9 Neurocognitive Disorders

Question 1

Most _____ disorders develop much later in life, whereas intellectual disability and specific learning disorder are believed to be present from birth.

Answer 1

neurocognitive

Question 2

_____, an often temporary condition displayed as confusion and disorientation; and mild or major neurocognitive disorder, a progressive condition marked by gradual deterioration of a range of cognitive abilities.

Answer 2

Delirium

Question 3

A. A disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment).

B. The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day

C. An additional disturbance in cognition (e.g., memory deficit, disorientation, language, visuospatial ability, or perception).

D. The disturbances in Criteria A and C are not better explained by another preexisting, established, or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal, such as coma.

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.

Specify whether:
Substance intoxication delirium: This diagnosis should be made instead of substance intoxication when the symptoms in Criteria A and C predominate in the clinical picture and when they are sufficiently severe to warrant clinical attention.

Answer 3

Delirium

Question 4

People with delirium appear confused, disoriented, and out of touch with their surroundings. They cannot focus and sustain their attention on even the simplest tasks. There are marked impairments in _____.

Answer 4

memory and language

Question 5

Major neurocognitive disorder (previously labeled _____) is a gradual deterioration of brain functioning that affects memory, judgment, language, and other advanced cognitive processes.

Answer 5

dementia

Question 6

A. Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition) based on:

1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a significant decline in cognitive function; and
2. A substantial impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment.

B. The cognitive deficits interfere with independence in everyday activities (i.e., at a minimum, requiring assistance with complex instrumental activities of daily living such as paying bills or managing medications).

C. The cognitive deficits do not occur exclusively in the context of a delirium.

D. The cognitive deficits are not better explained by another mental disorder (e.g., major depressive disorder, schizophrenia).

Answer 6

Major Neurocognitive Disorder

Question 6

A. Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition) based on:

1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a significant decline in cognitive function; and
2. A substantial impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment.

B. The cognitive deficits interfere with independence in everyday activities (i.e., at a minimum, requiring assistance with complex instrumental activities of daily living such as paying bills or managing medications).

C. The cognitive deficits do not occur exclusively in the context of a delirium.

D. The cognitive deficits are not better explained by another mental disorder (e.g., major depressive disorder, schizophrenia).

Answer 6

Major Neurocognitive Disorder

Question 7

A. Evidence of modest cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual motor, or social cognition) based on:

1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a mild decline in cognitive function; and
2. A modest impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment

B. The cognitive deficits do not interfere with capacity for independence in everyday activities (i.e., complex instrumental activities of daily living such as paying bills or managing medications are preserved, but greater effort, compensatory strategies, or accommodation may be required)

C. The cognitive deficits do not occur exclusively in the context of a delirium

D. The cognitive deficits are not better explained by another mental disorder (e.g., major depressive disorder, schizophrenia).

Answer 7

Mild Neurocognitive Disorder

Question 8

_____, the inability to recognize and name objects, is one of the most familiar symptoms.

Answer 8

Agnosia

Question 9

_____ agnosia, the inability to recognize even familiar faces, can be extremely distressing to family members.

Answer 9

Facial

Question 10

A. The criteria are met for major or mild neurocognitive disorder.

B. There is insidious onset and gradual progression of impairment in one or more cognitive domains (for major neurocognitive disorder, at least two domains must be impaired).

C. Criteria are met for either probable or possible _____ disease as follows:
For major neurocognitive disorder:
Probable _____ disease is diagnosed if either of the following is present; otherwise, possible _____ disease should be diagnosed.
1. Evidence of a causative _____ disease genetic mutation from family history or genetic testing
2. All three of the following are present:
a. Clear evidence of decline in memory and learning and at least one other cognitive domain (based on detailed history or serial neuropsychological testing).
b. Steadily progressive, gradual decline in cognition, without extended plateaus.
c. No evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease, or another neurological, mental, or systemic disease or condition likely contributing to cognitive decline).

For mild neurocognitive disorder:

Probable _____ disease is diagnosed if there is evidence of a causative _____ disease genetic mutation from either genetic testing or family history.

Possible _____ disease is diagnosed if there is no evidence of a causative _____ disease genetic mutation from either genetic testing or family history, and all three of the following are present:

1. Clear evidence of decline in memory and learning.
2. Steadily progressive, gradual decline in cognition, without extended plateaus.
3. No evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease, or another neurological or systemic disease or condition likely contributing to cognitive decline)

D. The disturbance is not better explained by cerebrovascular disease, another neurodegenerative disease, the effects of a substance, or another mental, neurological, or systemic disorder

Answer 10

Neurocognitive Disorder Due to Alzheimer’s Disease

Question 11

In _____ the German psychiatrist Alois Alzheimer first described the disorder that bears his name.

Answer 11

1907

Question 12

In a phenomenon referred to as “_____ syndrome”—perhaps as a result of fatigue or a disturbance in the brain’s biological clock.

Answer 12

sundowner

Question 13

People with neurocognitive disorder due to Alzheimer’s disease also display one or more other cognitive disturbances, including _____ (difficulty with language), _____ (impaired motor functioning), agnosia (failure to recognize objects), or difficulty with activities such as planning, organizing, sequencing, or abstracting information.

These cognitive impairments have a serious negative impact on social and occupational functioning, and they represent a significant decline from previous abilities

Answer 13

aphasia, apraxia

Question 14

A. The criteria are met for major or mild neurocognitive disorder.

B. The clinical features are consistent with a vascular etiology, as suggested by either of
the following:
1. Onset of the cognitive deficits is temporally related to one or more cerebrovascular events.
2. Evidence for decline is prominent in complex attention (including processing speed) and frontal-executive function.

C. There is evidence of the presence of cerebrovascular disease from history, physical examination, and/or neuroimaging considered sufficient to account for the neurocognitive deficits.

D. The symptoms are not better explained by another brain disease or systemic disorder.

Answer 14

Major or Mild Vascular Neurocognitive Disorder

Question 15

There is increasing recognition of neurocognitive disorder among athletes who receive repeated blows to the head. In the past this type of neurocognitive disorder was referred to as dementia pugilistic (which suggested that it was restricted to boxers or pugilists) but it is currently referred to as chronic traumatic _____ (CTE).

CTE is caused by repetitive head trauma that can provoke distinctive neurodegeneration.

Answer 15

encephalopathy

Question 16

While Alzheimer’s disease can affect many different parts of your brain, _____ disease only affects certain areas. _____ disease is a type of FTD because it affects the frontal and temporal lobes of your brain. Your brain’s frontal lobe controls important facets of everyday life.

Answer 16

Pick’s

Question 17

A. The criteria are met for major or mild neurocognitive disorder.
B. The disturbance has insidious onset and gradual progression.
C. Either (1) or (2);
1. Behavioral variant;
a. Three or more of the following behavioral symptoms:
i. Behavioral disinhibition.
ii. Apathy or inertia.
iii. Loss of sympathy or empathy.
iv. Perseverative, stereotyped or compulsive/ritualistic behavior.
v. Hyperorality and dietary changes.
b. Prominent decline in social cognition and/or executive abilities.

2. Language variant:
   a. Prominent decline in language ability, in the form of speech production, word finding, object naming, grammar, or word comprehension.

D. Relative sparing of learning and memory and perceptual-motor function.

E. The disturbance is not better explained by cerebrovascular disease, another neurodegenerative disease, the effects of a substance, or another mental, neurological, or systemic disorder.

Answer 17

Major or Mild Frontotemporal Neurocognitive Disorder

Question 18

Neurocognitive disorder due to _____ injury includes symptoms that persist for at least a week following the trauma, including executive dysfunction (e.g., difficulty planning complex activities) and problems with learning and memory.

Answer 18

traumatic brain

Question 19

A. The criteria are met for major or mild neurocognitive disorder.

B. There is evidence of a traumatic brain injury—that is, an impact to the head or other mechanisms of rapid movement or displacement of the brain within the skull, with one or more of the following:

1. Loss of consciousness.
2. Posttraumatic amnesia.
3. Disorientation and confusion.
4. Neurological signs (e.g., neuroimaging demonstrating injury; a new onset of seizures; a marked worsening of a preexisting seizure disorder; visual field cuts; anosmia; hemiparesis).

C. The neurocognitive disorder presents immediately after the occurrence of the traumatic brain injury or immediately after recovery of consciousness and persists past the acute post-injury period.

Answer 19

Major or Mild Neurocognitive Disorder Due to Traumatic Brain Injury

Question 20

_____ bodies are microscopic deposits of a protein that damage brain cells over time. The signs of this disorder come on gradually and include impairment in alertness and attention, vivid visual hallucinations, and motor impairment as seen in Parkinson’s disease. In fact, there is some overlap between this disorder and neurocognitive disorder due to Parkinson’s disease.

Answer 20

Lewy

Question 21

A. The criteria are met for major or mild neurocognitive disorder.

B. The disorder has an insidious onset and gradual progression.

C. The disorder meets a combination of core diagnostic features and suggestive diagnostic features for either probable or possible neurocognitive disorder with Lewy bodies.
For probable major or mild neurocognitive disorder with Lewy bodies, the individual has two core features, or one suggestive feature with one or more core features.
For possible major or mild neurocognitive disorder with Lewy bodies, the individual has only one core feature, or one or more suggestive features.

1. Core diagnostic features:
   a. Fluctuating cognition with pronounced variations in attention and alertness.
   b. Recurrent visual hallucinations that are well formed and detailed.
   c. Spontaneous features of parkinsonism, with onset subsequent to the development of cognitive decline.
2. Suggestive diagnostic features;
   a. Meets criteria for rapid eye movement sleep behavior disorder.
   b. Severe neuroleptic sensitivity

D. The disturbance is not better explained by cerebrovascular disease, another neurodegenerative disease, the effects of a substance, or another mental, neurological, or systemic disorder.

Answer 21

Major or Mild Neurocognitive Disorder With Lewy Bodies

Question 22

_____ disease is a degenerative brain disorder that affects about 1 in every 1,000 people worldwide.

Motor problems are characteristic among people with _____ disease, who tend to have stooped posture, slow body movements (called bradykinesia), tremors, and jerkiness in walking.

The voice is also affected; afflicted individuals speak in a soft monotone. The changes in motor movements are the result of damage to dopamine pathways.

Because dopamine is involved in complex movement, a reduction in this neurotransmitter makes affected individuals increasingly unable to control their muscle movements, which leads to tremors and muscle weakness.

Answer 22

Parkinson’s

Question 23

A. The criteria are met for major or mild neurocognitive disorder.
B. The disturbance occurs in the setting of established Parkinson’s disease.
C. There is insidious onset and gradual progression of impairment.
D. The neurocognitive disorder is not attributable to another medical condition and is not better explained by another mental disorder

Major or mild neurocognitive disorder probably due to Parkinson’s disease should be diagnosed if 1 and 2 are both met. major or mild neurocognitive disorder possibly due to Parkinson’s disease should be diagnosed if 1 or 2 is met:
1. There is no evidence of mixed etiology (i.e., absence of other neurodegenerative or
cerebrovascular disease or another neurological, mental, or systemic disease or condition likely contributing to cognitive decline).
2. The Parkinson’s disease clearly precedes the onset of the neurocognitive disorder.

Answer 23

Major or Mild Neurocognitive Disorder Due to Parkinson’s Disease

Question 24

The _____, which causes AIDS, can also cause neurocognitive disorder (called neurocognitive disorder due to _____ infection). This impairment seems to be independent of the other infections that accompany _____; in other words, the _____ infection itself seems to be responsible for the neurological impairment.

Answer 24

human immunodeficiency virus type 1 (HIV-1)

Question 25

Like neurocognitive disorder from Parkinson’s disease and several other causes, neurocognitive disorder resulting from HIV is sometimes referred to as _____ dementia, because it affects primarily the inner areas of the brain, below the outer layer called the cortex.

Answer 25

subcortical

Question 26

A. The criteria are met for major or mild neurocognitive disorder.
B. Tliere is documented infection with human immunodeficiency virus (HIV).
C. The neurocognitive disorder is not better explained by non-_____ conditions, including secondary brain diseases such as progressive multifocal leukoencephalopathy or cryptococcal meningitis.
D. The neurocognitive disorder is not attributable to another medical condition and is not better explained by a mental disorder.

Answer 26

Major or Mild Neurocognitive Disorder Due to HIV Infection

Question 27

_____ disease is a genetic disorder that initially affects motor movements, typically in the form of chorea, involuntary limb movements.

Just as with Parkinson’s disease, only a portion of people with _____ disease go on to display neurocognitive disorder—somewhere between 20% and 80%—although some researchers believe that all patients with _____ disease would eventually display neurocognitive impairments if they lived long enough.

Answer 27

Huntington’s

Question 28

A. The criteria are met for major or mild neurocognitive disorder.
B. There is insidious onset and gradual progression.
C. There is clinically established _____ disease, or risk for Huntington’s disease based on family history or genetic testing.
D. The neurocognitive disorder is not attributable to another medical condition and is not better explained by another mental disorder.

Answer 28

Major or Mild Neurocognitive Disorder Due to Huntington’s Disease

Question 29

Neurocognitive disorder due to _____disease is a rare progressive neurodegenerative disorder caused by “_____”—proteins that can reproduce themselves and cause damage to brain cells leading to neurocognitive decline.

Unlike other infectious agents such as bacteria or viruses, _____ are thought by some to have no DNA or RNA that can be destroyed by chemicals or radiation. As a result, there is no known treatment for _____ disease and the course of this disorder

Answer 29

prion

Question 30

A. The criteria are met for major or mild neurocognitive disorder.
B. The neurocognitive impairments do not occur exclusively during the course of a delirium and persist beyond the usual duration of intoxication and acute withdrawal.
C. The involved substance or medication and duration and extent of use are capable of
producing the neurocognitive impairment.
D. The temporal course of the neurocognitive deficits is consistent with the timing of substance or medication use and abstinence (e.g., the deficits remain stable or improve after a period of abstinence).
E. The neurocognitive disorder is not attributable to another medical condition or is not better explained by another mental disorder.

Answer 30

Substance/Medication-Induced Major or Mild Neurocognitive Disorder

Question 31

A. The criteria are met for major or mild neurocognitive disorder.
B. There is evidence from the history, physical examination, or laboratory findings that the neurocognitive disorder is the pathophysiological consequence of another medical condition.
C. The cognitive deficits are not better explained by another mental disorder or another specific neurocognitive disorder (e.g., Alzheimer’s disease, HIV infection).

Answer 31

Major or Mild Neurocognitive Disorder Due to Another Medical Condition