In recent history mental illness has been an unfortunate taboo topic; however, recently that has begun to change with people’s minds around the world changing and coming to recognize these dangerous diseases that plague our society. More information is released every day along with the decrease of stigmatization on this topic. One particularly cruel mental disorder is a neurocognitive disorder, which can affect many people for a variety of reasons. These disorders can be either major or minor, which is due to the effect the disease has on the person. While it is a scary thing that can happen to people, it—like many other mental disorders—should be something that more people know about, whether to have more information on the topic for the sake of having the knowledge or in the case of it personally affecting a specific person or one of their family members. To understand exactly what makes up this disorder, there are many different components that need to be understood. These include a description of the disorder, causes of the disorder, treatments for the disorder, and a case study of someone who experienced this disorder first hand.
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Neurocognitive disorder is a harsh disease with many distinct symptoms and effects, such as things like cognitive decline and decreased ability to be independent. Diagnosis of the disorder comes down to basically four main points. The first main point is that there has to be not only a decrease in the cognitive function of the person, but a significant one compared to how the person used to be. How significant this decline is can help to determine whether it falls under the major or minor description. The decline can manifest in many of the different cognitive functions: the person may have a harder time learning new information and creating new memories, they may have trouble with language in general—either speaking it or understanding it—they may have trouble in social situations because they are no longer able to understand their interaction with other people, and they may have trouble with keeping attention on someone or something. For the diagnosis to qualify, the decline can either be to one or multiple of these factors. To test if one of these cognitive domains has a problem, a person is usually subjected to an assessment by an appropriate mental health professional, which usually includes a neuropsychological test. The second main point is that it has to affect a persons ADL’s or activities of daily living; more specifically, it has to interfere with them. One important distinction to make here is that while minor neurocognitive disorder makes things harder—like managing medications or paying bills—due to needing from help with them, major neurocognitive disorder inhibits independence by greatly restricting the ability to do these tasks. The third main point is that these cognitive disabilities have to be consistently happening; they can not only uniquely occur in a state of delirium. The fourth and final point is that there must be no other mental health disorder diagnosis that would fit the patient better than this one (DSM 5 611). Now that the details of what makes up the process of diagnosing a neurocognitive disorder have been explained, it is important to next know what causes it.
Like many other mental disorders, this one has many causes; but in order to get the whole picture, multiple theoretical perspectives need to be explored, starting with the biological causes. As pointed out in the DSM 5, many neurocognitive disorders are due to other mental disorders; there is a big list of disorders that can biologically mess with the function of the mind. An important thing to mention is while a neurocognitive disorder is directly due to another disease, how they got that disease is usually due to something biological that is more specific. The first one, that is common in the elderly, is Alzheimer’s disease (Hatfield). This disease kills nerve cells in the brain; however, scientists are not sure exactly what causes this neuron damage. The likely responsible party for the damage is fragments of the beta-amyloid protein called plaques and twisted fibers of the tau protein called tangles. They build up in the space between nerve cells and inside of them. These are what scientists theorize are causing the harmful effects of Alzheimer’s such as confusion and serious memory loss. While Alzheimer’s is the number one cause of dementia—now called neurocognitive disorder—it is not the only one (“What is Alzheimer’s”). The second type of disease that can lead to a neurocognitive disorder is Huntington’s disease: a disease resulting from a problem occurring in the fourth chromosome (Nall). Similar to Alzheimer’s, this disease is also caused by defective proteins. This time the protein huntingtin is the cause of the disease. Although scientists are not sure how this protein does its damage, they do know it leads to trouble with cognitive processes, such as thinking and reasoning; thus, resulting in a neurocognitive disorder. This disorder is entirely dependent on genes—evident by its presence as a dominant allele—which points it under the biological theory (“Huntington’s Disease”). The third disease that can biologically interfere with the body and result in a neurocognitive disorder is vascular dementia. Unlike the others, whose causes were unknown and genetics respectively, vascular dementia is the result of something a little easier to see: a stroke. The blood vessel damage in the brain after said stroke results in—as seen before—issues with thinking; but this time they specifically affect the way a person makes or organizes their decisions. Like the others, vascular dementia also leads to the diagnosis of a neurocognitive disorder due to a disease (Nall). However, these diseases are not the only cause. While these reasons result in the disorder due to biological means, neurocognitive disorder can also be due to cognitive means.
When focusing more on the cognitive causes, it is more about what is put into the body; furthermore, one specific example would be drugs. There are many different types of drugs that can have varying neurocognitive effects. Alcohol, inhalants, cocaine, methamphetamine, opioids, phencyclidine and even prescription medication can all cause cognitive decline, whether it be major or minor. Another major point is that doing the drug and withdrawal from the drug can both cause a negative effect. The first one, alcohol, causes usually minor effects and is due mostly to the withdrawal symptoms for heavy drinkers; these drinkers—about thirty to forty percent of them—face mild neurocognitive disorder for the first few months after they curve their addiction and stop drinking. On the contrary, people who are older than fifty can face these withdrawal symptoms for a lot longer, drawn out period of time. Unfortunately, these symptoms can be hard to recognize by the actual person facing them, and are often instead recognized by the person’s family or friends. Inhalants, unlike alcohol, can have effects right after taking the drug and after a person has stopped taking them. Like alcohol, however, it has mostly minor cognitive effects. A study was performed that showcased after two years, people who had suffered cognitively had their functions return significantly after this time period; not only that, after fifteen years of abstinence from the inhalant, cognitive function had returned completely to normal. This fact, however, does not apply to a certain inhalant called leaded petroleum. The victims of this type of inhalant can have a major neurocognitive disorder and can still have cognitive impairment after the fifteen years. The final important drug to talk about would be opioids, which are especially dangerous because they can be prescribed. An astounding amount of people—thirty-three to thirty-nine percent—of users and people who are no longer users have cognitive issues related to their present or past use. Opioids, as opposed to most inhalant and alcohol use, are actually major and cause severe cognitive damage. It particularly affects executive function, memory, and learning. These things particularly affect the processes of taking information in and making decisions, which makes it hard for these people to solve their addiction problem. Again, like alcohol addicts, they require help from their friends and family to help prevent a major neurocognitive disorder from happening, or at least from making it any worse (Hartney). While all these causes may make it seem impossible to deal with a neurocognitive disorder, there are helpful treatments for these diseases too.
There are a few different ways to treat a neurocognitive disorder. While some of these disorders can actually be cured, many cannot; the treatments a lot of the people receive are more focused on comfort as opposed to curative. The first of these treatments are medications. An important thing to note is that medication used for Alzheimer’s disease is used for many different types of dementia, now called neurocognitive disorder (“What is Dementia”). The two main drug types used, memantine and cholinesterase inhibitors, treat symptoms like trouble with thinking, reasoning, confusion, and memory loss; they are also both FDA approved. Cholinesterase inhibitors work hard on the neurotransmitter acetylcholine. Breakdown of this neurotransmitter causes loss of nerve cell communication, resulting in decreased cognitive function related to memory and learning. Thankfully, the drug slows down this process by keeping acetylcholine concertation high. Three common examples of this drug would be Rivastigmate, Donepezil, and Galantamine (“Medications for Memory”). The second drug, memantine, is also very important, and can even sometimes be prescribed alongside a cholinesterase inhibitor for maximum effectiveness (“Dementia”). Memantine affects a different type of neurotransmitter; this one is responsible for processing information and is called glutamate (“Medications for Memory”). It can also improve things like memory and learning as well as return the ability to perform activities that the person was previously unable to do (“Dementia”; “Medications for Memory”). These, however, are not the only drugs that can help out patients with a neurocognitive disorder. While the last two were focused more on memory, these next three are more based on treating symptoms that result because of the neurocognitive disorder. They are anxiolytics—for treating anxiety—antidepressants—for treating a depressive mood—and antipsychotics—for treating aggression and delusions (“Treatments for Behavior”). While medication is a very common solution that we think of when treating an illness, it is not the only one. There are many different therapeutic nondrug ways that can help out a patient too.
The second main type of way to treat neurocognitive disorder focuses more on the behavioral tendencies of that patient. The first thing a person can do to help a person with neurocognitive disorder is to help modify the person’s environment and tasks. Things like noise and clutter in a patient’s house can cause problems with focusing and functioning and needs to be reduced as much as possible. Also, their house needs to be made safer; this can be achieved by removing sharp objects like keys and knives and adding safety measures that help prevent falls. As for tasks, a routine needs to be developed in order to make it easier for the person to know what to do. Furthermore, there should be a positive focus on tasks well done, not a negative focus based on failure. A lot of these strategies, including finding coping methods, can be accomplished by an occupational therapist; however, occupational therapy is not the only kind of therapy that can help these people out. There are also some alternative forms that have helped many neurocognitive disorder patients curve agitation and increase relaxation. The first one is focused on creating something, with a focus on the actual creating process as opposed to the result of the process: art therapy. The next three have a huge focus on the senses—hearing, smell, and touch—and help to greatly relax the person. They are music therapy—listening to music that is calming—aromatherapy—smelling plant based oils with good fragrances—and massage therapy. The fifth one, arguably one of the most popular, is pet therapy which helps to improve the mood of the people suffering from this disorder by interacting with animals, such as dogs (“Dementia”). Now that the description, causes, and treatments have been shown for neurocognitive disorder, it is important to tie all of these together into an actual example.
In order to fully understand a neurocognitive disorder, it is important to look at a case study of a specific person; the person that will be looked at is my grandpa Tom. Tom suffered from a neurocognitive disorder due to Parkinson’s disease. Parkinson’s disease, like Alzheimer’s and Huntington’s, can also result in a major or minor neurocognitive disorder (Nall). He was diagnosed about four years ago and faced symptoms like a decreased ability to remember things and a decreased ability to create new memories. At first his symptoms were minor. Many things were done to help him which reflect the points in this paper. One distinct thing was that he was given a more structured routine. He lived with my grandma at their house and she would make sure every day to keep him to a close routine: at this time he would get up, at this time he would he would go to bed, at these times he would eat breakfast, lunch, and dinner, etc. Another thing that happened was the house was assessed so that it could be safe for a person suffering from this disorder. An alarm was set up if he were to leave during the middle of the night, a metal bar was added in the bathroom to make it easier to use, and sharp objects were hidden or removed. Unfortunately, while my grandma tried her absolute best, caring for someone with a neurocognitive disorder is tough. Tom was in and out of Pleasant View nursing home due to falling. He was eventually transferred to Ottawa Pavilion because of issues with Pleasant View and was put on the dementia unit. He stayed there for nine months and progressively got worse. At the point that he was put onto this unit, he was already having lots of trouble with his ADL’s and was unable to do them by himself; this would categorize him as having a major neurocognitive disorder. He never got to leave the nursing home and was eventually put on hospice. He passed at the end of the nine month period. They never got the autopsy to prove he had Alzheimer’s, but the doctors who inspected him in the nursing home had strong suspicions that he had it.
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In conclusion, major or mild neurocognitive disorder is a deadly disease that affects a lot offifty people across the world. The cognitive impairment it does to its victims is truly cruel and can cause them isolation from other people and even themselves. It is caused by biological means such as genes or a stroke or cognitive means such as drugs. Yet, despite all this, it has many useful treatments including medication and different forms of therapy. While tragically this disease did end up taking Tom’s life, it was still an important learning experience. With every person affected by this, society gains more information about how to better treat it and maybe even prevent it. It also inspires people to dedicate their lives to learning about these disorders and training to be able to take care of the people with them. Finally, it also helps decrease the stigma around these diseases and improves the world’s perception of people with them, which helps our society as a whole.
- “Dementia.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 2 Aug. 2017, www.mayoclinic.org/diseases-conditions/dementia/diagnosis-treatment/drc-20352019.
- Hartney, Elizabeth. “Medication or Substance-Induced Neurocognitive Disorder.” Verywell Mind, Dotdash, 9 Oct. 2018, www.verywellmind.com/medication-or-substance-induced-neurocognitive-disorder-4144778.
- Hatfield, Rudolph C. “Neurocognitive Disorder due to another Medical Condition.” Gulf Bend Center. https://www.gulfbend.org/poc/view_doc.php?type=doc&id=15337&cn=5.
- “Huntington’s Disease.” Alzheimer’s Association, www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/huntington-s-disease.
- “Medications for Memory.” Alzheimer’s Association, www.alz.org/alzheimers-dementia/treatments/medications-for-memory.
- Nall, Rachel. “What is Dementia (Neurocognitive Disorder).” Medical News Today, MediLexicon International, 22 Sept. 2017, www.medicalnewstoday.com/articles/314850.php.
- “Treatments for Behavior.” Alzheimer’s Association, www.alz.org/alzheimers-dementia/treatments/treatments-for-behavior.
- “What is Alzheimer’s?” Alzheimer’s Association, www.alz.org/alzheimers-dementia/what-is-alzheimers.
- “What is Dementia?” Alzheimer’s Association, www.alz.org/alzheimers-dementia/what-is-dementia.
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