Neurocognitive Disorders – Dr. Mascolo
“Dementia is life-shortening; Delirium is life-threatening”
Delirium ("deviate from the furrow")
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DSM-5: Disturbance in
1. Attention (e.g., focus, shift) & Awareness (orientation to environment)
2. Additional disturbance in cognition (e.g., memory deficit, disorientation,
language)
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Typically: Acute onset (hours to days), fluctuating severity
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Clinical issue: immediate medical intervention!
Dementia ("out of one's mind") Now Major/Mild Neurocognitive Disorder
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DSM-5: Significant cognitive decline in at least one cognitive domain:
1. Learning & Memory
2. Language (aphasia):
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Expressive (“Broca’s Aphasia”) e.g., anomia, circumlocution
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Receptive (“Wernicke’s Aphasia”)
3. Perceptual/Motor
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apraxia (problems with purposeful movements)
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agnosia (“lack of knowledge”)
4. Social Cognition, e.g., “Theory of Mind” – (ugh)
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Subtypes -- e.g.:
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Alzheimer's Disease (6th leading cause of death)
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Vascular Disease
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Parkinson's Disease
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Huntington's Disease (Chorea)
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Substance/Medication-Induced (usually ETOH)
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Traumatic Brain Injury
Insidious onset -- initially "explained away"
Differential Dx:
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Pseudodementia (Major Depression)
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Amnestic Disorder - pure memory loss
Clinical issues: pt management, family support
Neurocognitive Disorders – Dr. Mascolo
Traumatic Brain Injury
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Traditional medical treatment includes:
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Drug Therapy:
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blood thickeners/thinners
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anxiolytics
Decrease Blood Pressure (via fluid restriction) to minimize swelling &
pressure
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Passively wait for nature to take its course (“all we can do now is wait”)
Pioneering medical treatment is 180o opposite:
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Actively monitor Intracranial Pressure (ICP)
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Drain CSF to make room for swelling/bleeding
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Raise blood pressure to force blood flow through constricted cerebral arteries
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Empirically Validated
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should be “Standards of Practice”
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instead finessed as “Guidelines”