Neurocognitive disorders

Approximately 10% of adults over 65 have a mild cognitive impairment (MCI). Minor cognitive changes may be noticeable to friends and family members, and confirmed by neuropsychological testing. Neuropsychological testing measures the level of cognitive functioning in a variety of critical areas. Studies on people with MCI have shown that approximately half will progress to a major cognitive disorder, such as Alzheimer's.

Neuropsychological testing to diagnose dementia

A diagnosis of dementia can be made with absolute certainty by looking at structural changes in the brain through a microscope or using positron emission tomography.  MRIs and CT scans can rule out tumors, head injuries, or strokes.  MRIs may also show if there is the brain shrinkage characteristic of Alzheimer's disease. Very young onset dementia may display in biomarkers in the cerebrospinal fluid. Lab tests can rule out thyroid disorders and vitamin deficiencies that cause memory loss. However, neuropsychiatrists can be reasonably certain of a diagnosis by using standardized measurements of cognitive functioning. Neuropsychological testing is important if one suspects even mild cognitive impairment.

Treating dementia

Unfortunately, there is no real treatment for dementia-type disorders. Current medications can help to slow the progression of decline. Two types of drugs used with Alzheimer's include cholinesterase inhibitors, such as donepezil (Aricept), and the drug memantine (Nameda). Other medications may be used, such as antidepressants or anti-anxiety medications. Expertise is needed because some medications can increase confusion, dizziness, and the risk of falls.

Understanding personality changes

Severe dementia such as Alzheimer's disease often results in significant behavior and personality changes. Sometimes, acting out can be linked to changes in routine, unexpected visitors, or a disliked task, such as bath time. These changes can be very difficult for family members and friends to deal with. The person they've known and loved for decades looks similar, but is no longer the same. Caregivers need to take breaks and get help to remain calm and prevent burning out. It is invaluable for caregivers to join support groups in order to gain insights into how others deal with this tragic illness. Supportive therapy can also be of value to caregivers.

Types of neurocognitive disorders

 
Mild cognitive disorders

The Diagnostic Statistical Manual-5 (DSM-5) distinguishes between "mild" and "major" neurocognitive disorders. Mild neurocognitive disorders include cognitive changes, regardless of age, that do not significantly interfere with daily functioning and independence. A friend or family member may suspect these changes, but they should be documented by neuropsychological testing. Mild cognitive disorders can later escalate into conditions such as Alzheimer's, but not all do.

Major cognitive disorders

Previously known as "dementia," neurocognitive disorders can have different causes, from Alzheimer's disease (the most common) to traumatic brain injury. Typically, cognitive performance in areas such as memory, language, perceptual-motor abilities, and social interaction is affected to the point that assistance is needed with daily activities, such as managing financial affairs.

Major cognitive disorders can result from any of the following:

  • Alzheimer's disease
  • Frontotemporal lobar degeneration
  • Vascular disease
  • Traumatic brain injury
  • HIV infection
  • Huntington's disease
  • Lewy body disease
  • Prion disease
  • Parkinson's disease
  • Other/multiple causes

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