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NEUROCOGNITIVE DISORDER DUE TO ALZHEIMER'S DISEASE
 

Prediction: Chronic, Progressive

      Occupational-Economic:
  • Prevents employment
  • Eventually needs total nursing care
      Wisdom vs Irrationality:
  • Progressive cognitive deterioration (memory, learning, executive functioning, language)
  • Delusions, hallucinations
      Courage vs Negative Emotion:
  • Anxiety, depression, anger
      Helping Others vs Detachment:
  • Social withdrawal
      Self-Control vs Disinhibition:
  • Impulsivity, dangerous risk taking, agitation
      Justice vs Antagonism::
  • Disrespectful, irresponsible, violent
      Medical:
  • Denial of illness; presence of causative genes (detected by commercial testing); signs of neuronal injury (hippocampal and temporoparietal cortical atrophy on MRI; temporoparietal hypometabolism on a fluorodeoxyglucose PET scan, elevated total tau and phospho-tau levels in CSF)

SYNOPSIS

Dementia in Alzheimer Disease F00 - ICD10 Description, World Health Organization
Dementia is a syndrome due to disease of the brain, usually of a chronic or progressive nature, in which there is disturbance of multiple higher cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement. Consciousness is not clouded. The impairments of cognitive function are commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behaviour, or motivation.

Alzheimer disease is a primary degenerative cerebral disease of unknown etiology with characteristic neuropathological and neurochemical features. The disorder is usually insidious in onset and develops slowly but steadily over a period of several years.

    F00.0 Dementia in Alzheimer disease with early onset

    Dementia in Alzheimer disease with onset before the age of 65, with a relatively rapid deteriorating course and with marked multiple disorders of the higher cortical functions.

    F00.1 Dementia in Alzheimer disease with late onset

    Dementia in Alzheimer disease with onset after the age of 65, usually in the late 70s or thereafter, with a slow progression, and with memory impairment as the principal feature.
Neurocognitive Disorder Due To Alzheimer's Disease - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with neurocognitive disorder due to Alzheimer's disease needs to meet all of the following criteria:

  • The criteria are met for major or mild neurocognitive disorder:

    • Major Neurocognitive Disorder

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

      • Concern of the individual, a knowledgeable informant, or the clinician that there has been a significant decline in cognitive function; and

      • A substantial impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment.

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

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

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

    • Mild Neurocognitive Disorder

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

      • Concern of the individual, a knowledgeable informant, or the clinician that there has been a mild decline in cognitive function; and

      • A modest impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment.

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

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

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

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

  • Criteria are met for either probable or possible Alzheimer's disease as follows:

    • For major neurocognitive disorder:

      Probable Alzheimer's disease
      is diagnosed if either of the following is present; otherwise, possible Alzheimer's disease should be diagnosed:

      • Evidence of a causative Alzheimer's disease genetic mutation from family history or genetic testing.

      • All three of the following are present:

        • Clear evidence of decline in memory and learning and at least one other cognitive domain (based on detailed history or serial neuropsychological testing).

        • Steadily progressive, gradual decline in cognition, without extended plateaus.

        • No evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease, or another neurological, mental, or systemic disease or condition likely contributing to cognitive decline).

    • For mild neurocognitive disorder:

      • Probable Alzheimer's disease is diagnosed if there is evidence of a causative Alzheimer's disease genetic mutation from either genetic testing or family history.

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

        • Clear evidence of decline in memory and learning.

        • Steady progressive, gradual decline in cognitiion, without extended plateaus.

        • No evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease, or another neurological or systemic disease or condition likely contributing to cognitive decline).

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

This disorder shows cognitive decline from a previous level of performance in one or more cognitive domains of higher cortical functioning:
  • learning and memory
  • complex attention
  • executive function (e.g., impaired planning, organizing, sequencing, abstracting)
  • language (e.g., aphasia)
  • perceptual-motor (e.g., agnosia [failure to recognize or identify objects despite intact sensory function], or apraxia [impaired ability to carry out motor activities despite intact motor function])
  • social cognition
This disorder is not due to any of the following:
  • other central nervous system conditions that cause progressive deficits in memory and cognition (e.g., cerebrovascular disease, Parkinson's disease, Huntington's disease, subdural hematoma, normal-pressure hydrocephalus, brain tumor)
  • systemic conditions that are known to cause dementia (e.g., hypothyroidism, vitamin B or folic acid deficiency, niacin deficiency, hypercalcemia, neurosyphilis, HIV infection)
  • substance-induced conditions (e.g., alcoholism)
  • other mental disorder (e.g., major depressive episode, schizophrenia)
Unfortunately, individuals with this neurocognitive disorder have a deteriorating course over 8 to 10 years, with a median life expectancy following diagnosis of 5 to 6 years. These cognitive deficits cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning. Unlike vascular neurocognitive disorder, this disorder has a gradual onset and progression, and lacks evidence indicative of cerebrovascular disease (e.g., focal neurological signs or radiological findings of multiple infarctions involving cortex and underlying white matter).

Early Detection Before Symptoms Develop

A new blood test, published in the journal Nature Medicine, can predict with 90% accuracy whether people will go on to develop mild cognitive impairment or Alzheimer's within three years. This new blood test would allow treatment for Alzheimer's at an earlier asymptomatic stage - when therapy would be more effective at slowing or preventing onset of symptoms. This blood test measures 10 molecules that reveal the breakdown of neural cell membranes in participants who later develop symptoms of cognitive impairment or Alzheimer's Disease.

Alzheimer's Disease CAT scan


Effective Therapies

Only 3 medications have been proven to slow the progression of this disorder (the cholinesterase inhibitors donepezil, galantamine and rivastigmine). With elderly demented individuals, atypical antipsychotic medications significantly increase mortality; thus they should only be used to treat aggressive or psychotic demented patients when there is severe distress or risk of physical harm to those living and working with the patient. Psychosocial interventions (supervised day activity programs, nursing home/extended care placement, disability pensions or government financial aid) and caregiver support are key to managing this disorder. Caregiver support groups are very beneficial to caregivers.

Ineffective Therapies

Cognitive training and cognitive rehabilitation haven't been shown to be effective.

Which Behavioral Dimensions Are Involved?

The ancient Greek civilization lasted for 1,300 years (8th century BC to 6th century AD). The ancient Greek philosophers taught that the 5 pillars of their civilization were: wisdom, courage, helping others, self-control, and justice. Psychiatry named the opposite of each of these 5 ancient themes as being a major dimension of psychopathology (i.e., irrationality, negative emotion, detachment, disinhibition, and antagonism). (Psychology named these same factors the "Big 5 dimensions of personality": "intellect", "neuroticism", "extraversion", "conscientiousness", and "agreeableness")

    Neurocognitive Disorder Due To Alzheimer's Disease: Irrationality
            Wisdom vs Irrationality:
      • Progressive cognitive deterioration (memory, learning, executive functioning, language)
      • Delusions, hallucinations
            Courage vs Negative Emotion:
      • Anxiety, depression, anger
            Helping Others vs Detachment:
      • Social withdrawal
            Self-Control vs Disinhibition:
      • Impulsivity, dangerous risk taking, agitation
            Justice vs Antagonism::
      • Disrespectful, irresponsible, violent

Description

Stories

Rating Scales

    Peanut Butter Test

    This screening test involves having a subject shut their eyes, cap one nostril and then someone else measuring the distance at which the subject can inhale and detect about a tablespoon of peanut butter (which was slowly moved up a ruler as the subject exhaled). In Alzheimer's patients, the left nostril is impaired so thoroughly that, on average, it has 10 centimeters less range than the right, in terms of odor detection. This asymmetry in odor detection is specific to Alzheimer's patients; neither control patients (those not suffering from cognitive decline) nor those with other types of cognitive impairment (like dementia) demonstrate this nostril difference. Caution: this test has not been fully confirmed by other researchers.

  • Self-Administered Gerocognitive Exam (SAGE) - designed to detect early signs of cognitive, memory or thinking impairments.

  • Neurocognitive Disorder Due To Alzheimer's Disease Rating Scales - Google Scholar

Treatment

Medical

Research

Other Web Pages

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