Neurocognitive Disorders Overview

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Questions and Answers

Which statement accurately describes neurocognitive disorders (NCDs)?

NCDs have a primary clinical deficit in emotional regulation.

NCDs are acquired disorders characterized by cognitive function deficits. (correct)

NCDs can be diagnosed based solely on behavioral symptoms.

NCDs are primarily developmental disorders.

How does the DSM-5 differentiate major neurocognitive disorder from dementia?

Dementia is a broader term than major NCD in clinical usage.

Dementia is exclusively linked to vascular causes.

Major NCD cannot exist without multiple cognitive impairments.

Major NCD requires impairment in only one cognitive domain. (correct)

What is a significant characteristic of mild neurocognitive disorder?

It is recognized as a diminished level of cognitive impairment. (correct)

It often leads directly to major NCD without exceptions.

It requires a comprehensive evaluation for all cognitive domains.

It is a permanent condition without treatment options.

Which of the following best encapsulates the diagnostic criteria for neurocognitive disorders?

They are based on defined cognitive domains along with objective evaluations. Signup and view all the answers

In the context of comorbidity, what is a common relationship observed among neurocognitive disorders?

Alzheimer’s disease and vascular pathology often influence each other's clinical expression. Signup and view all the answers

What is a key example of decision-making ability in everyday activities related to neurocognitive disorders?

Performing tasks that require input from multiple individuals. Signup and view all the answers

Which of the following cognitive domains is typically evaluated for symptoms of neurocognitive disorders?

Complex attention Signup and view all the answers

What distinguishes major neurocognitive disorders from other cognitive impairments according to the DSM-5?

A significant decline in at least one cognitive domain can suffice for a diagnosis. Signup and view all the answers

What is a significant feature of major neurocognitive disorders regarding recent memory?

Recent memory may be less preserved than other forms of memory. Signup and view all the answers

Which of the following cognitive functions is often preserved in severe major neurocognitive disorders?

Semantic memory Signup and view all the answers

Which of the following tasks assesses visual perception in neurocognitive disorders?

Line bisection tasks Signup and view all the answers

Which age group has been identified as having the highest susceptibility to delirium?

Older individuals Signup and view all the answers

In the context of neurocognitive disorders, what is considered a hallmark of expressive language difficulties?

Idiosyncratic word usage and grammatical errors Signup and view all the answers

What symptom is typically more associated with male patients experiencing delirium?

Motor agitation Signup and view all the answers

What distinguishes major delirium from mild delirium?

Major delirium displays clear behavioral outbursts. Signup and view all the answers

In diagnosing substance intoxication delirium, what factor is considered when recording ICD-10-CM codes?

Presence of comorbid substance use disorder. Signup and view all the answers

Which type of delirium is characterized by vivid hallucinations and agitation?

Hyperactive delirium Signup and view all the answers

What is a key characteristic of unspecified delirium?

It is a diagnosis with insufficient information. Signup and view all the answers

Which of the following is a cognitive function that major neurocognitive disorders may impair?

Effective navigation in new environments Signup and view all the answers

What diagnostic feature distinguishes between major neurocognitive disorder and delirium?

Duration and time course of symptoms Signup and view all the answers

What characterizes mild neurocognitive disorders in terms of word-finding difficulties?

Substitution of specific terms with general terms. Signup and view all the answers

Which cognitive ability is least likely to be preserved in severe major neurocognitive disorders?

Recent memory Signup and view all the answers

Which of the following is NOT a diagnostic criterion for mild neurocognitive disorder?

Cognitive deficits better explained by another mental disorder Signup and view all the answers

What condition is characterized by fully dependent functioning in daily activities?

Severe neurocognitive disorder Signup and view all the answers

What aspect of cognitive function is particularly assessed through praxis tasks?

Imitating gestures or movements Signup and view all the answers

Which area of cognitive function often shows difficulties in both major and mild neurocognitive disorders?

Mental and cognitive flexibility Signup and view all the answers

In what context is coding for unspecified mild neurocognitive disorder used?

When specific criteria for a subtype are not met Signup and view all the answers

Which neurocognitive disorder is specifically associated with behavioral disturbances?

Frontotemporal degeneration Signup and view all the answers

Which of the following best describes substance withdrawal delirium?

Acute confusion following substance withdrawal. Signup and view all the answers

What is the primary focus of management when delirium and major neurocognitive disorder are comorbid?

Prioritizing the management of delirium Signup and view all the answers

What is a common misconception about cognitive difficulties in major neurocognitive disorders?

All cognitive abilities are equally affected. Signup and view all the answers

Which coding category is pertinent when symptom criteria of delirium are present but do not fully meet delirium criteria?

Unspecified Delirium Signup and view all the answers

Which condition may mimic symptoms of major neurocognitive disorders but arises due to substance use?

Substance intoxication delirium Signup and view all the answers

Which factor does NOT interact with sex-related risks for delirium?

Physical activity level Signup and view all the answers

Which statement about anticholinergic use related to delirium is accurate?

It has no validated predictive relationship with delirium. Signup and view all the answers

What character should be recorded if there is no comorbid substance use disorder present?

9 Signup and view all the answers

Which coding applies specifically for opioid-induced delirium when taken as prescribed?

F11.921 Signup and view all the answers

In what situation should 'delirium due to another medical condition' be coded?

When there is evidence from medical history, physical examination, or lab results Signup and view all the answers

Which of the following is NOT a characteristic of delirium?

Constant delirium symptoms throughout the day Signup and view all the answers

What can characterize the emotional disturbances seen in individuals with delirium?

Rapid shifts between different emotional states Signup and view all the answers

What is a common risk factor for developing delirium in older adults?

Advanced age and severe illness Signup and view all the answers

Which is a potential outcome if delirium goes undetected and untreated?

Progression to stupor or coma Signup and view all the answers

During what time of day do symptoms of delirium often worsen?

Evening and night Signup and view all the answers

What underlying condition is delirium commonly associated with?

Neurocognitive disorder (NCD) Signup and view all the answers

Which diagnostic code is used when the specific substance causing delirium is unknown?

F19.921 Signup and view all the answers

What percentage of hospitalized individuals with delirium may die within one year after diagnosis?

38%-41% Signup and view all the answers

How long does delirium typically last in hospital settings?

About one week Signup and view all the answers

Which symptom is typically NOT associated with delirium?

Sudden clarity and insight Signup and view all the answers

Which groups are at higher risk for delirium?

Individuals with functional and cognitive impairments Signup and view all the answers

In terms of prevalence, what is the rate of delirium in older individuals postoperatively?

11%-51% Signup and view all the answers

What major behavioral symptom is particularly observed in NCD due to Alzheimer’s disease?

Apathy Signup and view all the answers

Which symptom is most commonly associated with visual hallucinations in neurocognitive disorders?

Paranoia Signup and view all the answers

What characterizes the cognitive decline in major NCD as opposed to mild NCD?

Performance 2 or more standard deviations below norms Signup and view all the answers

How is the performance of cognitive testing typically defined for mild NCD?

1–2 standard deviations below norms Signup and view all the answers

Which of the following domains is not typically impaired in neurocognitive disorders?

Moral reasoning Signup and view all the answers

What is the prevalence estimate for dementia at age 85 years?

30% Signup and view all the answers

In which phase of neurocognitive disorders is depression most likely to occur?

Early stages of NCD due to Alzheimer’s disease Signup and view all the answers

How should multiple behavioral disturbances in NCD be noted?

Using the specifier 'with behavioral disturbance' Signup and view all the answers

What defines the level of independence in individuals with mild NCD?

Independent but tasks require more time Signup and view all the answers

Which demographic may show the highest incidence of NCD based on U.S. studies?

African Americans Signup and view all the answers

What is a common symptom that can create a need for clinical attention in NCD?

Sleep disturbance Signup and view all the answers

What is the key feature for diagnosing a psychotic disorder due to neurocognitive conditions?

Judged relationship to NCD Signup and view all the answers

What is a primary consideration when classifying NCD based on the spectrum of cognitive decline?

The level of independence in daily activities Signup and view all the answers

Which factor is considered the strongest risk factor for both major and mild neurocognitive disorders (NCDs)?

Age Signup and view all the answers

Which group is reported to have a higher risk for vascular dementia in the United States?

African Americans and Latinx Signup and view all the answers

What role does cultural awareness play in the recognition of neurocognitive symptoms?

It can delay recognition and decrease help-seeking. Signup and view all the answers

In individuals undergoing neuropsychological assessment, which demographic factor is mentioned to potentially limit the applicability of testing norms?

Primary language Signup and view all the answers

Which of the following symptoms is more frequently expressed by women with major neurocognitive disorders compared to men?

Anxiety and depression Signup and view all the answers

What is a common challenge when differentiating between mild neurocognitive disorder and major depressive disorder?

Overlap of symptoms such as memory issues Signup and view all the answers

What type of assessment may be key in detecting mild neurocognitive disorder?

Longitudinal evaluations using quantified assessments Signup and view all the answers

What complicates the diagnosis or treatment of neurocognitive disorders in older individuals?

Co-occurrence with age-related diseases like delirium Signup and view all the answers

Which statement regarding neurocognitive symptoms at the mild level is accurate?

They are more likely noticed by those engaged in complex activities. Signup and view all the answers

What is a noted impact of diagnostic markers such as neuroimaging studies?

They may enhance initial assessments but lack specificity. Signup and view all the answers

What characterizes the cognitive deficits indicative of Alzheimer's disease?

Consistent memory and executive function deficits Signup and view all the answers

Which of the following disorders can complicate the diagnosis of neurocognitive disorders due to their similar presenting symptoms?

Major depressive disorder Signup and view all the answers

What impact does educational attainment have on the likelihood of developing neurocognitive disorders?

Lower education is associated with a higher risk. Signup and view all the answers

How does gender affect the incidence and manifestation of neurocognitive disorders?

Women experience more neurocognitive disorders due to a longer lifespan. Signup and view all the answers

What characteristic distinguishes frontotemporal neurocognitive disorder from Alzheimer's disease?

Insight and judgment are often impaired in the early stages. Signup and view all the answers

Which of the following symptoms is typically associated with the behavioral variant of frontotemporal NCD?

Lack of insight regarding personal behavior. Signup and view all the answers

Which population study finding indicates a significant risk related to dementia diagnoses?

Suicide risk is three to eight times higher in dementia patients. Signup and view all the answers

In contrast to Alzheimer's disease, which variant of frontotemporal NCD is characterized by progressive language impairment?

Agrammatic/nonfluent variant. Signup and view all the answers

Which of the following is a potential consequence of caregiver involvement in cases of Alzheimer's disease?

Increased health issues for the caregiver. Signup and view all the answers

What symptom can make the diagnosis of NCD due to Alzheimer's disease complicated?

Comorbidity with cerebrovascular disease. Signup and view all the answers

What type of cognitive deficits is often observed in elderly individuals who exhibit suicidal behavior?

Impaired decision-making. Signup and view all the answers

Which of the following can be a feature of the language variant of frontotemporal NCD?

Impairments in expressive language. Signup and view all the answers

What is the primary focus of ongoing assessments for individuals with a history of Alzheimer's disease?

To evaluate mood and suicidality. Signup and view all the answers

What distinguishes the neurocognitive symptoms of frontotemporal NCD from Alzheimer's disease?

Learning and memory are generally preserved. Signup and view all the answers

Which of the following factors is NOT typically considered in the diagnosis of NCD due to Alzheimer's disease?

Duration of physical health complaints. Signup and view all the answers

How does the presentation of symptoms differ in the behavioral variant of frontotemporal NCD?

Prominent apathy and disinhibition occur. Signup and view all the answers

What is a common clinical assessment factor for distinguishing between Alzheimer's disease and major depressive disorder?

Improvement with treatment of depression. Signup and view all the answers

What is the required code for major neurocognitive disorder due to probable Alzheimer's disease?

G30.9 followed by F02.81 Signup and view all the answers

Which of the following presentations is typically observed in neurocognitive disorder due to Alzheimer's disease?

Amnestic presentation Signup and view all the answers

What would indicate 'probable' diagnosis of Alzheimer's disease in neurocognitive disorder?

Evidence of a causative Alzheimer's disease gene Signup and view all the answers

Which symptom is NOT typically associated with Alzheimer's disease?

Complete memory retention Signup and view all the answers

At which stage are depression, irritability, and/or apathy most commonly seen in Alzheimer's disease?

Mild NCD Signup and view all the answers

What is a significant risk factor for neurocognitive disorder due to Alzheimer's disease?

Late-life smoking Signup and view all the answers

The strongest genetic risk factor associated with Alzheimer's disease is indicated by which polymorphism?

APOE*E4 Signup and view all the answers

What diagnostic marker is NOT characteristic of Alzheimer's disease pathology?

Excessive dopamine activity Signup and view all the answers

Which neuropsychiatric symptom is commonly observed in individuals with Alzheimer's disease?

Apathy Signup and view all the answers

What procedure may indicate the presence of Alzheimer's pathology in terms of biomarkers?

Cerebrospinal fluid (CSF) analysis Signup and view all the answers

Which statement about the prevalence of neurocognitive disorders due to Alzheimer's disease is accurate?

Steadily increases with age Signup and view all the answers

What is the average duration of survival after a diagnosis of Alzheimer's disease?

Approximately 10 years Signup and view all the answers

Which of the following contributes most significantly to the complexity of diagnosing Alzheimer's disease in certain populations?

Cultural perceptions of memory loss Signup and view all the answers

What role does traumatic brain injury (TBI) play regarding neurocognitive disorders?

Increases risk, especially in men Signup and view all the answers

Which genetic mutation is commonly associated with major or mild frontotemporal neurocognitive disorder?

MAPT gene Signup and view all the answers

What is a key distinguishing feature of major or mild frontotemporal neurocognitive disorder when compared to typical Alzheimer's disease?

Greater incidence of early-onset forms Signup and view all the answers

What condition is characterized by supranuclear gaze palsies and axial-predominant parkinsonism?

Progressive supranuclear palsy Signup and view all the answers

Which of the following is a core symptom of major or mild neurocognitive disorder with Lewy bodies?

Recurrent complex visual hallucinations Signup and view all the answers

Which behavioral presentations may lead to misdiagnosis of behavioral-variant major or mild frontotemporal NCD?

Hallucinations and delusions Signup and view all the answers

What is the typical median survival time after diagnosis for individuals with major or mild frontotemporal neurocognitive disorder?

3-4 years Signup and view all the answers

What defines the presence of causal genetic factors in diagnosing probable frontotemporal neurocognitive disorder?

Presence of tau mutations or distinctive atrophy Signup and view all the answers

Which of the following accurately describes the prevalence of NCD associated with Lewy bodies?

Higher among elderly males Signup and view all the answers

What symptom is not typically related to major or mild vascular neurocognitive disorder?

Early onset memory deficits Signup and view all the answers

Which of the following symptoms is a characteristic of major or mild NCD with Lewy bodies?

Frequent falls and syncope Signup and view all the answers

What distinguishes logopenic progressive aphasia from other forms of aphasia?

Left temporoparietal dysfunction Signup and view all the answers

Which condition emerges with spontaneous parkinsonism before cognitive decline?

Parkinson's disease Signup and view all the answers

What is a common symptom seen in behavioral-variant major or mild frontotemporal NCD?

Disinhibition or apathy Signup and view all the answers

What characterizes the clinical diagnosis process for major or mild neurocognitive disorder with Lewy bodies?

Thorough assessment including caregiver observations Signup and view all the answers

What is the average duration of survival for individuals after the onset of cognitive decline in noncognitive disorder with Lewy bodies (NCDLB)?

5.5-7.7 years Signup and view all the answers

Which diagnostic marker is indicative of neurocognitive disorder with Lewy bodies?

Low striatal dopamine transporter uptake on SPECT Signup and view all the answers

How is the distinction between neurocognitive disorder with Lewy bodies (NCDLB) and neurocognitive disorder due to Parkinson’s disease made?

By the sequence of cognitive and motor symptoms Signup and view all the answers

Which of the following factors is equally significant in both NCDLB and Alzheimer's disease?

Genetic risk factors Signup and view all the answers

What type of imaging is primarily used to assess cerebral blood flow in vascular neurocognitive disorder?

Single Photon Emission Computed Tomography (SPECT) Signup and view all the answers

What is a common clinical presentation observed in individuals suffering from vascular neurocognitive disorder?

Fluctuations in cognitive function with intermittent stability Signup and view all the answers

Which characteristic is true for neurocognitive disorder with Lewy bodies compared to other neurodegenerative diseases?

More functional impairment than expected for cognitive deficits Signup and view all the answers

What underlying pathology is primarily associated with neurocognitive disorder with Lewy bodies?

Misfolding and aggregation of α-synuclein Signup and view all the answers

What additional code should be used when diagnosing major or mild vascular neurocognitive disorder?

Documented evidence of cerebrovascular events Signup and view all the answers

Which characteristic differentiates probable vascular neurocognitive disorder from possible vascular neurocognitive disorder?

Significant parenchymal injury shown on imaging Signup and view all the answers

Which of the following statements regarding diagnostic criteria for NCD based on Parkinson’s disease is accurate?

Cognitive symptoms may begin simultaneously or before motor symptoms. Signup and view all the answers

What is a plausible consequence of having multiple pathological lesions in neurocognitive disorder?

Rapid cognitive decline and shorter survival time Signup and view all the answers

Which condition might present with prominent slow-wave activity on an electroencephalogram?

Neurocognitive disorder with Lewy bodies Signup and view all the answers

Which factor significantly influences the neurocognitive outcomes of vascular brain injury?

Neuroplasticity factors Signup and view all the answers

For a diagnosis of major vascular NCD, which condition is considered necessary?

At least two documented strokes Signup and view all the answers

What is a common initial symptom of mild non-alcoholic fatty dementia?

Reduced processing speed Signup and view all the answers

The prevalence of vascular dementia is highest among which demographic group in the United States?

African Americans Signup and view all the answers

What is the primary characteristic distinguishing complicated mild TBI from uncomplicated mild TBI?

Presence of traumatic intracranial abnormalities Signup and view all the answers

Which condition is NOT a recognized major risk factor for vascular neurocognitive disorders?

High vitamin D levels Signup and view all the answers

Which cognitive domain is particularly affected by disruption in cortical-subcortical circuits due to vascular NCD?

Complex attention Signup and view all the answers

In which age group is the prevalence of vascular NCD observed to be the highest?

90 years and older Signup and view all the answers

How is the severity of a TBI classified?

Using specific clinical thresholds Signup and view all the answers

Which type of vascular NCD is specifically associated with post-stroke cognitive impairment?

Poststroke NCD Signup and view all the answers

What commonly seen symptom following a stroke can lead to a diagnosis of dementia?

Impaired verbal communication Signup and view all the answers

What percentage of individuals are diagnosed with dementia within 3 months after having a stroke?

20%-30% Signup and view all the answers

Which type of information is essential for establishing etiological certainty in vascular NCD?

Neuroimaging abnormalities Signup and view all the answers

Which brain areas are primarily affected in major or mild vascular NCD?

White matter, basal ganglia, or thalamus Signup and view all the answers

Which condition would likely be assessed for through physical examination and history-taking when investigating vascular NCD?

History of cerebrovascular disease Signup and view all the answers

What duration of loss of consciousness is indicative of major or mild NCD due to traumatic brain injury (TBI)?

Equal to or less than 30 minutes Signup and view all the answers

Which of the following is a common cognitive impairment associated with TBI?

Social cognition Signup and view all the answers

What Glasgow Coma Scale score suggests a moderate level of consciousness alteration after a TBI event?

9–12 Signup and view all the answers

Which factor is NOT a risk factor for adverse cognitive outcomes after TBI?

Higher preinjury cognitive abilities Signup and view all the answers

How long do neurocognitive impairments typically persist after mild TBI?

Days to weeks Signup and view all the answers

What type of brain injury could result in additional cognitive impairments based on the affected brain region?

Contusion Signup and view all the answers

Which of the following information is NOT used to support the diagnosis of NCD due to TBI?

Patient age at injury Signup and view all the answers

What is a common cause of TBI in children according to prevalence data?

Falls Signup and view all the answers

Which condition co-occurring with TBI might warrant reevaluation of neurocognitive symptoms?

PTSD Signup and view all the answers

What is the expected trajectory for cognitive recovery following moderate or severe TBI?

Long-term improvement without full recovery Signup and view all the answers

How do the long-term risks for suicide in individuals with TBI relate to depression?

Depression significantly contributes but is not the sole factor Signup and view all the answers

Which diagnostic marker is considered relevant for identifying NCD due to TBI?

Contemporaneous neuroimaging findings Signup and view all the answers

What might indicate a persistent symptom after mild TBI that requires further investigation?

Worsening of symptoms over time Signup and view all the answers

What is a primary consequence of major neurocognitive disorder due to TBI?

Difficulty in independent living and self-care Signup and view all the answers

Which of the following is a prominent neuromotor feature in major neurocognitive disorder due to TBI?

Severe incoordination and ataxia Signup and view all the answers

What symptom is likely to amplify cognitive complaints in individuals with a TBI history?

Comorbid depressive and anxious symptoms Signup and view all the answers

Among the following, which medical condition is NOT commonly associated with moderate-to-severe TBI?

Asthma Signup and view all the answers

Which of the following criteria must be met for a diagnosis of substance/medication-induced major neurocognitive disorder?

Impacts of the substance persist beyond intoxication Signup and view all the answers

What distinguishes substance-induced major neurocognitive disorder from other disorders?

Cognitive impairments remain consistent with the timing of substance use Signup and view all the answers

Which term describes the emotional dysregulation seen in individuals with severe TBI?

Loss of emotional control Signup and view all the answers

What is the importance of considering differential diagnosis in major or mild NCD due to TBI?

To ensure accurate assessment of neurocognitive symptoms Signup and view all the answers

When diagnosing substance-induced neurocognitive disorder, what must clinicians record alongside the condition?

The presence of a comorbid substance use disorder Signup and view all the answers

Which factor is essential to consider when assessing neurocognitive symptoms post-TBI?

Possible factors of factitious disorder or malingering Signup and view all the answers

Which medication-related factor must be evaluated when diagnosing neurocognitive disorders?

The duration and extent of substance use Signup and view all the answers

What aspect of daily functioning is significantly impaired in individuals with major neurocognitive disorder?

Basic self-care and daily activities Signup and view all the answers

What can exacerbate independent living challenges in individuals with TBI?

Loss of emotional control and apathy Signup and view all the answers

What underlying condition is important to evaluate in patients with suspected neurocognitive disorders following TBI?

Presence of emotional disturbances or personality disorders Signup and view all the answers

What type of symptoms may early presentations of Huntington's disease resemble?

Signs of another neurocognitive disorder Signup and view all the answers

Which cognitive deficits are particularly implicated in functional decline associated with Huntington's disease?

Speed of processing and attention Signup and view all the answers

Which condition must be differentiated from Huntington's disease due to its similar symptoms of chorea?

Wilson's disease Signup and view all the answers

What is considered a Huntington's disease phenocopy?

Symptoms identical to Huntington's without genetic mutation Signup and view all the answers

What symptom related to Huntington's disease may lead to greater daily care needs as the disease progresses?

Severe choreic movements Signup and view all the answers

In cases where mood symptoms are a principal clinical concern in Huntington's disease, what additional diagnosis may be indicated?

Depressive disorder due to Huntington's disease Signup and view all the answers

Which factor is critical in supporting the diagnosis of major neurocognitive disorder due to another medical condition?

Temporal association between condition onset and cognitive deficits Signup and view all the answers

What additional conditions should also be considered as potential causes of neurocognitive disorders aside from Huntington's disease?

Nutritional and infectious conditions Signup and view all the answers

What condition is most commonly associated with neurocognitive disturbances in HIV-infected individuals?

Substance use disorder Signup and view all the answers

Which cytokine levels are identified as a risk factor for neurocognitive dementia in HIV infection?

Tumor necrosis factor–alpha Signup and view all the answers

What percentage of HIV-infected individuals are likely to show evidence of asymptomatic neurocognitive impairment (ANI)?

Around 30% to 50% Signup and view all the answers

What is a significant effect of chronic long-term systemic and brain inflammation on individuals with HIV?

Increased neurocognitive impairment Signup and view all the answers

Which demographic group displays a higher incidence of neurocognitive impairment due to HIV infection?

Older women with lower educational quality Signup and view all the answers

What effect does antiretroviral therapy have on neurocognitive function?

It can cause neurotoxic effects Signup and view all the answers

What is the typical age range when HIV infection begins to peak in high-income countries?

Late adolescence to young adulthood Signup and view all the answers

Which comedic disorder is often diagnosed alongside major or mild NCD due to HIV due to its worsening effects?

Major depressive disorder Signup and view all the answers

Which diagnostic marker is NOT typically used for assessing HIV infection?

Cognitive function testing Signup and view all the answers

Which neurocognitive profile may interact with aging factors in individuals with HIV, leading to increased prevalence of impairment?

Subcortical neurocognitive profile Signup and view all the answers

What can chronic exposure to antiretroviral drugs lead to in individuals with HIV?

Neurotoxicity resulting in cognitive decline Signup and view all the answers

Which condition related to HIV infection can often lead to opportunistic infections in the brain?

Cerebrovascular disease Signup and view all the answers

How does the risk of neurocognitive dementia relate to educational levels in the context of HIV?

Lower education levels may increase the risk Signup and view all the answers

Which of the following factors is NOT directly linked with the progression or diagnosis of NCD due to HIV?

Personal income level Signup and view all the answers

What combination of cognitive impairments is frequently seen in alcohol-induced neurocognitive disorder (NCD)?

Impaired memory and learning along with executive function Signup and view all the answers

Which imaging technique is used to identify neurocognitive disorders in chronic alcohol use disorder?

Magnetic Resonance Imaging (MRI) Signup and view all the answers

What is a common characteristic of inhalant-induced neurocognitive disorders (NCDs)?

Presence of a distinctive rash around the nose or mouth Signup and view all the answers

Which factor does NOT significantly increase the risk of substance/medication-induced NCDs?

Younger age Signup and view all the answers

Which cognitive area typically shows prominent impairments in neurocognitive disorders associated with HIV infection?

Executive function and attentional tasks Signup and view all the answers

What symptoms may accompany mild neurocognitive disorders induced by drugs with central nervous system depressant effects?

Increased irritability and sleep disturbances Signup and view all the answers

Which demographic is reported to have a higher prevalence of alcohol-induced major NCD?

Men with early substance use history Signup and view all the answers

What common neurocognitive consequence is associated with prolonged substance withdrawal?

Rebound depression and hypersomnia Signup and view all the answers

Which condition must be distinctly differentiated from substance/medication-induced NCDs?

Traumatic brain injury Signup and view all the answers

What cognitive impairment is typically NOT observed in individuals with neurocognitive disorders due to inhalant use?

Language fluency issues Signup and view all the answers

Which of the following neuroimaging findings might one expect in an individual with chronic substance use and NCD?

Cortical thinning and white matter loss Signup and view all the answers

What symptom is associated with severe substance/medication-induced major NCD distinctive from other conditions?

Incoordination and ataxia Signup and view all the answers

What role does early onset of multiple substance use have in the development of NCDs?

It often contributes to the risk of developing inhalant-induced NCDs Signup and view all the answers

In terms of cognitive efficiency, how may substance/medication-induced NCDs uniquely impact functionality?

They can augment existing cognitive impairments Signup and view all the answers

What is the typical age group for the peak incidence of sporadic CJD?

67 years Signup and view all the answers

Which of the following symptoms is considered a prodromal stage of prion disease?

Fatigue Signup and view all the answers

Which diagnostic test is considered the most sensitive for diagnosing prion disease?

Real-time quaking induced conversion (RT-QuIC) Signup and view all the answers

Which of the following is NOT a risk factor for prion disease?

Exposure to pesticides Signup and view all the answers

In the context of neurocognitive disorders due to Parkinson's disease, what factor increases diagnostic confidence?

Prior diagnosis of Parkinson's disease Signup and view all the answers

What is a common feature of major neurocognitive disorder associated with Parkinson's disease?

Rapid eye movement sleep behavior disorder Signup and view all the answers

Which genetic factor has been indicated as enhancing the risk of sporadic prion disease?

Codon 129 polymorphism of the PRNP gene Signup and view all the answers

What is the estimated prevalence of neurocognitive disorder due to prion disease?

1 case per 1 million people Signup and view all the answers

Which of the following best describes the progression of prion disease?

Rapid progression to major NCD over several months Signup and view all the answers

Among ethnicities studied, which group showed a lower incidence of prion disease?

Ethnic Chinese in Taiwan Signup and view all the answers

Which element is emphasized as a potential source of prion transmission?

Contaminated surgical instruments Signup and view all the answers

What is one of the most common findings in brain imaging for prion disease?

Multifocal gray matter hyperintensities Signup and view all the answers

What cognitive feature is often observed early in the course of Parkinson's disease?

Pronounced apathy Signup and view all the answers

What is true regarding the gender differences in neurocognitive disorder prevalence associated with Parkinson's disease?

Discrepancies exist, but unclear if incidence differs by gender Signup and view all the answers

What potential risk factor is associated with worse cognitive outcomes in individuals with Parkinson's disease?

Older age at disease onset Signup and view all the answers

Which cognitive deficits are typically identified in individuals at the mild NCD phase due to Parkinson's disease?

Executive dysfunction and reduced attention Signup and view all the answers

What distinguishes dementia with Lewy bodies from neurocognitive disorder due to Parkinson’s disease?

Cognitive decline must occur after a Parkinson’s diagnosis Signup and view all the answers

Which brain disorder must be distinguished from major NCD due to Parkinson's disease upon diagnosis?

Multiple system atrophy Signup and view all the answers

What is a common early psychiatric symptom in individuals diagnosed with Huntington's disease?

Apathy Signup and view all the answers

What cognitive feature might remain relatively intact in advanced stages of Huntington's disease?

Verbal memory Signup and view all the answers

What is a potential consequence of antipsychotic medication in NCD patients?

Induction of parkinsonism Signup and view all the answers

Which factor increases the risk of suicide among individuals with Huntington's disease?

Presence of depressive symptoms Signup and view all the answers

What is the average life expectancy after the clinical diagnosis of Huntington's disease?

10-20 years Signup and view all the answers

What features on neuropsychological testing could be indicative of Parkinson's disease at its early stages?

Deficits in attention and memory Signup and view all the answers

What common pre-diagnostic symptom might appear up to a decade before motor symptoms in Huntington's disease?

Depression Signup and view all the answers

Which symptom is often most affected by advanced Huntington's disease, leading to significant communication barriers?

Speech production Signup and view all the answers

What is a significant behavioral disturbance that may occur in individuals with Huntington's disease?

Disinhibition Signup and view all the answers

What hallmark of cognitive impairment is commonly observed in neurocognitive disorders like Parkinson’s disease?

Executive function deficits Signup and view all the answers

Which coding category is used for major neurocognitive disorder due to multiple etiologies without behavioral disturbance?

F02.80 Signup and view all the answers

In cases where cognitive deficits persist despite successful treatment of an associated medical condition, what may be a potential cause?

Another cognitive disorder Signup and view all the answers

What does the presence of multiple medical conditions contributing to a neurocognitive disorder indicate?

Major neurocognitive disorder Signup and view all the answers

When coding for major neurocognitive disorder due to vascular disease, which code is applicable for behavioral disturbance?

F01.51 Signup and view all the answers

Which of the following applies to unspecified neurocognitive disorder?

It causes clinically significant distress Signup and view all the answers

What condition is NOT coded when identifying multiple etiologies for neurocognitive disorder?

Vascular disease Signup and view all the answers

Which factor is essential in diagnosing the cause behind neurocognitive disorder when there are persistent cognitive deficits?

Previous medical history Signup and view all the answers

When coding for neurocognitive disorders, what must be done in cases of major or mild NCD due to multiple etiologies?

Code all etiologies first Signup and view all the answers

What is a potential benefit of utilizing precision medicine approaches for neurocognitive disorders?

Personalized treatment strategies based on genetic profiles Signup and view all the answers

Which area is NOT highlighted as a target for future Alzheimer's disease research?

Patient lifestyle management Signup and view all the answers

What emerging therapy is noted for its possible application in mild neurotrauma?

Therapeutic hypothermia Signup and view all the answers

What challenge does precision medicine face in the practical application for neurocognitive disorders?

Unethical use of genetic data Signup and view all the answers

Which of these methods has been described as a composite approach to treating neurodegenerative disorders?

Evidence-informed guided use of medications combined with other therapies Signup and view all the answers

What role does white matter tract integrity play in stroke recovery?

It is a key biomarker for guiding neurorehabilitation interventions. Signup and view all the answers

What aspect of research is deemed crucial for addressing equity in neurocognitive disorder treatment?

Investigation of the utility of potential interventions Signup and view all the answers

Which emerging technology is being investigated for its potential benefits in neurodegenerative disorder treatment?

Telehealth and digital technologies Signup and view all the answers

What is the projected increase in the prevalence rate of neurocognitive disorders for individuals over 65 in the U.S. by 2050?

From 8.3% to 16.7% Signup and view all the answers

What primarily drives the increase in the prevalence of Alzheimer's disease globally?

Overall increase in the aging population Signup and view all the answers

What is a major limitation of brief cognitive screening instruments in assessing neurocognitive disorders?

They cannot accurately diagnose mild cognitive impairment Signup and view all the answers

Which demographic group is facing a notable lack of resources for accessing neurocognitive assessments?

Ethnic minority groups and rural areas Signup and view all the answers

What percentage of the global mean prevalence of dementia is projected to be in sub-Saharan Africa?

1.5% Signup and view all the answers

Which of the following is NOT a tool used for the diagnosis of neurocognitive disorders?

Genetic predisposition models Signup and view all the answers

Which cognitive assessment method is integral for a comprehensive evaluation of neurocognitive disorders?

A multi-test battery approach Signup and view all the answers

What level of caregiving burden is estimated for family members of Alzheimer's patients in the U.S.?

19.2 million caregivers providing uncompensated care Signup and view all the answers

What is a common misconception regarding neurocognitive disorders in developing countries?

They are often seen as a normal part of aging Signup and view all the answers

How can clinicians best address the varying causes of cognitive difficulties?

By considering a comprehensive evaluation of factors Signup and view all the answers

Which of the following regions is projected to see a fourfold increase in its elderly population affecting NCD prevalence?

Sub-Saharan Africa Signup and view all the answers

What is considered a leading pathological hallmark of Alzheimer's disease?

Accumulation of amyloid protein in plaques Signup and view all the answers

What is the estimated fair market value of uncompensated care provided by family members for Alzheimer's patients?

$83 billion Signup and view all the answers

Which neurocognitive disorder primarily affects patients aged 45 to 65?

Frontotemporal dementia Signup and view all the answers

What is the typical duration from the initial stage of Alzheimer's disease to death?

6 to 12 years Signup and view all the answers

What aspect of neurocognitive disorders does not conform to traditional aging changes?

Behavioral disturbances Signup and view all the answers

Which of the following is NOT a common risk factor for developing neurocognitive disorders?

Physical activity Signup and view all the answers

What type of treatment is primarily focused on alleviating symptoms related to neurocognitive disorders?

Supportive therapy Signup and view all the answers

Which of the following cognitive symptoms is often prioritized by caregivers in Alzheimer's disease?

Memory loss Signup and view all the answers

What is a potential outcome of prolonged undetected delirium in patients?

Increased mortality rates Signup and view all the answers

Which pharmacological treatment is used for Alzheimer's disease?

Cholinesterase inhibitors Signup and view all the answers

What characterizes vascular dementia compared to Alzheimer's disease?

Cerebrovascular incidents Signup and view all the answers

Which of the following non-cognitive symptoms is often distressing for caregivers of Alzheimer’s patients?

Social withdrawal Signup and view all the answers

What is a common feature associated with frontotemporal dementia?

Language disturbances Signup and view all the answers

How are biomarkers used in the context of neurocognitive disorders?

To provide definitive diagnosis Signup and view all the answers

What is the relationship between educational attainment and neurocognitive disorders?

Low educational attainment is a risk factor Signup and view all the answers

What describes the typical progression of Alzheimer’s disease symptoms?

Progressive decline over time Signup and view all the answers

What is a critical consideration for clinicians when prescribing cholinesterase inhibitors for dementia patients?

Side effect profiles and necessary monitoring measures must be considered. Signup and view all the answers

Which aspect of caregiver support is crucial to enhancing the management of neurodegenerative diseases?

Providing resources that improve caregiver well-being. Signup and view all the answers

What is highlighted as an effective strategy for managing non-cognitive symptoms in neurocognitive disorder patients?

Using integrated care plans and person-centered approaches. Signup and view all the answers

How do non-pharmacological interventions benefit individuals with neurodegenerative diseases?

They support cognition and emotional outcomes holistically. Signup and view all the answers

What common misconception exists regarding the effectiveness of non-pharmacological interventions?

They can be as effective as drugs in certain scenarios. Signup and view all the answers

What is the primary ethical principle emphasized during bedside clinical decision-making for patients with dementia?

Autonomy Signup and view all the answers

What is an essential factor to consider when adjusting medication doses for patients with neurocognitive disorders?

Patients' individual responses and tolerability to medications. Signup and view all the answers

What aspect of caregiving is crucial for preventing negative emotional outcomes in caregivers?

Offering training in managing caregiver stress and problem-solving. Signup and view all the answers

Which factors can affect a person's cognitive capacity when assessing their ability to give informed consent?

Intoxication, medication side effects, and physical illnesses Signup and view all the answers

Which legal aspect should medical students understand regarding neurocognitive disorder patients?

Informed consent processes and capacity assessments are critical. Signup and view all the answers

In cases of advanced dementia, what typically happens when a person cannot participate in their capability assessment?

A substitute decision maker is sought Signup and view all the answers

What does the National Dementia Strategy in the UK emphasize in relation to the management of dementia?

The importance of non-pharmacological interventions. Signup and view all the answers

Which aspect of caregiver education is deemed essential for providing quality patient care?

Understanding the biology of dementia Signup and view all the answers

What is a significant risk faced by unpaid caregivers of individuals with neurocognitive disorders?

Decreased engagement in personal health. Signup and view all the answers

What role do advance directives play in patient care for individuals with neurocognitive disorders?

They ensure treatment conforms to the patient's prior wishes Signup and view all the answers

What is essential for caregivers when managing end-of-life care for patients with dementia?

Maintaining a focus on the patient's quality of life Signup and view all the answers

What role do advocacy and policy play in supporting caregivers of individuals with neurocognitive disorders?

They can promote caregiver well-being and satisfaction significantly. Signup and view all the answers

How do different state laws impact patient rights regarding consent and refusal of medical treatments?

Variation in laws requires tailored training for caregivers Signup and view all the answers

How do educational resources contribute to the effectiveness of caregiver training programs?

They increase caregivers' skills and enhance patient care. Signup and view all the answers

What might result from inadequate support for caregivers of individuals with neurocognitive disorders?

Diminished well-being and more frequent placement of care recipients. Signup and view all the answers

What is a significant challenge caregivers face in the context of patient autonomy for dementia patients?

Patients' decision-making capacity can fluctuate Signup and view all the answers

Which best describes the purpose of informed consent in the context of dementia care?

To ensure patients have the opportunity to express their wishes Signup and view all the answers

What emerging area in neurocognitive disorder research focuses on individualized treatment approaches?

Precision medicine Signup and view all the answers

In what situation may facilities require an assessment of patient rights during the legal guardianship evaluation?

For all patients under guardianship laws Signup and view all the answers

What is a primary consideration when caregivers assist patients experiencing cognitive impairments?

Creating an environment conducive to decision-making Signup and view all the answers

Which statement accurately reflects the evolution of research in neurocognitive disorders?

Technological advances signal a potential renaissance in the field Signup and view all the answers

What is a key ethical concern when engaging with neurocognitive disorder patients during treatment planning?

Engaging the patient in the decision-making process Signup and view all the answers

Study Notes

Neurocognitive Disorders (NCDs)

NCDs are a group of disorders characterized by impaired cognitive function that are acquired rather than developmental.
NCDs are defined by their underlying pathology, often the etiology as well.
The DSM-5 criteria for NCDs are closely aligned with current consensus criteria.
Major Neurocognitive Disorder (MND) is the DSM-5 term for dementia.
Mild Neurocognitive Disorder (MND) is a less severe form of cognitive impairment.
Diagnostic criteria for both MND and MND are provided.
NCDs frequently coexist, and their relationships are characterized under different chapter subheadings, including differential diagnosis, risk and prognostic factors, and comorbidity.
MND is broader than dementia.
MND can be diagnosed if significant cognitive decline occurs in only one cognitive domain.
Examples of impaired everyday activities in individuals with NCDs include complex attention, executive function, planning, decision-making, and memory.

Cognitive Abilities of Individuals with NCDs

MND often involves repeated self-talk, difficulty recalling recent events, and reliance on list-making or calendars.
Severe MND may result in relatively preserved semantic, autobiographical, and implicit learning compared to recent memory.
Immediate memory span is the ability to repeat a list of words or digits.
Recent memory assesses the process of encoding new information.
Individuals with MND often have difficulties with expressive or receptive language, with idiosyncratic word usage; grammatical errors, and spontaneity of output and economy of utterances.
Individuals with MND may have noticeable word-finding difficulty and may substitute general for specific terms.
Perceptual-motor abilities in individuals with MND may be impaired, including visual perception, visuoconstructional, perceptual-motor, praxis, and gnosis
Individuals with MND may have difficulties with familiar activities, navigation in familiar environments, and relying more on maps or others for directions.
Individuals with MND may need to exert greater effort for spatial tasks such as carpentry, assembly, sewing, or knitting.
Visual perception can be detected through line bisection tasks.
Motor-free perceptual tasks require identifying and/or matching figures.
Visuoconstructional tasks involve hand-eye coordination.
Perceptual-motor tasks integrate perception with purposeful movement.
Praxis refers to the integrity of learned movements, such as imitating gestures or recognizing objects.

Delirium

Delirium can be diagnosed as acute or persistent.
The ICD-10-CM codes for substance intoxication delirium depend on whether or not there is a comorbid substance use disorder present for the same class of substance.
Substance withdrawal delirium is a diagnosis that should be made instead of substance withdrawal when symptoms predominate and are severe.
Medication-induced delirium is a diagnosis made when symptoms arise as a side effect of a medication taken as prescribed.
Delirium due to another medical condition is diagnosed when the disturbance is attributable to the physiological consequences of another medical condition.
Delirium is a severe condition that lasts about one week in hospital settings.
Delirium is characterized by an acute impairment of consciousness, characterized by a disturbance in attention and reduced awareness of the environment.
This deficit affects many higher cerebral cortical functions, leading to a change in other cognitive functions.
The disturbance in attention is manifested by reduced ability to direct, focus, sustain, and shift attention.
The disturbance develops over a short period of time, usually hours to a few days, and tends to fluctuate during the course of the day.
The etiology should be coded according to the appropriately etiological subtype.
Delirium often occurs in the context of an underlying NCD.
Delirium is associated with disturbance in the sleep-wake cycle.
Individuals with delirium may exhibit emotional disturbances such as anxiety, fear, depression, irritability, anger, euphoria, and apathy.
Delirium is a condition that affects older individuals and can be diagnosed in hospitals, nursing homes, and post-acute care settings.
The prevalence of delirium varies depending on the individual's characteristics, setting of care, and detection method sensitivity.
Delirium may progress to stupor, coma, seizures, or death, particularly if undetected and the underlying cause(s) remains untreated.
Delirium may be associated with cognitive decline or major neurocognitive disorder (NCD) in the elderly, particularly in those with preexisting underlying cognitive impairment.
Mortality among hospitalized individuals with delirium is high.
Risk and prognostic factors for delirium include functional impairment, preexisting cognitive impairment, sensory impairment, increasing age, illness severity or comorbidity, infection, depression, history of stroke, and history of alcohol use.
Both major and mild NCDs can increase the risk for delirium and complicate the course.
Older individuals are especially susceptible to delirium compared with younger adults.
Symptoms associated with delirium may vary in men and women.
Diagnosis of delirium involves distinguishing between delirium characterized by vivid hallucinations, delusions, language disturbances, and agitation from other psychotic disorders, manic or major depressive episodes, and acute stress disorder.
When delirium and major NCD are comorbid, the management of the delirium should generally be given priority.
Other specified delirium categories apply to presentations where symptoms characteristic of delirium cause clinically significant distress or impairment.
Unspecified Delirium is a category that applies to presentations where symptoms characteristic of delirium cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Major or Mild Neurocognitive Disorder Due to Alzheimer’s Disease

Major and Mild Neurocognitive Disorders have specific diagnostic criteria.
The current severity of these disorders is classified as mild: difficulties with instrumental activities of daily living (e.g., housework, managing money), moderate: difficulties with basic activities of daily living (e.g., feeding, dressing), and severe: fully dependent.
Mild neurocognitive disorders are characterized by a modest cognitive decline from a previous level of performance in one or more cognitive domains, such as complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition.
Coding and recording procedures for major neurocognitive disorders due to an etiological subtype include G30.9 Alzheimer's disease, F02.80 major neurocognitive disorder due to probable Alzheimer's disease, F02.80 major neurocognitive disorder due to traumatic brain injury, F02.81 major neurocognitive disorder due to traumatic brain injury, and F06.34 bipolar and related disorder due to traumatic brain injury.
For mild neurocognitive disorder due to any of the medical etiologies listed above, code G31.84 is used, and code R41.9 is used for unspecified mild neurocognitive disorder.

Subtyping of Neurocognitive Disorders (NCDs)

NCDs are primarily subtyped according to the known or presumed etiological/pathological entity or entities underlying the cognitive decline. These subtypes are distinguished on the basis of a combination of time course, characteristic domains affected, and associated symptoms.
In certain etiological subtypes, the diagnosis depends substantially on the presence of a potentially causative entity, such as Parkinson’s or Huntington’s disease, or a traumatic brain injury or stroke.
For other etiological subtypes (generally the neurodegenerative diseases like Alzheimer’s disease, frontotemporal degeneration, and Lewy body disease), the diagnosis is based primarily on the cognitive, behavioral, and functional symptoms.
NCDs are frequently managed by clinicians in multiple disciplines. For many subtypes, multidisciplinary international expert groups have developed specialized consensus criteria based on clinicopathological correlation with underlying brain pathology.

Neurocognitive Disorders (NCDs)

Psychotic features are common in many NCDs, particularly in the mild-to-moderate stage of major NCDs due to Alzheimer’s disease, Lewy body disease, and frontotemporal degeneration.
Paranoia and other delusions are common features, and often a persecutory theme may be a prominent aspect of delusional ideation.
Hallucinations may occur in any modality, although visual hallucinations are more common in NCDs than in depressive, bipolar, or psychotic disorders.
Mood disturbances, including depression, anxiety, and elation, may occur.
Depression is common early in the course of NCD due to Alzheimer’s disease, Lewy body disease, or frontotemporal degeneration.
Individuals with NCD can present with a wide variety of behavioral symptoms.
Sleep disturbance is a common symptom that can create a need for clinical attention and may include symptoms of insomnia, hypersomnia, and circadian rhythm disturbances.
Apathy is common in both mild and major NCDs, observed particularly in NCD due to Alzheimer’s disease and may be a prominent feature of NCD due to frontotemporal degeneration.
Other important behavioral symptoms include wandering, disinhibition, hyperphagia, and hoarding.

Diagnostic Features

Major NCD roughly corresponds to the condition labeled in ICD-10 and ICD-11 (as well as in DSM-IV).
The core feature of NCDs is acquired cognitive decline in one or more cognitive domains.
Performance on an objective assessment that falls below the expected level or has been observed to decline over time is a key indicator.
Neuropsychological testing is a crucial part of the standard evaluation of neurocognitive disorders (NCDs), particularly in the evaluation of mild NCD.
For major NCD, performance is typically 2 or more standard deviations below appropriate norms (3rd percentile or below), while for mild NCD, performance typically lies in the 1–2 standard deviation range (between the 3rd and 16th percentiles).
Criterion B relates to the individual's level of independence in everyday functioning.
Individuals with major NCD will have impairment of sufficient severity so as to interfere with independence, such that others will have to take over tasks that the individuals were previously able to complete on their own.
Individuals with mild NCD will have preserved independence, although there may be subtle interference with function or a report that tasks require more effort or take more time than previously.

Prevalence and Incidence

The prevalence of NCD varies widely by age and by etiological subtype.
Overall, international prevalence estimates for dementia are approximately 1%–2% at age 65 years and as high as 30% by age 85 years.
The prevalence of mild NCD is very sensitive to the definition of the disorder, particularly in community settings, where evaluations are less detailed.
Estimates of the prevalence of mild cognitive impairment among older individuals are fairly variable, ranging from 2% to 10% at age 65 and 5% to 25% by age 85.
Prevalence and incidence of dementia vary cross-nationally and among ethnic and racialized populations in the United States, although methodological differences complicate rate comparisons.
Some U.S. studies found that incidence is highest in African Americans followed, in decreasing order, by American Indians/Alaska Natives, Latinx, Pacific Islanders, non-Latinx Whites, and Asian Americans.

Risk Factors

Age is the strongest risk factor for major and mild NCDs, as it increases the risk of neurodegenerative and cerebrovascular disease.
Risk of NCDs also varies by ethnic and racialized background, with variations in the risk of underlying diseases, predisposing conditions, environment, and other factors.
Lower education and literacy are risk factors for NCDs that can vary by ethnoracial group because of differential exposure to adverse social determinants of health.
Neurocognitive symptoms are more likely to be noticed, particularly at the mild level, in individuals who engage in complex occupational, domestic, or recreational activities.
Sex- and gender-related factors may influence incidence and prevalence, the etiology (risk and protective factors), and the clinical manifestations of major and mild NCD.

Diagnostic Markers

Diagnostic markers, such as neuropsychological assessments, are key measures for diagnosing NCDs, particularly at the mild level, where functional changes are minimal and symptoms are more subtle.
Neuropsychological thresholds are sensitive to the specific test(s) and norms employed, as well as to test conditions, sensory limitations, and intercurrent illness.
When formal neuropsychological testing is unavailable or not feasible, brief assessments and global brief mental status tests can provide insight.
Additional diagnostic markers may come into play, particularly neuroimaging studies such as magnetic resonance imaging scans and positron emission tomography scans.

Functional Consequences

Major and mild neurocognitive disorders (NCDs) have functional consequences that affect human functioning, as cognition plays a central role in human life.
The criteria for these disorders and the threshold for differentiating mild from major NCD are based on functional assessment.
Both mild and major NCD may be difficult to distinguish from a persistent delirium, which can co-occur.

Differential Diagnosis

Differential diagnosis between normal cognition and mild NCD, as well as between mild and major NCD, is challenging.
Careful history taking and objective assessment are critical.
A longitudinal evaluation using quantified assessments may be key in detecting mild NCD.
The distinction between mild NCD and major depressive disorder, which may co-occur with NCD, can also be challenging.
A careful clarification of the individual's baseline status will help distinguish an NCD from a specific learning disorder or other neurodevelopmental disorders.

Alzheimer's Disease

Major or mild neurocognitive disorder due to Alzheimer's disease has diagnostic criteria that include insidious onset and gradual progression of impairment in one or more cognitive domains.
The core features of major or mild neurocognitive disorder (NCD) due to Alzheimer's disease include an insidious onset and gradual progression of cognitive and behavioral symptoms.
The typical presentation is amnestic, with impairment in memory and learning, but unusual nonamnestic presentations, particularly visuospatial and logopenic aphasic variants, also exist.
For individuals with NCD due to Alzheimer's disease, symptoms extend beyond cognitive deficits to include neuropsychiatric symptoms such as agitation, apathy, depression, delusions, and sleep disorders.
Neuropsychiatric symptoms are nearly universal in Alzheimer's disease.
The prevalence of overall NCD due to Alzheimer's disease rises steeply with age, with an estimated 5.4 million Americans of all ages having dementia due to Alzheimer's disease in 2016.
Alzheimer's disease (NCD) progresses gradually from mild to severe dementia, with a mean duration of survival after diagnosis of approximately 10 years.
The disease is more common in older adults due to the increased likelihood of comorbid medical illness and mixed pathology.

Risk Factors for Alzheimer's Disease

Age is definitively the strongest risk factor for NCD, as prevalence estimates demonstrate.
The most common risk factors are polygenic, with over 45 risk genes/loci having been identified, typically with small effects on risk.
The strongest genetic susceptibility polymorphism, apolipoprotein E4 (APOE*E4), increases risk and decreases age at onset, particularly in homozygous individuals.
Culture-related diagnostic issues include individuals' and families' level of awareness and concern about neurocognitive symptoms.
Sex- and gender-related diagnostic issues may also play a role in the development and course of NCD.

Diagnostic Markers for Alzheimer's Disease

Diagnostic markers such as amyloid-predominant neuritic plaques, tau-predominant neurofibrillary tangles, and neuronal loss observed microscopically or manifested in regional cortical atrophy are hallmarks of the pathological diagnosis of Alzheimer's disease.
Genetic testing for such mutations is commercially available, although usually without clinical utility.
Since amyloid beta-42 deposition in the brain occurs early in the pathophysiological cascade, amyloid-based diagnostic tests such as amyloid imaging on brain PET scans and reduced levels of amyloid beta-42 in the CSF may have diagnostic value.
Signs of neuronal injury, such as hippocampal and temporoparietal cortical atrophy on magnetic resonance image scans and temporoparietal hypometabolism on fluorodeoxyglucose PET scans, provide evidence of neuronal damage but are less specific for Alzheimer's disease.

Suicide Risk

Large-scale studies indicate elevated rates of suicidal thoughts or behavior in individuals with NCD due to a variety of etiologies compared with persons without an NCD.
A nationwide study in Taiwan reported that attempted suicide in late life is associated with subsequent dementia.

Impact of Alzheimer's Disease

Major or mild neurocognitive disorders (NCDs) due to Alzheimer's disease have a serious and substantial impact on individuals, their caregivers, and families.
Early in the disease course, memory loss, disorientation, and mood symptoms adversely impact independence and create safety concerns.
As the disease advances, individuals become increasingly disabled in instrumental and basic daily living activities, slowly becoming fully dependent on others.

Caregiver Impact

Caregivers for those with NCD due to Alzheimer's disease often experience a decline in their social network and develop health and mental health problems.

NCD due to other Neurodegenerative Processes

Major and mild NCDs due to other neurodegenerative processes (e.g., Lewy body disease, frontotemporal degeneration) share similar insidious onset and gradual decline as Alzheimer's disease but have unique features.

NCD with Lewy Bodies

Often characterized by fluctuations in cognition, parkinsonian features, gait issues, and visual hallucinations.

Frontotemporal NCD

Presents with behavioral or language variant.
Behavioral variant: changes in social behavior like disinhibition, apathy, or repetitive behavior.
Language variant: impairments in expressive language or word comprehension.

Differential Diagnosis For NCD

Depression can resemble NCD due to reduced daily functioning and concentration.
Improvement with treatment of depression can help differentiate.
If depressive symptoms are judged to be caused by Alzheimer's disease, a diagnosis of depressive disorder due to Alzheimer's disease should be given instead of major depressive disorder.

Comorbidity

Major or mild NCD due to Alzheimer's disease often co-occurs with cerebrovascular disease, contributing to the clinical picture.
If a comorbid condition contributes to NCD in an individual with Alzheimer's disease, then NCD due to multiple etiologies should be diagnosed.

Frontotemporal Neurocognitive Disorder (NCD)

Characterized by progressive behavioral/personality changes or language impairment.
Behavioral variant: apathy, disinhibition, loss of interest in socialization, self-care, and personal responsibilities, socially inappropriate behaviors.
Language variant: semantic and agrammatic/nonfluent variants.
Insight is often impaired, delaying medical consultation.
Cognitive decline is less prominent in early stages.
Common neurocognitive symptoms: lack of planning, distractibility, poor judgment.
Deficits in executive function: poor performance on tests of mental flexibility, abstract reasoning, response inhibition.
Learning and memory are relatively spared in early stages.
Prevalence is common in individuals younger than 65 years.
Median survival: 6-11 years after symptom onset and 3-4 years after diagnosis.
Survival is shorter and decline is faster than in typical Alzheimer's disease.

Genetic Factors in Frontotemporal NCD

Approximately 40% of individuals have a family history of early-onset NCD.
Approximately 10% show an autosomal dominant inheritance pattern.
Genetic mutations: MAPT, GRN, C9ORF72, TDP-43, VCP, CHMP2B, FUS.

Distinction of Frontotemporal NCD from Other Neurodegenerative Diseases

Alzheimer's disease: decline in learning and memory is an early feature.
Lewy bodies: core and suggestive features of Lewy bodies must be present.
Parkinson's disease: spontaneous parkinsonism emerges well before cognitive decline.
Vascular NCD: history of cerebrovascular event is temporally related to cognitive impairment, neuroimaging reveals infarctions or white matter lesions.
Frontotemporal NCD can overlap clinically and pathologically with progressive supranuclear palsy, corticobasal degeneration, and motor neuron disease.

Distinguishing Frontotemporal NCD from Mental Disorders

Can be mistaken for major depression, bipolar disorders, or schizophrenia.
Progressive neurocognitive difficulties will help distinguish.
A thorough medical evaluation should exclude treatable causes of NCDs like metabolic disturbances, nutritional deficiencies, and infections.

Neurocognitive Disorder with Lewy Bodies (NCDLB)

Also known as dementia with Lewy bodies (DLB).
Includes progressive cognitive impairment, recurrent visual hallucinations, rapid eye movement (REM) sleep behavior disorder, hallucinations in other sensory modalities, apathy, anxiety, depression, and delusions.
Requires a thorough assessment due to variable presentation.
Accurate diagnosis is essential as individuals are sensitive to neuroleptic drugs, which should be used with caution.
Individuals often experience falls, syncope, or transient episodes of unresponsiveness.
Autonomic dysfunction: orthostatic hypotension, constipation, urinary incontinence, hypersomnia, hyposmia.
Prevalence varies from 0% to 1.2% of the general elderly population and from 0% to 9.7% of all dementia cases.
Gradual onset and insidious progression.
Distinct from Parkinson's disease in which cognitive decline is manifested early in the illness, while in Parkinson’s the disorder starts in the brain stem and cognitive decline is later.

NCDLB: Genetic Factors and Risk Factors

Genetic risk factors are important.
Onset of symptoms typically between ages 50-89, with most cases occurring in the mid-70s.
Disease course progresses through severe dementia to death.
Average survival: 5.5-7.7 years from the onset of cognitive decline.

Diagnostic Markers for NCDLB

Low striatal dopamine transporter uptake on SPECT or PET scan.
Abnormal myocardial scintigraphy.
Polysomnographic confirmation of REM sleep without atonia.
Neuropsychological testing beyond brief screening may be necessary.

NCDLB: Functional Impact

Individuals are more functionally impaired than expected based on cognitive deficits.
This is due to motor and autonomic impairments, sleep disorders, and prominent psychiatric symptoms.
Quality of life is worse than those with Alzheimer's disease.

NCDLB: Distinction from NCD due to Parkinson's Disease

For dementia attributed to Parkinson's disease, the diagnosis must be present for at least 1 year before cognitive decline reaches the level of major NCD.
For NCDLB, cognitive symptoms may begin before, with, or in the absence of parkinsonism.

NCDLB: Coexisting Pathology

Lewy body pathology frequently coexists with Alzheimer’s disease, TDP-43 pathology, and cerebrovascular disease pathology.
Multiple pathologies may accelerate cognitive decline and shorten survival.

Vascular Neurocognitive Disorder

Probable vascular neurocognitive disorder diagnosed if:
- Supported by neuroimaging evidence of parenchymal injury.
- Neurocognitive syndrome is temporally related to cerebrovascular events.
- Both clinical and genetic evidence of cerebrovascular disease is present.
Involves establishing an NCD with cerebrovascular disease as the primary pathology.
Presentation is heterogeneous due to type, extent, and location of vascular lesions.
Pathogenic mechanisms: hypoperfusion, hypoxia, oxidative stress, inflammation, endothelial dysfunction, impairment of autoregulation, disruption of neurovascular coupling.

Vascular NCD: Presentation

Many individuals present with multiple infarctions, acute stepwise or fluctuating decline in cognition, intervening periods of stability, and improvement.
Others may experience gradual onset, rapid development of deficits, or a complex presentation.
Gradual onset and slow progression often attributed to small vessel disease, leading to lesions in white matter, basal ganglia, or thalamus.

Vascular NCD: Cognitive Deficits

Disruption of cortical-subcortical circuits affects complex attention, particularly speed of information processing, and executive function.
Clinical subtypes: poststroke NCD, subcortical ischemic vascular NCD, multi-infarct (cortical) NCD, and cortical-subcortical vascular NCD.

Vascular NCD: Assessment

Assessment relies on history, physical examination, and neuroimaging.
Etiological certainty requires demonstration of abnormalities on neuroimaging.
A probable diagnosis can be made without neuroimaging if the neurocognitive impairment is temporally associated with well-documented strokes.
For mild vascular NCD, a history of a single stroke or extensive white matter disease is generally sufficient.
For major vascular NCD, two or more strokes, a strategically placed stroke, or a combination of white matter disease and one or more lacunes is generally necessary.

Vascular NCD: Relationship to Neuroimaging and Cognitive Symptoms

The relationship between identifiable vascular pathologies in the brain on neuroimaging and the cognitive symptoms is imperfect, requiring clinical judgment to relate the vascular lesions to the cognitive syndrome.

Vascular NCD: Prevalence

Second most common cause of NAD after Alzheimer's disease.
Prevalence in the United States:
- 0.98% for individuals aged 71-79 years.
- 4.09% for those aged 80-89 years.
- 6.19% for those aged 90 years or older.
Within 3 months following stroke, 20%-30% of individuals are diagnosed with dementia.
- 12.3% prevalence in Europe.
- Higher prevalence in those aged 60-69 years compared to those older than 90 years.
Mixed dementia: Alzheimer’s plus vascular pathology present in 5.5% of the overall cohort, with higher prevalence in those older than 90 years (10.6%).
Higher prevalence of vascular dementia among African Americans, Mexican Americans, and South Asian Americans, possibly due to higher rates of risk factors like diabetes and cardiovascular disease.

Vascular NCD: Prevalence Across Regions

In Japan and other Asian countries, the prevalence of dementia due to Alzheimer's disease has increased relative to vascular dementia.
Currently, the prevalence of dementia due to Alzheimer's disease among Japanese Americans is 2.6 times higher than that of vascular dementia.

Vascular NCD: Gender

Stroke is more common in men through age 65 years, but more common in women after age 65 years.
Rate of vascular NCD was higher in men in some studies.

Vascular NCD: Onset

Can occur at any age, but prevalence increases exponentially after age 65 years.
In older individuals, additional pathologies are often present and partly account for neurocognitive deficits.
Course can vary from acute onset with partial improvement to stepwise decline to progressive decline, with fluctuations and plateaus.

Vascular NCD: Neurocognitive Outcomes

Influenced by neuroplasticity factors like education, physical exercise, and mental activity.

Vascular NCD: Risk Factors

Same as those for cerebrovascular disease and stroke:
- Hypertension
- Diabetes
- Smoking
- Obesity
- High cholesterol levels
- High homocysteine levels
- Other risk factors for atherosclerosis and arteriolosclerosis
- Atrial fibrillation
- Conditions increasing the risk of cerebral emboli
Cerebral amyloid angiopathy (CAA) is an important risk factor.

Diagnostic Markers for Vascular NCD

Structural neuroimaging using MRI or CT.
No other established biomarkers.

Major or Mild Neurocognitive Disorder due to Traumatic Brain Injury (TBI)

Major or mild NCD due to TBI is a common condition resulting from a disruption of brain structure and/or function due to biomechanical forces
TBI severity is classified as mild, complicated mild, moderate, or severe
Common cognitive impairments include attention, processing speed, learning and memory, executive function, and social cognition
The prevalence of major and mild TBI varies with injury severity and time since injury
In the US, there are over 2.87 million TBIs annually, including over 837,000 in children
Leading causes of TBI in the US include falls, collisions, motor vehicle crashes, and assaults
Men are more likely to experience TBI than women but women have a higher risk after age 65
The course of recovery from TBI is variable and influenced by various factors
Neurocognitive impairments are most severe in the acute period following TBI, and may be accompanied by emotional and behavioral disturbances
Neurocognitive impairments associated with mild TBI typically resolve within days to weeks after the injury, with complete resolution within 3-12 months
Persistent symptoms after mild TBI should trigger consideration of other potential causes
Neurocognitive impairments and associated functional limitations produced by moderate and severe TBI typically improve over weeks to months after the injury
Risk factors for adverse cognitive outcomes after TBI include age older than 40 years, lower preinjury cognitive abilities, preinjury depressive symptoms, and injury severity
Pre-injury alcohol or substance use disorders increase the risk of sustaining a TBI and the risk of adverse cognitive outcomes
Diagnostic markers for major or mild NCD due to TBI may include contemporaneous computed tomographic or MRI findings, subtle neurological signs, or deficits in saccades and smooth-pursuit eye movements co-occurring with frontally mediated cognitive impairments
Individuals with TBI, including moderate or severe TBI, are at an increased long-term risk for suicide
Rates of suicidal ideation and suicide attempt are as high as 10% and 0.8%–1.7% over the first 20 years after TBI

Substance/Medication-Induced Major or Mild Neurocognitive Disorders

The ICD-10-CM codes for substance/medication-induced major or mild neurocognitive disorders are based on the following criteria:
- The criteria are met for major or mild neurocognitive disorder
- The neurocognitive impairments do not occur exclusively during the course of a delirium
- The involved substance or medication and its use can produce the neurocognitive impairment
- The temporal course of the neurocognitive deficits is consistent with the timing of substance or medication use
- The neurocognitive disorder is not attributable to another medical condition or is not better explained by another mental disorder
For substance-induced major neurocognitive disorder, the clinician should record "mild [substance] use disorder" before the substance-induced major neurocognitive disorder
For alcohol and sedative, hypnotic, or anxiolytic substances, a mild substance use disorder is insufficient to cause a substance-induced major neurocognitive disorder
If a moderate or severe substance use disorder is comorbid with the substance-induced major neurocognitive disorder, the clinician should record "moderate [substance] use disorder" or "severe [substance] use disorder"
If there is no comorbid substance use disorder, the clinician should record only the substance-induced major neurocognitive disorder
The substance/medication-induced neurocognitive disorder (NCD) is a condition characterized by neurocognitive impairments that persist beyond the usual duration of intoxication and acute withdrawal
The ICD-10-CM code corresponds to the applicable drug class
In cases where a substance is judged to be an etiological factor but the specific substance is unknown, the ICD-10-CM code for the other (or unknown) substance class is used
If the substance-induced neurocognitive disorder occurs without a comorbid substance use disorder, no accompanying substance use disorder is noted
Diagnostic features include neurocognitive impairments that persist beyond the usual duration of intoxication and acute withdrawal
The given substance and its use must be known to be capable of causing the observed impairments
The temporal course of the substance-induced NCD must be consistent with that of the given substance
Inhalant-induced neurocognitive disorders (NCDs) are often associated with the smell of the inhalant on an individual's breath or a rash around the individual's nose or mouth
Mild NCD induced by drugs with central nervous system depressant effects may manifest with added symptoms of increased irritability, anxiety, sleep disturbance, and dysphoria
NCD induced by stimulant drugs may manifest with rebound depression, hypersomnia, and apathy
In severe forms of substance/medication-induced major NCD, there may be prominent neuromotor features, such as incoordination, ataxia related to cerebellar damage, and motor slowing
Prevalence of these conditions is not well known
Substance/medication-induced major or mild NCDs are more likely in those who are older, have longer duration of use, and have other risk factors such as nutritional deficits
For alcohol use disorder, the rate of mild NCD is approximately 30%-40% in the first 2 months of abstinence
Major NCD is rare and may result from concomitant nutritional deficits, as in alcohol-induced amnestic-confabulatory NCD
Alcohol-induced major NCD may be more common in men
Development and course of substance use disorders tend to occur during late adolescence and peak in the 20s and 30s
Risk factors for substance/medication-induced NCDs include older age, longer duration of use, and persistent use past age 50 years
Magnetic resonance imaging (MRI) is a diagnostic tool used to identify neurocognitive disorders in individuals with chronic alcohol use disorder
Functional consequences of substance/medication-induced major or mild NCD can be augmented by reduced cognitive efficiency and difficulty concentrating beyond that seen in many other NCDs
Individuals with substance use disorders, substance intoxication, and substance withdrawal are at increased risk for other conditions
Substance use disorders, substance intoxication, and substance withdrawal are highly comorbid with other mental disorders

Major or Mild Neurocognitive Disorder Due to HIV Infection

HIV disease is caused by infection with human immunodeficiency virus type-1 (HIV-1)
HIV infects several types of cells, most particularly CD4 lymphocytes and monocytes
Over time, the infection can cause severe decreases in the CD4 count, resulting in severe immunocompromise
Some individuals with HIV infection develop a neurocognitive disorder (NCD)
HIV infection can lead to major or mild neurocognitive dementia (NCD) in individuals of increasing age, lower education levels, or female sex
The risk of NCD is also increased with prior episodes of immunosuppression, high viral loads in the cerebrospinal fluid, and increased levels of tumor necrosis factor–alpha (TNF-α)### Neurocognitive Disturbances Associated with HIV
One-third to over half of HIV-infected individuals show signs of neurocognitive disturbance.
Most of these disturbances are asymptomatic neurocognitive impairment (ANI).
In North America and Western Europe, ANI accounts for most neurocognitive disturbances in HIV-infected individuals.
Mild neurocognitive disorder (NCD) due to HIV accounts for around 25% of individuals.
Major NCD criteria are met in less than 5% of individuals with HIV-related neurocognitive disturbances.
Women with HIV have a higher rate of neurocognitive impairment compared to men, potentially linked to differences in educational attainment.
The progression of NCD due to HIV can vary:
- Resolve
- Improve
- Remain stable
- Slowly worsen
- Rapidly worsen
- Fluctuate
Rapid progression is uncommon with current treatment but may occur in older individuals or those with specific comorbidities.
Older individuals with HIV are more likely to experience additive and interactive neurocognitive effects of HIV and aging.
More than 50% of individuals with HIV in the US are older than 50 years.
Long-term antiretroviral therapy is indicated for HIV control, but some treatments can contribute to neurocognitive impairment through inflammation, neurotoxicity, and metabolic changes.
Risk and prognostic factors for neurocognitive impairment in HIV include:
- Inadequate HIV control in the central nervous system (CNS)
- Antiretroviral drug-resistant viral strains
- Chronic inflammation
- Comorbid conditions:
  - Aging
  - Substance use disorder
  - Hypertension
  - Diabetes
  - Past CNS trauma
  - Co-infections (e.g., hepatitis C virus)

Neurocognitive Disorder Due to Prion Disease

Prion disease can develop at any age in adults.
The peak age for sporadic Creutzfeldt-Jakob disease (CJD) is approximately 67 years.
Prodromal symptoms of prion disease may include:
- Fatigue
- Anxiety
- Appetite or sleep problems
- Difficulty concentrating
After several weeks, these symptoms may be followed by:
- Incoordination
- Vision changes
- Abnormal gait
- Myoclonic, choreoathetoid, or ballistic movements
- Startle reflex
- Rapidly progressive dementia
The disease typically progresses rapidly to major NCD within 6 months.
Atypical presentations are possible, requiring confirmation through biopsy or autopsy.
Prevalence is unknown but very low due to short survival.
Annual incidence of sporadic CJD is approximately 1-2 cases per million.
Incidence varies with age, being higher in individuals 65 years or older.
Incidence is higher in Whites compared to Blacks.
Genetic mutations in the prion protein gene (PRNP) are present in up to 15% of prion disease cases.
Diagnostic markers for prion disease are confirmed by:
- Brain biopsy
- Autopsy
- Cerebrospinal fluid (CSF) protein analysis (e.g., 14-3-3 and tau)
- Real-time quaking induced conversion (RT-QuIC)
- Magnetic resonance brain imaging with diffusion-weighted imaging (DWI)

Neurocognitive Disorder Probably Due to Parkinson's Disease

Parkinson's disease can lead to cognitive decline, diagnosed as major or mild NCD.
NCD due to Parkinson's disease is diagnosed when:
- The disturbance occurs in the setting of established Parkinson's disease.
- There is insidious onset and gradual progression of impairment.
- The neurocognitive disorder is not due to another medical condition or mental disorder.
If the Parkinson's disease diagnosis precedes the onset of the neurocognitive disorder, the NCD is considered "probably due to Parkinson's disease".
Associated features of NCD due to Parkinson's disease include:
- Apathy
- Depressed mood
- Anxious mood
- Hallucinations
- Delusions
- Personality changes
- Rapid eye movement (REM) sleep behavior disorder
- Excessive daytime sleepiness
- Freezing of gait
- Falls
- Bilateral involvement early in the disease
- Postural instability and gait disturbance (PIGD) subtype
- Hyposmia
Parkinson's disease prevalence increases with age, with higher rates in men than women.
The prevalence of NCD due to Parkinson's disease is higher in men than in women.
Up to 80% of individuals with Parkinson's disease will eventually develop a major NCD.
Mild NCD often develops early in the course of Parkinson's disease.
Risk factors for Parkinson's disease include:
- Exposure to pesticides
- Solvents
- Potentially traumatic brain injury
Risk factors for NCD among individuals with Parkinson's disease include:
- Older age at disease onset
- Increasing severity of disease
- Prominent gait symptoms
- Severe autonomic disturbance (particularly orthostatic hypotension)
- REM sleep behavior disorder
- Male sex
- Fewer years of formal education
- GBA gene mutations
- APOE*E4 genotype
Neuropsychological testing is crucial for detecting cognitive deficits, particularly in the mild NCD phase.
Characteristic features observed on neuropsychological testing include:
- Reduced attention
- Executive dysfunction
- Slowed information processing
- Memory deficits
- Visuospatial function deficits
Dopamine transporter scans (e.g., DaT scans) can differentiate Lewy body-related dementias from non–Lewy body-related dementias.

Neurocognitive Disorder Due to Huntington's Disease and Others

Huntington's disease is a progressive cognitive impairment that typically precedes motor abnormalities.
Definite Huntington's disease diagnosis is made when:
- Unequivocal, extrapyramidal motor abnormalities are present.
- There is a family history of Huntington's disease.
- Genetic testing shows a CAG trinucleotide repeat expansion in the HTT gene.
Associated features of Huntington's disease include:
- Irritability
- Apathy
- Anxiety
- Obsessive-compulsive symptoms
- Depression
- Genetic and physiological psychosis
The worldwide prevalence of Huntington's disease is estimated to be 2.7 per 100,000.
The age at diagnosis varies, but symptoms are most often observed between ages 35 and 45 years.
The disease is gradually progressive with an average survival of 10-20 years after diagnosis.
Phenotypic expression varies based on motor, cognitive, and psychiatric symptoms.
Psychiatric and cognitive abnormalities can predate motor abnormalities by a decade or more.
Initial symptoms requiring care often include:
- Irritability
- Anxiety
- Depressed mood
Other behavioral disturbances may include:
- Pronounced apathy
- Disinhibition
- Impulsivity
- Impaired insight
Early movement symptoms may involve:
- Fidgetiness of the extremities
- Mild apraxia
As the disorder progresses, other motor problems include:
- Impaired gait (ataxia)
- Postural instability
- Impaired speech production (dysarthria)
Advanced motor disease severely affects gait with progressive ataxia, leading to non-ambulatory status.
Huntington's disease has an elevated suicide risk compared to the general population.
Risk factors for suicidal thoughts include:
- Depressive symptoms
- Anxiety
- Irritability
- Psychosis
- Apathy
The most frequent causes of death in Huntington's disease are pneumonia, other infections, and suicide.
Huntington's disease can lead to functional decline in the prodromal phase and at early diagnosis.
Emotional, behavioral, and cognitive aspects of the disease (disinhibition and personality changes) are highly associated with functional decline.
Cognitive deficits contributing to functional decline include:
- Speed of processing
- Initiation
- Attention
Severe choreic movements may interfere with activities like bathing, dressing, and toileting.
Early symptoms of Huntington's disease may resemble other mental disorders, but genetic testing or the development of motor symptoms will differentiate Huntington's disease.
Early symptoms, particularly executive dysfunction and impaired psychomotor speed, may resemble other neurocognitive disorders (NCDs), such as major or mild vascular NCD.
Huntington's disease must be differentiated from other disorders or conditions associated with chorea, such as:
- Wilson's disease
- Drug-induced tardive dyskinesia
- Sydenham's chorea
- Systemic lupus erythematosus
- Senile chorea
Huntington's disease phenocopy is possible, resulting from a variety of potential genetic factors.
Major or mild neurocognitive disorder due to another medical condition can cause neurocognitive disorders other than those specific etiologies already included in prior NCD criteria sets.
These conditions include:
- Structural lesions
- Hypoxia related to hypoperfusion from heart failure
- Endocrine conditions
- Nutritional conditions
- Other infectious conditions
- Immune disorders
- Hepatic or renal failure
- Metabolic conditions
- Other neurological conditions
- Unusual causes of central nervous system injury (e.g., electrical shock, intracranial radiation)
Temporal association between the onset or exacerbation of the medical condition and the development of the cognitive deficit supports the NCD being a pathophysiological consequence of the medical condition.

### Neurocognitive Disorders (NCDs)

NCDs: A group of mental health conditions associated with cognitive or psychological impairment involving higher cortical function.
Progression: The progression of an NCD is usually commensurate with the underlying medical condition. If the medical condition is treatable, the neurocognitive deficit may improve. If the medical condition deteriorates, NCD symptoms will worsen.
Diagnosis: The presence of an attributable medical condition does not rule out the possibility of another etiology of major or mild NCD.
Multiple Etiologies: If cognitive deficits persist even after successful treatment of an associated medical condition, another etiology may be responsible for the cognitive decline.
Coding: In cases of major or mild NCD due to multiple etiologies, code all medical conditions (except vascular disease) followed by F02.81 (behavioral disturbance) or F02.80 (no behavioral disturbance). If vascular disease is present code F01.51 (behavioral disturbance) or F01.50 (no behavioral disturbance).

Clinical Practice Insights

Challenge: NCDs are a significant health challenge with high costs for healthcare systems and informal caregivers.
Differentiation: NCDs can be challenging to differentiate from other risk factors and psychological issues, such as mild cognitive impairment or pseudodementia.
Classification: A clear classification framework is essential for diagnosis, clinical intervention, and therapeutic planning.
Increasing Trend: There is an increasing trend toward the recognition of NCD's importance in clinical practice, research, and public health policy.
Prevalence: Over 200 million people worldwide suffer from NCDs.
Age: The most significant predictor of NCDs is increased age.
Alzheimer's Disease: The most common type of NCD affecting over thirty million individuals worldwide.
Risk Factors: Late-life depression, cerebrovascular disease, low educational attainment, low midlife occupational attainment, and hypertension are risk factors for NCDs.
Symptoms: Alzheimer's disease is characterized by memory loss and cognitive decline, with symptoms typically progressing over time. The person may develop other cognitive and non-cognitive symptoms.
Hallmarks: The main pathological hallmarks of AD are amyloid plaques between nerve cells and neurofibrillary tangles inside the cells.
Early Recognition: Early recognition and treatment of individuals with AD provide the opportunity for appropriate intervention.
Treatment: Treatment is generally supportive, encompassing physical and mental health care.

### Types of Dementia

Vascular Dementia: A major type of NCD, with cerebrovascular incidents being the main cause for elucidating clinical manifestations of neurocognitive disorders.
Frontotemporal Dementia: A less common NCD, accounting for about 15-17% of all dementias. It predominantly affects younger patients (45-65 years of age).

### Treatment Approaches for Neurocognitive Disorders

Pharmacological Treatments: Cholinesterase inhibitors (rivastigmine, galantamine, donepezil) can temporarily stabilize, improve, and decrease symptoms for cognition for 6 to 12 months.
Support Interventions: Non-pharmacological interventions include nonspecific supportive care, management of underlying conditions, monitoring of cognitive performance, and supportive care resolution.
Person-Centered Care: Person-centered care with individualized approaches, including physical touch by staff and family, may be necessary for individuals with dementia.
Medication Adherence: Medication adherence is a challenge for those with dementia.

Non-Pharmacological Interventions

Cognitive Stimulation Therapy, Physical Activity, Social Interaction, and Arts-Based Interventions: These non-pharmacological interventions aim to support cognition and emotional outcomes, or to target the person more holistically.
National Dementia Strategy in the UK: Emphasizes the importance of non-pharmacological interventions.
Meta-Analysis: A recent meta-analysis showed overall improvement in outcomes for people living with ND in the community, their care staff, those living in hospital settings, and in care homes.

### Caregiver Support

Caregiver Burden: Caregiver support is crucial, as the physical and emotional toll of caregiving can be substantial.
Interventions: Respite care services, adult day programs, support groups, and one-on-one caregiver training in stress management and problem-solving.
Caregiver Training: Teaches caregivers strategies to help patients compensate for their disabilities and preserve function.
Well-being: Caregiver well-being is related to many outcomes, including the likelihood of their care recipient being placed in a long-term care facility and their satisfaction with the caregiving role.

### Conclusion

Non-pharmacological interventions and caregiver support are essential for improving the management of neurodegenerative diseases and promoting overall well-being.
Caregiver well-being is crucial due to the demands of patient care, which can put caregivers' personal lives at risk.

Ethical and Legal Considerations in Neurocognitive Disorders

Capacity assessment is crucial in managing patients with neurocognitive disorders.
Informed consent and capacity assessments are essential for ethical and legal reasons.
Autonomy, beneficence, nonmalfeasance, justice, and informed consent are key ethical principles in clinical decision-making.
Surrogate decision-makers, often family members, play a significant role in care decisions.
Advance directives are legal and medical instruments that outline patient preferences for end-of-life care.
Caregiver well-being is essential for successful patient care and caregiver well-being.

End-of-Life Care Management in Dementia

End-of-life care management is a significant concern in dementia care.
Patients' rights to refuse or consent to medical treatments are evolving as laws vary between states.
Legal guardianship may be necessary for specific exams or treatments.
Patients have the right to contest their designation as a ward and to regain capacity.

Decision-Making Capacity in Dementia

Decision-making capacity can fluctuate in dementia patients.
Capacity assessment involves evaluating a patient's ability to understand, appreciate, reason, and express choices regarding treatment.
Factors affecting cognitive capacity include active mental disorders, cognitive reserve, intoxication, delirium, dementia, physical illnesses, and medication side effects.
Substitute decision-makers are sought when patients lack sufficient decision-making capacity.
Ethical considerations guide consent confirmation and decision-making by support workers and caregivers.

Neurocognitive Disorders Research

Neurocognitive disorders research is marked by slow progress but technological advances are expected to improve the field.
Six areas of research focus include molecular and cellular biology, gene therapy, precision medicine, biomarker research, dementia research, and big data applications.
Precision medicine offers personalized treatment strategies using genetic information, but ethical considerations related to access, privacy, and potential misuse exist.
Emerging therapies and technologies include pharmacological treatments, psychoeducation, digital technologies, telehealth, non-invasive brain stimulation, exercise, nutrition, alternative and complementary medicine, and blended modalities.

Importance of Clinical Practice Evolution

Clinical practice must evolve with research evidence to ensure access to the latest treatments and technologies for people with neurocognitive disorders.
Precision medicine approaches for neurocognitive disorders (NCDs) could offer personalized treatment strategies.
Ethical considerations regarding access to genetic testing, privacy of genetic information, and potential misuse are significant in precision medicine for NCDs.
Further research is needed to develop pragmatic tools and frameworks for the practical application of precision medicine in NCDs.

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Explore the characteristics and diagnostic criteria of Neurocognitive Disorders (NCDs), including Major and Mild Neurocognitive Disorders, as per DSM-5 standards. This quiz covers the etiology, risk factors, and practical examples of cognitive impairments in daily activities related to NCDs.

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Questions and Answers

Which statement accurately describes neurocognitive disorders (NCDs)?

How does the DSM-5 differentiate major neurocognitive disorder from dementia?

What is a significant characteristic of mild neurocognitive disorder?

Which of the following best encapsulates the diagnostic criteria for neurocognitive disorders?

In the context of comorbidity, what is a common relationship observed among neurocognitive disorders?

What is a key example of decision-making ability in everyday activities related to neurocognitive disorders?

Which of the following cognitive domains is typically evaluated for symptoms of neurocognitive disorders?

What distinguishes major neurocognitive disorders from other cognitive impairments according to the DSM-5?

What is a significant feature of major neurocognitive disorders regarding recent memory?

Which of the following cognitive functions is often preserved in severe major neurocognitive disorders?

Which of the following tasks assesses visual perception in neurocognitive disorders?

Which age group has been identified as having the highest susceptibility to delirium?

In the context of neurocognitive disorders, what is considered a hallmark of expressive language difficulties?

What symptom is typically more associated with male patients experiencing delirium?

What distinguishes major delirium from mild delirium?

In diagnosing substance intoxication delirium, what factor is considered when recording ICD-10-CM codes?

Which type of delirium is characterized by vivid hallucinations and agitation?

What is a key characteristic of unspecified delirium?

Which of the following is a cognitive function that major neurocognitive disorders may impair?

What diagnostic feature distinguishes between major neurocognitive disorder and delirium?

What characterizes mild neurocognitive disorders in terms of word-finding difficulties?

Which cognitive ability is least likely to be preserved in severe major neurocognitive disorders?

Which of the following is NOT a diagnostic criterion for mild neurocognitive disorder?

What condition is characterized by fully dependent functioning in daily activities?

What aspect of cognitive function is particularly assessed through praxis tasks?

Which area of cognitive function often shows difficulties in both major and mild neurocognitive disorders?

In what context is coding for unspecified mild neurocognitive disorder used?

Which neurocognitive disorder is specifically associated with behavioral disturbances?

Which of the following best describes substance withdrawal delirium?

What is the primary focus of management when delirium and major neurocognitive disorder are comorbid?

What is a common misconception about cognitive difficulties in major neurocognitive disorders?

Which coding category is pertinent when symptom criteria of delirium are present but do not fully meet delirium criteria?

Which condition may mimic symptoms of major neurocognitive disorders but arises due to substance use?

Which factor does NOT interact with sex-related risks for delirium?

Which statement about anticholinergic use related to delirium is accurate?

What character should be recorded if there is no comorbid substance use disorder present?

Which coding applies specifically for opioid-induced delirium when taken as prescribed?

In what situation should 'delirium due to another medical condition' be coded?

Which of the following is NOT a characteristic of delirium?

What can characterize the emotional disturbances seen in individuals with delirium?

What is a common risk factor for developing delirium in older adults?

Which is a potential outcome if delirium goes undetected and untreated?

During what time of day do symptoms of delirium often worsen?

What underlying condition is delirium commonly associated with?

Which diagnostic code is used when the specific substance causing delirium is unknown?

What percentage of hospitalized individuals with delirium may die within one year after diagnosis?

How long does delirium typically last in hospital settings?

Which symptom is typically NOT associated with delirium?

Which groups are at higher risk for delirium?

In terms of prevalence, what is the rate of delirium in older individuals postoperatively?

What major behavioral symptom is particularly observed in NCD due to Alzheimer’s disease?

Which symptom is most commonly associated with visual hallucinations in neurocognitive disorders?

What characterizes the cognitive decline in major NCD as opposed to mild NCD?

How is the performance of cognitive testing typically defined for mild NCD?

Which of the following domains is not typically impaired in neurocognitive disorders?

What is the prevalence estimate for dementia at age 85 years?

In which phase of neurocognitive disorders is depression most likely to occur?

How should multiple behavioral disturbances in NCD be noted?

What defines the level of independence in individuals with mild NCD?

Which demographic may show the highest incidence of NCD based on U.S. studies?

What is a common symptom that can create a need for clinical attention in NCD?

What is the key feature for diagnosing a psychotic disorder due to neurocognitive conditions?

What is a primary consideration when classifying NCD based on the spectrum of cognitive decline?

Which factor is considered the strongest risk factor for both major and mild neurocognitive disorders (NCDs)?

Which group is reported to have a higher risk for vascular dementia in the United States?

What role does cultural awareness play in the recognition of neurocognitive symptoms?

In individuals undergoing neuropsychological assessment, which demographic factor is mentioned to potentially limit the applicability of testing norms?

Which of the following symptoms is more frequently expressed by women with major neurocognitive disorders compared to men?

What is a common challenge when differentiating between mild neurocognitive disorder and major depressive disorder?

What type of assessment may be key in detecting mild neurocognitive disorder?

What complicates the diagnosis or treatment of neurocognitive disorders in older individuals?

Which statement regarding neurocognitive symptoms at the mild level is accurate?

What is a noted impact of diagnostic markers such as neuroimaging studies?

What characterizes the cognitive deficits indicative of Alzheimer's disease?

Which of the following disorders can complicate the diagnosis of neurocognitive disorders due to their similar presenting symptoms?

What impact does educational attainment have on the likelihood of developing neurocognitive disorders?