Mild Neurocognitive Disorder

Is Mild Neurocognitive Disorder Different from Normal Aging?

• American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
• Aging And Dementia. (2015, October 11). Retrieved November 18, 2015, from http://www.alzheimerstreatment.space/2015/10/11/aging-and-dementia/
• Attix, Deborah K., and Kathleen A. Welsh-Bohmer.(2006). Geriatric Neuropsychology: Assessment and Intervention. New York: Guilford, Print.
• Baylor Scott & White Health (2014). Mild Neurocognitive Disorder. Retreived from: http://www.sw.org/HealthLibrary?page=Mild%20Neurocognitive%20Disorder.
• Blazer, D. G. & Steffens, D. C. (2009). The American Psychiatric Publishing textbook of geriatric psychiatry. Washington, DC: American Psychiatric Pub.
• Demant, K.M., Almer, G.M., Vinberg, M., Kessing, L.V., & Miskowiak, K.W. (2013). Effects of cognitive remediation on cognitive dysfunction in partially or fully remitted patients with bipolar disorder: Study protocol for a randomized controlled trial. Trials, 14, 338.
• Ganguli, M., Blacker, D., Blazer, D. G., Grant, I., Jeste, D. V., Paulsen, J. S.,(2011) The Neurocognitive Disorders Work Group of the American Psychiatric Association’s (APA) DSM5 Task Force. Classification of Neurocognitive Disorders in DSM-5: A Work in Progress. The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry, 19(3), 205–210.
• Owen, L. & Subran-Lea, S.I. (2011). Metabolic agents that enhance ATP can improve cognitive functioning: A review of the evidence for glucose, oxygen, pyruvate, creatine, and l-carnitine. Nutrients, 3(8), 735-755.
• Sirven, Joseph I., and Barbara L. Malamut.(2008) Clinical Neurology of the Older Adult. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, Print.
• Stokin, G., Krell-Roesch, J., Petersen, R. V., & Geda, Y. E. (2015). Mild neurocognitive disorder: An old wine in a new bottle. Harvard review of psychiatry, 23(5), 368-376. doi: 10.1097/HRP.0000000000000084
• Tuokko, H. & Hadjistavropoulos, T. (1998). An assessment guide to geriatric neuropsychology. Hoboken: Taylor and Francis.
• Tusaie, Kathleen R., and Joyce J. Fitzpatrick.(2013) Advanced Practice Psychiatric Nursing: Integrating Psychotherapy, Psychopharmacology, and Complementary and Alternative Approaches. New York, NY: Springer. Print.
• Woods, R. & Clare, L. (2008). Handbook of the clinical psychology of ageing. Chichester, West Sussex, England: John Wiley & Sons.

Etiology

• Age
• Family history
• Genetics
• Cerebral vascular disease
• Lower socioeconomic status
• Gender
• Brain plaques or Lewy bodies

Treatments:

(Attix & Welsh-Bohmer, 2006; Sirven & Malamut, 2008)

• For Mild NCD caused by extraneous factors, treating that may resolve the disorder
• Mild NCD from other causes generally does not improve and may worsen.
• Other treatments include:
• medications
• therapy
• lifestyle changes
• New research suggests increasing ATP production may help cognitive decline

Prevalence:

(APA, 2013; Baylor & White, 2014; Demant, Almer, Vinberg, Kessing, & Miskowiak, 2013)

• Only available for older populations
• After age 60 prevalence rates increase dramatically
• Needs to be examined in narrow age bands
• Major NCD = dementia rates:
• 1-2% at 65
• up to 30% by 85
• MCI = Mild NCD:
• 2-10% at 65
• 5-25% at 85

(The American Psychiatric Association, 2013)

Diagnostic Difficulties

• Changes in sensory processes
• Higher prevalence and/or variety of medical problems than younger populations
• Preexisting learning disorders
• Medications
• Boundaries between normal cognition and mild NCD are arbitrary

(APA, 2013; Tuokko & Hadjistavropoulos, 1998)

Subtypes

• Alzheimer's disease
• Dementia
• Cerebrovascular disease
• Frontotemporal lobar degeneration
• Lewy Body disease
• Huntington's disease
• Traumatic brain injury (TBI)
• HIV disease
• Possibly prion disease
• Substance-use-associated disease

(Ganguli et al., 2011)

Normal Aging vs. Mild NCD

(Aging and Dementia, 2015)

Diagnostic Criteria

A. Evidence of modest cognitive decline from a previous level of performance in one or more cognitive domains

B. The cognitive deficits do not interfere with capacity for independence in everyday activities

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

D. The cognitive deficits are not better explained by another mental disorder

(The American Psychiatric Association, 2013)

A presentation by:

Candice Giesinger

Madison Harvey

Brooke Hoffman

Devery Wild

So Are They Different?

• Yes!
• Mild NCD is more than normal aging, less than Major NCD
• "Cognitive and behavioural changes compatible with normal aging should not be misinterpreted as being indicative of abnormal or pathological change in functioning."

(Stokin, Krell-Roesch, Petersen, & Geda, 2015; Tuokko & Hadjistavropoulos, 1998)

Mild Neurocognitive Disorder

(Mild NCD)

• Minor decline in cognitive function that does not result in loss of independence

(Stokin, G., Krell-Roesch, J., Petersen, R.C., & Geda, Y. E., 2015)

Societal Views

References:

• A common misconception is that age is related to general decline in most cognitive abilities
• Changes are only labeled as a "disease" in extreme cases
• Therefore, there is a need for normative information based on age

(Blazer & Steffens, 2009; Tuokko & Hadjistavropoulos, 1998; Woods & Clare, 2008)

Normal Aging

• Aging is defined as "a series of time-dependent anatomical and physiological changes that reduce physiological reserve and functional capacity"
• Successful aging occurs when an individual achieves "optimal physical, psychological, and social possibilities for living"
• Primary vs. secondary aging

(Blazer & Steffens, 2009; Woods & Clare, 2008)

Questions?