Other Neurocognitive Disorders

Other Neurocognitive Disorders - Cognitive Conundrums & Acute Alarms

• Delirium: Acute, fluctuating syndrome of disturbed consciousness, attention, and cognition. A medical emergency.
  • 📌 Causes (I WATCH DEATH): Infection, Withdrawal, Acute metabolic, Trauma, CNS pathology, Hypoxia, Deficiencies, Endocrinopathies, Acute vascular, Toxins/Drugs, Heavy metals.

Other Neurocognitive Disorders - Brain Blood Blockades

• Vascular Neurocognitive Disorder (VaD): Cognitive loss from cerebrovascular disease (CVD).
  • Types: Multi-infarct, strategic infarct, subcortical (Binswanger's), mixed (VaD+AD).
• Clinical Features:
  • Onset: Abrupt, stepwise (multi-infarct) OR gradual (subcortical).
  • Focal neurological signs present.
  • Executive dysfunction, slow processing prominent.
  • Mood: Depression, apathy common.
• Risk Factors:
  • HTN, DM, dyslipidemia, smoking, AF, prior stroke/TIA.
• Diagnosis:
  • Clinical + CVD evidence (history, signs).
  • Neuroimaging: MRI/CT shows infarcts, leukoaraiosis.
  • Hachinski Score > 7 supportive.
• Management:
  • Control vascular risk factors.

⭐ Stepwise decline classic for multi-infarct; subcortical VaD often gradual with executive dysfunction.

Other Neurocognitive Disorders - Protein Problems & Parkinson's Plus

• Alpha-synucleinopathies (LBD & PDD): Characterized by Lewy body pathology.

• Dementia with Lewy Bodies (LBD)

  • Core (📌 Foul Play Has Rules):
    • Fluctuating cognition (attention/alertness)
    • Parkinsonism (spontaneous: bradykinesia, rest tremor, rigidity)
    • Hallucinations (recurrent visual)
    • REM sleep behavior disorder (RBD)
  • Supportive: Severe neuroleptic sensitivity, repeated falls, syncope, autonomic dysfunction.

• Parkinson's Disease Dementia (PDD)

  • Dementia developing in established Parkinson's Disease.

• Other Parkinson's Plus Syndromes:
  • PSP: Vertical gaze palsy, postural instability.
  • MSA: Autonomic failure, cerebellar signs, parkinsonism.
  • CBD: Asymmetric apraxia, alien limb.

Other Neurocognitive Disorders - Frontal Flips & Rare Riddles

• Frontotemporal Dementia (FTD): Progressive neurodegeneration of frontal and/or temporal lobes.
  • Behavioral Variant (bvFTD): Early personality/behavioral changes (disinhibition, apathy, stereotypies), executive dysfunction. Memory relatively spared initially.

    ⭐ Behavioral variant FTD (bvFTD) often presents with early personality changes and executive dysfunction, with memory relatively spared initially.

  • Primary Progressive Aphasia (PPA): Language-led dementias.
    • Semantic Variant (svPPA/SD): Loss of word meaning, anomia, impaired object knowledge.
    • Nonfluent/Agrammatic Variant (nfvPPA/PNFA): Speech apraxia, agrammatism, effortful speech.
• Creutzfeldt-Jakob Disease (CJD): Rapidly progressive dementia, myoclonus, ataxia. Prion disease; 14-3-3 protein in CSF.
• Huntington's Disease: Subcortical dementia, chorea, psychiatric symptoms. Autosomal dominant, CAG repeat.
• HIV-Associated Neurocognitive Disorder (HAND): Cognitive, motor, behavioral symptoms in HIV infection. Spectrum from asymptomatic impairment to dementia.

High-Yield Points - ⚡ Biggest Takeaways

• Amnestic NCD: Anterograde amnesia is key; often from thiamine deficiency (Wernicke-Korsakoff) or hypoxia.
• Delirium: Acute onset, fluctuating consciousness, and inattention distinguish from dementia.
• NCD due to TBI: Severity linked to LOC duration; post-concussive symptoms are frequent.
• Substance-Induced NCD: Commonly from alcohol/sedatives; reversibility is possible.
• NCD due to HIV: Features subcortical dementia with motor slowing and apathy.
• CJD: Rapid dementia, myoclonus, characteristic EEG/CSF (14-3-3 protein).
• NPH: Triad: gait apraxia, cognitive decline, urinary incontinence; potentially reversible.