Neurocognitive Disorder (NCD) / Dementia – Signs, Types and Treatment

Neurocognitive disorders (NCD)

Neurocognitive disorders constitute a realm of diagnoses related to memory and functional impairment in daily living. As our knowledge of these disorders grows, it becomes imperative to explore the subtypes, their diagnostic criteria, and current treatment options. In this blog post, we will the four primary types of NCD (Alzheimer’s disease, Vascular dementia, Lewy body dementia, and Frontotemporal dementia), presenting symptoms, treatments, prognosis, and the treatment of behavioral disturbances related to dementia.

DSM-5 Criteria for Major Neurocognitive Disorder

The DSm-5 criteria for diagnosing Major NCD include:

1. Evidence of significant cognitive decline that is based on neuropsychological testing or clinical assessment.
   
   
2. Decline in one or more domains encompassing “SAMPLE”: social cognition, attention, memory, perceptual motor skills, language and executive function.
   
   
3. Individuals must exhibit a reduction in the ability to perform Activities of Daily Living (ADLs).

DSM-5 Criteria for Mild Neurocognitive Disorder

Mild NCD has similar diagnostic criteria to Major NCD, with key differences being:

1. There is only modest evidence of cognitive decline.
   
   
2. There is no reduction in the ability to perform ADLs.

The Four Main Types of Neurocognitive Disorders

1. Alzheimer’s Disease:

This progressive disorder engenders memory decline, cognitive impairment, and reasoning deficiencies. It is marked by the accumulation of abnormal protein deposits in the brain, leading to disrupted neural connections.

2. Vascular Dementia:

Occurring due to reduced blood flow to the brain, often following strokes or small vessel disease, vascular dementia results in varying cognitive impairments based on the affected brain regions.

3. Lewy Body Dementia (LBD) aka Dementia with Lewy Bodies (DLB):

Lewy body dementia features cognitive fluctuations, visual hallucinations, and motor symptoms akin to Parkinson’s disease. It commonly co-occurs with Parkinson’s disease as they both arise from the presence of Lewy bodies, which are abnormal protein deposits in the brain.

4. Frontotemporal Dementia:

Primarily affecting the frontal and temporal lobes, this subtype results in personality, behavior, and language changes. Disinhibition, apathy, and impaired social awareness are characteristic.

Symptoms, Treatments, and Prognosis

Symptoms, treatments, and prognoses diverge based on the specific neurocognitive disorder subtype. Early symptoms might involve memory decline, impaired judgment, language difficulties, or behavioral changes. Prognosis varies widely, with Alzheimer’s disease often exhibiting a more gradual decline, while frontotemporal dementia may lead to rapid changes in personality and behavior.

Treatment avenues span a spectrum of interventions. Acetylcholinesterase inhibitors and memantine slow symptom progression in Alzheimer’s disease. Behavioral disturbances can be addressed using antidepressants, mood stabilizers, antipsychotics, or benzodiazepines. Comprehensive treatment also includes paying attention to care takers of patients with dementia, who often bare a heavy burden and require assistance of their own. Treatment of commonly co-occuring diagnoses such as depression and anxiety may also be prudent.

Prevalence and Risk Factors

The prevalence of neurocognitive disorders increases with age, with approximately 10% of individuals aged 70 and over experiencing them. By age 85, this number soars to 33%. Genetic factors can play a role, as can modifiable risk factors including hypertension, diabetes, obesity, smoking, sedentary lifestyle, substance use, traumatic brain injuries, depression, and exposure to air pollution.

Detecting Cognitive Impairment

Clinicians receive training in using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) screening tools, which are used to assess cognitive impairment. MMSE scores of 23 or lower and MoCA scores of 25 or lower may indicate impairment.

Neurocognitive disorders encompass a diverse range of conditions, each with unique symptoms, treatments, and prognoses. As we unravel the complexities of these disorders, we empower individuals, caregivers, and healthcare professionals to better navigate the intricate landscape of cognitive impairments. By understanding the DSM-5 criteria, delving into the main subtypes, grasping risk factors, and embracing available treatments, we stand poised to offer the necessary support and interventions to enhance the lives of those affected by neurocognitive disorders.