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Neurocognitive Disorders

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Problem-based Behavioral Science and Psychiatry

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Abstract

We hope you are continuing to enjoy learning about the different categories of psychiatric diagnoses! This chapter covers neurocognitive disorders (NCDs) that affect medically vulnerable and elderly patients and that highlight the close connection between body, brain, and behavior.

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Author information

Authors and Affiliations

  1. Department of Psychiatry, University of Hawai‘i John A. Burns School of Medicine, 1356 Lusitana Street, University Tower 4th Floor, 96813, Honolulu, HI, USA

    June C. Lee D.O. & Junji Takeshita M.D.

  2. VA Pacific Islands Healthcare System, 459 Patterson Road, 96819, Honolulu, HI, USA

    Russ S. Muramatsu M.D.

Authors
  1. June C. Lee D.O.
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  2. Russ S. Muramatsu M.D.
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  3. Junji Takeshita M.D.
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Corresponding author

Correspondence to June C. Lee D.O. .

Editor information

Editors and Affiliations

  1. John A. Burns School of Medicine, University of Hawaiʻi, HONOLULU, Hawaii, USA

    Daniel Alicata

  2. School of Medicine, University of Nevada, Reno, Nevada, USA

    Negar Jacobs

  3. John A. Burns School of Medicine, University of Hawaiʻi, HONOLULU, Hawaii, USA

    Anthony Guerrero

  4. School of Medicine, University of Nevada, RENO, Nevada, USA

    Melissa Piasecki

Appendices

Appendix A: Tables with Possible Answers to the Vignettes

Case Vignette 25.1: Presenting Situation Eli Thompson

Learning Issue Table 25.1.1

Facts

Hypotheses

Information needed

Learning issues

76–year-old man with hypertension and diabetes

Depressive disorders

Obtain history from patient, family, and caregivers

What are the different presentations of normal memory, normal age-related decline, mild neurocognitive disorder, and MNCD? (See Table 25.2)

Behavior and memory changes (forgets name of grandchildren and medications)

MNCDs

Identify baseline level of cognition and functioning

 

Death of his wife a year ago

Mild neurocognitive disorders

  

Retirement 2 years ago

Normal aging

  
 

Delirium

  
  1. MNCD major neurocognitive disorder

Learning Issue Table 25.1.2

Facts

Hypotheses

Information needed

Learning issues

Alcohol use history

Major neurocognitive disorders

Cognitive testing

What are the differentiating factors between depression, MNCD, and delirium? (see Table 25.3)

No history of depression

Depression

Laboratory testing (CBC, BMP, RPR, vitamin B12, folate, TSH)

What are the potential etiologies of MNCD? (See Table 25.4)

No illicit drug use

Delirium

Imaging of the brain (non-contrast CT of the brain)

 

Taking antihypertensive and oral hypoglycemic medication

Alcohol intoxication or withdrawal delirium

  

No family history of neurocognitive disorders

   

No movement problems, falls, or hallucinations

   

Sleep problems

   

No depressive symptoms

   
  1. BMP basic metabolic panel, CT computed tomography, MNCD major neurocognitive disorder

Learning Issue Table 25.1.3

Facts

Hypotheses

Information needed

Learning issues

MMSE score 26/30

MNCD due to Alzheimer’s disease

Neuropsychological testing

What are the standard laboratory and imaging tests for MNCD? (See Table 25.5)

Clock-Drawing Test was normal

Major frontotemporal neurocognitive disorder

 

What is the MMSE and Clock-Drawing Test?

Lab results normal

Major vascular neurocognitive disorder

  

Heavy-metal screening normal

   

Non-contrast CT scan of the brain significant for mild cortical atrophy and periventricular white matter changes

   
  1. CT computed tomography, MMSE Mini Mental State Examination, MNCD major neurocognitive disorder

Learning Issue Table 25.1.4

Facts

Hypotheses

Information needed

Learning issues

Hip fracture after fall

Acute delirium due to alcohol withdrawal, pain medications, or surgery

Medication list

What are the common causes of delirium? (See Table 25.6)

Disorientation, delusions, and hallucinations

 

Laboratory testing (CBC, BMP, urinalysis, urine toxicology screen)

What is the treatment of delirium?

Severe agitation and combativeness with staff

   

Antipsychotic medication used for agitation

   

Learning Issue Table 25.1.5

Facts

Hypotheses

Information needed

Learning issues

MMSE score was 23/30

Depression

Response to SSRI medication (repeat GDS)

What is the GDS?

Irritability with staff and family

Major neurocognitive disorder

 

What is the treatment for geriatric depression?

GDS scored 9 out of 15 points

Delirium

  

SSRI prescribed for depression

   
  1. SSRI selective serotonin reuptake inhibitor, GDS Geriatric Depression Scale, MMSE Mini Mental State Examination

Learning Issue Table 25.1.6

Facts

Hypotheses

Information needed

Learning issues

Mr. Thompson living in an assisted living facility

Major neurocognitive disorder due to Alzheimer’s disease

Obtain more information on functional status

What is the pathophysiology of Alzheimer’s disease?

MMSE score was 20/30

  

What are the stages of Alzheimer’s disease? (See Table 25.7)

  1. MMSE Mini Mental State Examination

Appendix B: Answers to Review Questions

Answers:

  1. 1.

    C

  2. 2.

    C

  3. 3.

    A

  4. 4.

    E

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Lee, J., Muramatsu, R., Takeshita, J. (2016). Neurocognitive Disorders. In: Alicata, D., Jacobs, N., Guerrero, A., Piasecki, M. (eds) Problem-based Behavioral Science and Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-319-23669-8_25

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  • DOI: https://doi.org/10.1007/978-3-319-23669-8_25

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-23668-1

  • Online ISBN: 978-3-319-23669-8

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