Notes problem 5
Focus on neurocognitive disorder/ dementia and Korsakoff/ amnestic disorder and delirium not on
traumatic brain injury.
Neurocognitive disorders: Neurocognitive disorder is a general term that describes decreased mental
function, especially in the executive control areas, due to a medical disease other than a psychiatric
illness
To put it simply, dementia is not a disease in its own right. Dementia is the name for a group of
symptoms that commonly include problems with memory, thinking, problem solving, language and
perception. Dementia is caused by different diseases that affect the brain. Alzheimer's disease is the
most common.
Cognitive impairments
o Learning and memory
Inability to learn new information or to remember it.
Anterograde amnesia: memory loss acquired after the onset of amnesia.
(hippocampus and medial temporal lobes, basal forebrain)
Retrograde amnesia: inability to recall events that occurred before the onset
of amnesia. (hippocampus, temporal lobe)
Forgetfulness is likely to become a full-blown inability to recall events.
o Attention and arousal
Early signs:
Lack of attention.
Easily distracted.
Well learnt activities are performed slower. (apraxia, parietal lobe
left hemisphere. )
o Language
Rambling.
Difficulty reading and understanding the speech of others.
Aphasia speech disorders resulting in difficulties producing or
comprehending speech Broca’s and Wernicke’s area.
Fluent aphasia: the production of incoherent, jumbled speech.
Non-fluent aphasia: inability to initiate speech or respond to speech
with anything but simple words.
o Visual-perceptual functioning
, Agnosia: loss of ability to recognize objects, persons, sounds, shapes and/or
smells while the specific sense is not defective and there is no significant
memory loss someone people lose smell or/and taste due to covid is this
agnosia too?
o Motor skills
Apraxia loss of the ability to execute or carry out learnt movements,
despite having the desire and the physical ability to perform the movements.
o Executive functions
Prefrontal cortex damaged.
Wisconsin card sorting task: sorting cards following a specific rule and then
another specific rule.
Consequences:
Poor judgement.
Inappropriate behaviour.
Erratic mood swings.
o Higher order intellectual functioning
Impairment in more abstract tasks simple calculations, reason deductively
draw on general knowledge when undertaking a task or activity.
- Clinical assessment
o Important for:
Determining the actual nature of the deficit and its location.
Providing information about onset, type, severity and progression of
symptoms.
Discriminate between neurological deficits that have an organic base and
psychiatric symptoms that do not.
Identify the focus for rehabilitation.
o Done with:
EEG, PET scans, fMRI, blood tests and chemical analysis of cerebrospinal
fluids.
o First a test is used to establish what areas may be damaged and then these areas are
looked at with other means such as an fMRI scan.
- Diagnosis
o Difficulties
Deficits found in neurocognitive disorders often closely resemble those of
other psychopathologies.
Focus on neurocognitive disorder/ dementia and Korsakoff/ amnestic disorder and delirium not on
traumatic brain injury.
Neurocognitive disorders: Neurocognitive disorder is a general term that describes decreased mental
function, especially in the executive control areas, due to a medical disease other than a psychiatric
illness
To put it simply, dementia is not a disease in its own right. Dementia is the name for a group of
symptoms that commonly include problems with memory, thinking, problem solving, language and
perception. Dementia is caused by different diseases that affect the brain. Alzheimer's disease is the
most common.
Cognitive impairments
o Learning and memory
Inability to learn new information or to remember it.
Anterograde amnesia: memory loss acquired after the onset of amnesia.
(hippocampus and medial temporal lobes, basal forebrain)
Retrograde amnesia: inability to recall events that occurred before the onset
of amnesia. (hippocampus, temporal lobe)
Forgetfulness is likely to become a full-blown inability to recall events.
o Attention and arousal
Early signs:
Lack of attention.
Easily distracted.
Well learnt activities are performed slower. (apraxia, parietal lobe
left hemisphere. )
o Language
Rambling.
Difficulty reading and understanding the speech of others.
Aphasia speech disorders resulting in difficulties producing or
comprehending speech Broca’s and Wernicke’s area.
Fluent aphasia: the production of incoherent, jumbled speech.
Non-fluent aphasia: inability to initiate speech or respond to speech
with anything but simple words.
o Visual-perceptual functioning
, Agnosia: loss of ability to recognize objects, persons, sounds, shapes and/or
smells while the specific sense is not defective and there is no significant
memory loss someone people lose smell or/and taste due to covid is this
agnosia too?
o Motor skills
Apraxia loss of the ability to execute or carry out learnt movements,
despite having the desire and the physical ability to perform the movements.
o Executive functions
Prefrontal cortex damaged.
Wisconsin card sorting task: sorting cards following a specific rule and then
another specific rule.
Consequences:
Poor judgement.
Inappropriate behaviour.
Erratic mood swings.
o Higher order intellectual functioning
Impairment in more abstract tasks simple calculations, reason deductively
draw on general knowledge when undertaking a task or activity.
- Clinical assessment
o Important for:
Determining the actual nature of the deficit and its location.
Providing information about onset, type, severity and progression of
symptoms.
Discriminate between neurological deficits that have an organic base and
psychiatric symptoms that do not.
Identify the focus for rehabilitation.
o Done with:
EEG, PET scans, fMRI, blood tests and chemical analysis of cerebrospinal
fluids.
o First a test is used to establish what areas may be damaged and then these areas are
looked at with other means such as an fMRI scan.
- Diagnosis
o Difficulties
Deficits found in neurocognitive disorders often closely resemble those of
other psychopathologies.
