Neurocognitive disorders: what are they, types, characteristics and causes

The set of diagnostic entities, known as “neurocognitive disorders”, are classified in the diagnostic manuals of most used mental disorders, and are characterized mainly because people who suffer from any of them have a condition cognitive.

This cognitive condition is characterized by a deterioration in various basic psychological processes such as perception, attention, memory and other cognitive abilities. This decline, when pronounced, causes discomfort and difficulties in carrying out daily tasks.

Next we will see the main characteristics of neurocognitive disorders, as well as the different clinical pictures in which they can occur.

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What are neurocognitive disorders?

Neurocognitive disorders are made up of a set of conditions based on a pronounced deficit in various cognitive processes, which are also neurobiological in nature. In the case of a slight decline in these cognitive processes, it could be considered to be an evolutionary consequence of aging.

On the other hand, if there were difficulties for normal cognitive development due to disorders such as delirium or confusional syndrome, dementia or the syndrome amnesic, we could speak of a neurocognitive disorder, which usually causes discomfort in the person who suffers from it and interferes with their life activities daily.

The most common warning signs that usually occur are as follows:

• Notable memory problems (p. (e.g., he does not remember where he leaves things).
• Changes in mood and behavior (p. (e.g., he is more angry than normal).
• Remarkable clumsiness when performing basic tasks of daily life (p. g., shopping, cooking, dressing, etc.).
• Difficulty expressing yourself (p. (e.g., you are telling a story and suddenly you lock up and forget it).

Therefore, if some type of neurocognitive disorder is diagnosed, it would be ideal for those close to the affected person to be alert to the alarm signals and to seek professional help immediately, in order that a professional can make an adequate diagnosis and thus be able to carry out a treatment according to their needs to delay the decline as long as possible and thus remain as independent as possible and for longer weather.

In the field of clinical psychology and psychiatry, with respect to neurocognitive disorders or dementias, there is a name known as "senility or pathological old age", differentiated from normal old age, known as "senescence". Although, it is true that these names taken into clinical practice are not so easy to distinguish because there are no normative criteria that can help differentiate them.

This difficulty in distinguishing a neurocognitive disorder from normal senescence or old age is due to the skills found declining (such as memory, attention or degree of independence) are not dichotomous (have them or not), but are found developed along a continuum where it is very difficult to draw a line separating senility from normal cognitive decline associated with age.

Thus, it is not easy to differentiate cases with mild cognitive difficulties from others with cognitive abilities functioning at a usual performanceNor is it easy to distinguish them from a case of dementia that is beginning to manifest itself.

It is important to note that cognitive impairment and, especially neurocognitive disorders, are not synonymous with being aging because not all people experience a noticeable decline in their physical faculties, nor do they mental; Furthermore, through the latest medical advances, cases have been detected in younger people, which facilitates a better prognosis in their treatment.

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Types of neurocognitive disorders

The most colloquial term that is usually used to describe neurocognitive disorders is that of "dementia", and it is defined as "decline in form progressive development of the different mental and functional aptitudes causing alterations in behavior and limiting the autonomy of the person who does it. suffers ”.

Next we will see the neurocognitive disorders and their main characteristics and diagnostic criteria.

1. Delirium

It is also known as "confusional syndrome" and is fundamentally characterized by a disorder in the state of consciousness, which affects attention and its symptoms fluctuate throughout the day. This disorder usually appears abruptly and its duration is short.

The prodromal or preceding symptoms of delirium are: apathy, unstable mood, sudden changes in attention, sensitivity to light and noise, and trouble sleeping.

In this confusional syndrome there is usually a cognitive alteration characterized by several of the following symptoms:

• Spatio-temporal disorientation.
• Difficulty distinguishing the lived reality from a dream.
• Illusions or hallucinations, mainly visual.
• Language difficulties.
• Symptoms of anxiety, depression, irritability, among others.
• Tachycardia and sweating.
• Agitation, restlessness, etc.
• Insomnia problems.

May have been hypoactive, being more common in the elderly; although it is more common for delirium to have hyperactive symptoms, as a consequence of the side effects of certain drugs or some medications.

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2. Minor Neurocognitive Disorder (DSM-5)

Neurocognitive disorders are mental disorders that have an organic origin at the brain level (as a gradual loss of neurons) and are developed by various causes that we will see more ahead.

These disorders are composed of several symptoms that are listed below, so it will significantly influence the life of the person suffering from them.

TO. A neurocognitive disorder is primarily characterized by mild cognitive decline in one or both of the following cognitive domains:

• Preoccupation with impaired cognitive abilities (p. (e.g., you notice that you lose your memory capacity).
• Cognitive impairment detected in a neuropsychological evaluation test.

B. In addition, this decline significantly interferes with the normal performance of the person in the activities of daily life, which before he used to do without any difficulty.

C. This decline does not occur in the course of a delirium.

D. This cognitive decline is not caused by another mental disorder, such as major depression or schizophrenia.

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3. Major Neurocognitive Disorder (DSM-5) or Dementia (DSM-IV-TR, ICD-10 and ICD-11)

The symptoms of Major Neurocognitive Disorder are the same as those of Minor Neurocognitive Disorder, but with the difference that in the elderly they present with a greater degree of cognitive impairment that interferes even more with the independence of the person, so you need more help.

• The most common cognitive symptoms of neurocognitive disorders are:
• Memory decline, usually being one of the first symptoms in these cases.
• Trouble orienting yourself in time and where you are.
• Inability to recognize family members.
• Difficulties communicating and using words (eg, difficulty remembering names of objects).
• Also difficulty recognizing previously familiar objects (eg, a chair)
• Trouble performing simple tasks.
• Difficulties walking, so they can suffer falls.
• Fluctuating mood swings.
• Problems when planning the execution of a task.
• You can undergo changes in personality traits.

Causes of the development of major neurocognitive disorder or dementia

Neurocognitive disorders have various etiological causes for their subsequent development. They are listed below in a classified manner, based on the common factors from which they originated.

1. Diseases that are neurodegenerative (most common causes)

In this group are the following: Alzheimer's, Parkinson's disease, Lewy body disease, frontotemporal dementia, multiple sclerosis, amyotrophic lateral sclerosis, prion disease familial, progressive supranuclear palsy, mixed Alzheimer-Lewy body dementia, olive-ponto-cerebellar atrophy and Huntington. Is about pathologies in which there is a progressive destruction of nervous tissue.

2. Diseases that are not neurodegenerative

Within this group is the vascular dementia (multi-infarct, Binswanger's disease).

Acquired causes

Among these causes are metabolic diseases (thyroid, liver, high calcium levels), poisoning by some types of drugs, alcoholism, nutritional deficiencies (vitamin B12), vasculitis, tumors, hydrocephalus, severe head trauma and Wernicke-Korsafoff syndrome, produced by chronic alcoholism together with a deficiency of thiamine (vitamin B1).

3. Infectious causes

Diseases found within this group are sporadic prion disease, neuosyphilis, acquired immunodeficiency syndrome (AIDS), and meningitis.

As can be seen, there is a great diversity of causes of neurocognitive disorders or dementias, which in turn can be classified as follows:

• Primary dementias: its cause is unknown.
• Secondary dementias: they are developed as a consequence of another pathology.

The previous classification can be subdivided between:

• Reversible dementias: these are usually those that have been caused by an endocrine or metabolic disease.
• Irreversible dementias: these are neurodegenerative diseases (p. eg, Alzheimer's)

Treatment

Given the difficulties in making a diagnosis, it is necessary that this requires the evaluation of professionals from different disciplines, as it happens when carrying out an adequate treatment.

The first review is usually carried out by the family doctor, who performs a first examination and, in case of detecting symptoms compatible with dementia, refer the patient to be examined by the neurologist or psychiatrist in order to make a specialized diagnosis and, in case of detecting dementia, these Specialists will begin the treatment sessions, together with the help of psychologists, in order to delay the cognitive decline that is taking place. developing; It is possible that there are variations in the treatment process according to the intervention model that each clinic or hospital considers most appropriate.

In said treatment the prescription of drugs by the doctor will be combined with the psychosocial intervention that the psychologist will carry out, whose main objective is to maintain and, if possible, improve the autonomous development of the patient, training the skills of the patient who are in decline.