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

A summary of the characteristics of neurocognitive disorders, very common pathologies.

The set of diagnostic entities, known as "neurocognitive disorders", are classified in the most widely used diagnostic manuals of mental disorders, and are mainly characterized by the fact that people suffering from any of them have a cognitive impairment.

This cognitive impairment is characterized by a decline in several basic psychological processes such as perception, attention, memory and other cognitive skills. This decline, when pronounced, causes discomfort and difficulties in carrying out everyday tasks.

We will now take a look at the main characteristics of neurological disorders. we will look at the main characteristics of neurocognitive disordersas well as the different clinical pictures in which they may present.

What are neurocognitive disorders?

The neurocognitive disorders are composed 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 an evolutionary consequence of aging.

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

The most common warning signs that usually occur are the following:

• Noticeable memory problems (e.g., not remembering the place where he/she leaves things).
• Changes in mood and behavior (e.g., more angry than usual).
• Noticeable difficulty in performing basic tasks of daily living (e.g., shopping, cooking, dressing, etc.).
• Difficulty in expressing himself (e.g., he is telling a story and suddenly blocks and forgets).

Therefore, if some type of neurocognitive disorder is diagnosed, it would be advisable for those close to the affected person to be alert to the warning signs and seek professional help immediately.In the field of psychology and psychology, it is important for the person concerned to be aware of the warning signs and seek professional help immediately, so that a professional can make a proper diagnosis and thus be able to carry out a treatment according to their needs in order to delay the decline as much as possible and thus remain as independent as possible and for a longer period of time.

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

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

Therefore, it is not easy to it is not easy to differentiate cases with mild cognitive difficulties from others with cognitive skills functioning at usual performance.It is also not 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 aging because not all people experience a noticeable decline in their physical or mental faculties; in addition, through recent medical advances, it has been possible to detect cases in younger people, which facilitates a better prognosis in their treatment.

Types of neurocognitive disorders

The most colloquial term commonly used to refer to neurocognitive disorders is "dementia", and is defined as "progressive decline of different mental and functional abilities, causing behavioral alterations and limiting the autonomy of the person suffering from it".

The following are the neurocognitive disorders and their main characteristics and diagnostic criteria.

1. Delirium

It is also known as "confusional syndrome" and it is characterized is characterized fundamentally by a disorder in the state of consciousness, affecting attention and its symptomatology fluctuates.It affects attention and its symptomatology fluctuates throughout the day. This disorder usually appears abruptly and its duration is brief.

The prodromal or preceding symptoms of delirium are: apathy, mood instability, abrupt changes in attention, sensitivity to light and noise, and difficulty sleeping..

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

• Spatio-temporal disorientation.
• Difficulty to distinguish 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.

There may be a state of hypoactivityIt is more common in elderly people; although it is more frequent that in delirium there are hyperactive symptoms, as a consequence of the side effects of certain drugs or some medications.

2. Minor neurocognitive disorder (DSM-5)

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

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

A. A neurocognitive disorder is characterized primarily by cognitive decline in a mild manner with respect to one or both of the following cognitive domains:

• Concern about a decline in your cognitive skills (e.g., you notice that you are losing your memory capacity).
• Cognitive impairment detected on a neuropsychological assessment test.

B. In addition this decline significantly interferes with the person's normal performance of activities of daily living, which he/she used to perform without any difficulty.

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

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

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 major neurocognitive disorder they present with a greater degree of cognitive impairment that further interferes with the person's independence. in the major neurocognitive disorder they are presented with a greater degree of cognitive impairment that interferes even more in the person's independence, so that he/she needs more help.and therefore requires greater assistance.

• The most common cognitive symptoms of neurocognitive disorders are:
• Memory decline, usually being one of the first symptoms in these cases.
• Problems with orientation in time and place.
• Inability to recognize family members.
• Difficulties in communicating and using words (e.g., difficulty remembering names of objects).
• Also difficulty recognizing once familiar objects (e.g., a chair).
• Problems performing simple tasks.
• Difficulty walking, so they may fall.
• Fluctuating mood swings.
• Problems in planning the execution of a task.
• May have changes in personality traits.

Causes for the development of major neurocognitive disorder or dementia

Neurocognitive disorders have several etiological causes for their further development. They are listed below in a classified manner, depending on the common factors by which they were originated.

1. Diseases that are neurodegenerative (most common causes).

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

2. Non-neurodegenerative diseases

This group includes vascular dementia (multi-infarct, Binswanger's disease).

Acquired causes

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

3. Infectious causes

The diseases that fall into this group are sporadic prion disease, neurosyphilis, 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: their cause is unknown.
• Secondary dementias: they are developed as a consequence of another pathology.

The above classification can be subdivided into:

• Reversible dementias: they are usually those caused by an endocrine or metabolic disease.
• Irreversible dementias: these are neurodegenerative diseases (e.g. Alzheimer's).

Treatment

Given the difficulties in making a diagnosis, this requires the evaluation of professionals from different disciplines, as in the case of neurodegenerative diseases (e.g. Alzheimer's).The same is true for appropriate treatment.

The first checkup is usually performed by the family physician, who performs an initial examination and, if symptoms compatible with dementia are detected, will refer the patient for examination by a neurologist or psychiatrist to make a specialized diagnosis and, if dementia is detected, these specialists will begin treatment sessions, along with the help of psychologists, in order to delay the cognitive decline that is developing; there may be variations in the treatment process depending on the intervention model considered most appropriate by each clinic or hospital.

In such treatment will combine the prescription of medication by the physician with psychosocial intervention by the psychologist.The main objective is to maintain and, if possible, improve the patient's autonomous performance, training the patient's skills that are in decline.