1. Used to be called Dementia Neurocognitive Disorders

2. Didn’t we just do this? No, we were studying NEURODEVELOPMENTAL disorders. So what’s the difference? These disorders are not developmental, and often happen later in life

3. Neurocognitive Disorders These disorders are unique because their underlying pathology and etiology can often be determined in the brain Criteria to be diagnosed with an NCD is based on defined cognitive domains: Complex attention Executive function (planning, decision making) Learning and memory Language Perceptual-motor abilities Social cognition (recognize emotions)

4. Neurocognitive Disorders 1. Delirium 2. Major and Mild Cognitive Disorders: A. Due to Alzheimer’s Disease B. With Lewy Bodies C. Due to Traumatic Brain Injury D. Due to HIV Infection E. Due to Prion Protein Disease F. Due to Parkinson’s Disease G. Due to Huntington’s Disease H. Due to Another Medical Condition I. Due to Multiple Etiologies

5. 1. Delirium Delirium is a disturbance in attention and awareness developing over a very short period of time (hours or days) Has additional disturbances in cognition (memory, language, orientation, etc.) There must be evidence that the disturbance is the direct result of another medical condition, substance use, or substance withdrawl

6. Delirium continued... Specifiers: You must specify whether the person has: Substance intoxication delirium Substance withdrawl delirium Medication-induced delirium Delirium due to another medical condition

7. Delirium continued... Specifiers: Acute (lasting hours or days) Persistent (lasting weeks or months) Specifiers: Hyperactive Hypoactive Mixed Level of Activity

8. Delirium Symptoms Disturbance with sleep-wake cycles (sleepy during the day, nightime agitation, difficulty falling asleep, etc.) Emotional disturbances (anxiety, fear, depression, irritability, anger, euphoria, apathy) Rapid changes in emotions

9. Delirium Prevalence Highest among hospitalized older individuals 1-2% of normal population 14% of population over age 85 10-30% of older people in emergency departments 60% of individuals in nursing homes or post-acute care settings Up to 83% of all individuals at the end of life

10. Delirium Risk Factors 1. Environmental Increased with a history of falls, low levels of activity, use of drugs or medications 2. Genetic Susceptibility is greatest in infancy and childhood, and then when an individual is over 65

11. 2a. Major and Mild Cognitive Disorders: Specifier: Due to Alzheimer’s Before you can be diagnosed with Alzheimer’s, you must meet the criteria of having a Major or Mild Neurocognitive Disorder. Criteria for a MAJOR NCD are below: 1. You must have a decline in performance in one or more cognitive domains (attention, decision making, learning and memory, language, perceptual-motor, or social cognition) 2. The deficits must interfere with independence in everyday activities, requiring assistance from others 3. You do not have delirium 4. The deficits can not be explained by any other mental illness MILD is these symptoms but less intense, and you don’t require assistance for daily activities

12. Alzheimer’s The diagnostic criteria for probable Alzheimer’s are listed below: 1. You must meet the criteria for having a major or mild cognitive disorder (listed on last slide) 2. There is a genetic mutation from family history of genetic testing 3. There is clear evidence of decline in memory and learning 4. Steadily progressive, gradual decline in cognition, without extended plateaus 5. No evidence of mixed etiology ***Possible Alzheimer’s is diagnosed if there is no genetic history

13. Symptoms of Alzheimer’s Depression Apathy Psychotic Features Irritability Agitation Combativeness Wandering Eye Gait distrubrance (can’t walk normally) Dysphagia (difficulty swallowing) Incontinence Myoclonus (muscle twitching) Seizures

14. Development and Course of Alzheimer’s Progresses gradually, with severe dementia to the death Survival after diagnosis is around 10 years Late-stage individuals are mute and bed-bound Occurs mostly in 80 and 90-year-olds, but can start in 50’s and 60’s Older individuals usually have medical comorbidities

15. Risk Factors 1. Environmental Traumatic Brain Injury can cause Alzheimer’s Other environmental factors are always being researched 2. Genetic and Physiological Age is the strongest risk factor Genetic susceptibility in those who apolipoprotein E4 There are also rare Alzheimer’s disease genes Those with Down’s Syndrome will get it if they survive to late adulthood Do you think you can prevent Alzheimer’s? If so, how?

16. PET images

17. Videos Ted Talk What is Alzheimer's? Alzheimer's Patients

18. Therapy for Neurocognitive Disorders? There is a lot of time, money, and resources, that are put into diagnosing and taking care of individuals with neurocognitive disorders. Next class, we will have a guest speaker who will talk about one of the therapies that is done with senior citizens living with neurocognitive disorders! Homework: Go online, and see if you can find at least 2 different therapies or things that doctors and caregivers do to help people living with neurocognitive disorders. Perhaps you will find the one we will be learning about! Write a paragraph about each