drug called memantine.

31. NEUROCOGNITIVE
DISORDER DUE TO
TRAUMATIC BRAIN INJURY
• It is a mental health condition that sometimes arises in
the long-term outcome of a physical injury that results
in brain damage.
• Some people affected by neurocognitive disorder due to
traumatic brain injury experience symptoms that are
severe enough to degrade their ability to lead
independent lives
• Others experience milder symptoms and retain most of
their day-to-day mental function.

32. • Neurocognitive disorder due to a traumatic brain injury
comes in both major and mild forms.
• People with the major form of the disorder have
symptoms that the general public commonly refers to
as dementia (including such things as memory
problems, a declining ability to think logically, and a
declining ability to make decisions or control one’s
behavior).
• People with mild neurocognitive disorder due to a
traumatic brain injury don’t have dementia-like
symptoms; instead, they have less dramatic changes in
their mental function that can worsen over time.

33. DIFFERENCE BETWEEN MILD
AND MAJOR NEUROCOGNITIVE
DIORDER
• People with mild neurocognitive disorder have
impairments in their conscious brain functions
• Prominent enough to produce testing results lower than
those found in people unaffected by a disorder
• But not prominent enough to produce serious life
disruption.

34. CONTINUED
….
• individuals with major vascular neurocognitive disorder
produce test results that are considerably lower than
those produced by individuals with the mild form of the
disorder
• Have impairments that at least partially eliminate their
ability to live successfully without some form of outside
care.