Neurocognitive Disorders (Mild and Major)

Definition

At one time, all neurocognitive disorders were lumped together under the classification of dementia, because they involve similar cognitive impairments and decline, and most often affect the elderly. Although Alzheimer's disease accounts for the majority of cases of neurocognitive disorders, there are actually a total of nine medical conditions that similarly affect mental functions such as memory, thinking, and the ability to reason. Some also affect the motor system. In addition to Alzheimer's, these include frontotemporal degeneration, Huntington’s disease, Lewy body disease, traumatic brain injury (TBI), Parkinson’s disease, prion disease, and dementia/neurocognitive issues due to HIV infection. These neurocognitive disorders are categorized and diagnosed as either mild or major in nature, depending on the severity of symptoms. Some, such as TBI and HIV, can typically affect younger as well as older people. Mild neurocognitive disorder is also called slight cognitive impairment, while major neurocognitive disorder is generally considered full-out dementia.

Symptoms

The mental and behavioral symptoms of the nine recognized neurocognitive disorders are the same or similar, whether they are mild or major. They include a decline in thinking skills, such as the ability to plan, make a decision, focus on a task, remember the names of objects and people, perform daily tasks, and speak and behave in socially accepted ways. When there is only a slight decline in one or more of these functions, the disorder is mild. When there is a severe decline in one or more of the same functions, the disorder is considered major. Where someone falls on the spectrum of neurocognitive impairment is often measured by the degree to which the condition affects a patient's level of independence. In both mild and major neurocognitive disorders, the decline is enough to attract the attention of loved ones or health-care providers, and the disorder can be confirmed through testing.

Causes

Neurocognitive disorders are acquired conditions that represent underlying brain pathology that results in a decline in faculties; they are not developmental conditions. They are caused by brain damage in areas that affect learning and memory, planning and decision making, the ability to correctly use and understand language, hand-eye coordination, and the ability to act within social norms, such as dressing appropriately for the weather or occasion, showing empathy, and performing routine tasks. To be diagnosed as a neurocognitive disorder, the symptoms must be associated with a medical condition, not another mental health problem, and there can be no evidence of delirium, a separate, temporary disorder with similar symptoms.

Treatments

When a major or mild neurocognitive disorder is suspected, testing can be performed by a neuropsychologist, and the condition can be diagnosed by a neurologist or geriatric psychiatrist. Antidepressants and medications that treat memory loss and other symptoms are available. Ongoing psychotherapy and psychosocial support for patients and families are usually necessary for clear understanding and proper management of the disorder and to maintain a better quality of life for everyone involved.

References

Simpson JR. DSM-5 and Neurocognitive Disorders. The Journal of the American Academy of Psychiatry and the Law. June 2014;42(2):159-164.

Hugo J, Ganguli M. Dementia and Cognitive Impairment. Clinics in Geriatric Medicine. August 2014;30(3):421-442.

Understanding Mental Disorders. Dementia and Other Memory Problems. 2015; American Psychiatric Association.

Last reviewed 10/05/2017