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Neurocognitive Disorders
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Neurocognitive Disorders
Neurocognitive disorders in DSM 5 include
Delirium and followed by syndromes of
Major Neurocognitive Disorder (NCD) and
Mild Neurocognitive disorder.
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Neurocognitive Disorders
Both types of NCD have subtypes
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Neurocognitive Disorders
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Neurocognitive Disorders
• Cognitive deficits
are present in many
mental disorders
but only disorders
whose core
features are
cognitive are
included in the
NCD category.
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COGNITIVE DOMAIN
• 1. Perceptual and
motor ...
• Eg. Visual
perception,
• Perceptual-motor
• Praxis and gnosis
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COGNITIVE DOMAIN
• 2. social cognition
• Social recog...
• theory of mind
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COGNITIVE DOMAIN
• 3.Complex
attention
• Sustained atttention
• Selective attentiuon
• Divided attentiuon
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COGNITIVE DOMAIN
• 4. executive function
• Planning
• Decision making
• Working memory
• Feedback/ error utilization
• Overriding habits/inhibition
• Mental/cognitive flexibility
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YELLOW
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BLACK
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GREEN
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VIOLET
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Neurocognitive Disorders
Delirium
. A disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift
attention) and awareness (reduced orientation to the environment).
The disturbance develops over a short period of time (usually hours to a few days),
represents a change from baseline attention
E. There is evidence from the history, physical examination, or laboratory findings that •
the disturbance is a direct physiological consequence of another medical condition,
substance intoxication or withdrawal (i.e., due to a drug of abuse or to a medication),
or exposure to a toxin, or is due to multiple etiologies.
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Neurocognitive Disorders
Delirium
Clinical features
The cardinal feature is disturbed
consciousness as drowsiness,
decreased awareness of the
surroundings, disorientation and
distractibility
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Neurocognitive Disorders
Delirium
Clinical features cont
Causes of delirium:
• Drugs & alcohol intoxication,
withdrawal and delirium tremens,
opiates, prescribed drugs,
Antiochinergics, sedatives, digoxin,
diuretics, lithium, and steroids.
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Neurocognitive Disorders
Delirium
Causes of delirium: cont
It is a medical emergency
o The underlying cause must be
treated
drugs must suspected as a
common cause
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Neurocognitive Disorders
Delirium
Management of delirium cont
Drug treatment
Used to treat the underlying cause,
control agitation and distress and allow
adequate sleep.
Haloperidol is used and some cases
are treated with atypical
antipsychotics. 23
Neurocognitive Disorders
Delirium
Outcome
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Neurocognitive Disorders
amnesia and amnesic syndromes
Amnesia Is Loss Of Memory For
Episodic Memory As
Anterograde Amnesia And
Retrograde Amnesia.
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Neurocognitive Disorders
amnesia and amnesic syndromes
Causes of amnesia:
Transient
Transient global amnesia
Transient epileptic amnesia
Head injury
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Neurocognitive Disorders
amnesia and amnesic syndromes
Causes of amnesia:
persistent
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Neurocognitive Disorders
amnesia and amnesic syndromes
Clinical features
Profound deficit in episodic
memory
Disorientation for time
Loss of autobiographical
information
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Neurocognitive Disorders
amnesia and amnesic syndromes
Korsakov syndrome
also called
Wernicke Korsakov Syndrome
A syndrome that follows
Wernicke’s encephalopathy
Delirium, ataxia, pupillary
abnormalities, ophthalmoplegia,
nystagmus, and peripheral
neuropathy
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Neurocognitive Disorders
amnesia and amnesic syndromes
Korsakov syndrome
also called
Wernicke Korsakov Syndrome
It is due to thiamine deficiency caused by
alcohol abuse, hyperemesis gravidarum,
severe malnutrition, or due to infarction,
tumors or infection
Korsakov syndrome
also called
Wernicke Korsakov Syndrome
It is regarded as a medical emergency
And diagnosed by decreased red cell
transketolase level and increased MRI signal
in midline structures
Korsakov syndrome
also called
Wernicke Korsakov Syndrome
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Neurocognitive Disorders
amnesia and amnesic syndromes
Transient global Amnesia
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Dementia
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Dementia
It is often
precipitated
by intercurrent
illness or
change in
social
circumstances 35
Dementia
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Dementia
Aimless behavior
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Dementia
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Dementia
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Dementia
Alzheimer’s disease
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Dementia
Alzheimer’s disease
clinical features
Amnesia, gradual and progressive
Aphasia-unable to understand/ express
speech
Apraxia-unable to perform
task/movement even he understands it
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Dementia
Alzheimer’s disease
Neuropathology
The brain is shrunken, widened sulci,
enlarged ventricles, brain weight is
reduced.
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Dementia
Alzheimer’s disease
etiology
Genes.
Most of the cases are not genetically
inherited but in rare cases it is familial and
causative mutations were identified in three
genes, APP(amyloid precursor protein,
presenilin1 and presenilin 2.
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Dementia
Alzheimer’s disease
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Dementia
vascular dementia
Clinical features: •
It appears in the late sixties or seventies. •
Emotional and personality changes appear first •
followed by impairment of memory and intellect.
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Dementia
vascular dementia
Depression, emotional liability and confusion
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Dementia
Dementia with Lewy Bodies
Is the second or third most frequent cause
of dementia
The cardinal feature is Lewy bodies in the
cerebral cortex.
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Dementia
Dementia with Lewy Bodies
Neuropathology
Presence of Lewy bodies in the cerebral
cortex
They are seen in the substantial nigra
Presence of α-synuclein and ubiquitin
proteins.
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Dementia
Frontotemporal Dementias
Is the second most common form of
presenile dementia.
Presentation is usually between 45&70
years of age.
Prominence of behavioral rather than
cognitive features.
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Dementia
Frontotemporal Dementias
The frontal form present with behavioral
and personality change and the temporal
form with language disorder.
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Dementia
Frontotemporal Dementias
Subtypes include :
Pick’s disease.
Semantic dementia
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Dementia
Frontotemporal Dementias
On neuroimaging there is focal and
asymmetrical atrophy of the temporal and
frontal poles.
EEG is usually normal unlike the diffuse
slowing in Alzheimer's disease.
Acetylcholine and dopamine are not
affected but serotonin markers are
reduced.
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Thank you
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