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1 DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this photo and/or video. If you don t want your photo taken, please let us know. Thank you! ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.

2 Neurocognitive Disorders: Delirium vs Dementia Trent Suggs, MD PGY-4 Psychiatry Resident, UNR SOM August 11, 2017

3 Neurocognitive Disorders The Neurocognitive Disorders (NCDs) are those in which impaired cognition has not been present since birth or very early life, and thus represents a decline from a previously attained level of functioning.

4 Neurocognitive Disorders 2 The neurocognitive disorders (NCDs) begin with delirium, followed by the syndromes of major NCD, mild NCD, and their etiological subtypes Delirium Dementia: Alzheimer s disease Frontotemporal lobar degeneration Lewy body disease Vascular disease Traumatic Brain Injury Substance/medication induced HIV infection Prion disease Parkinson s disease Huntington s disease

5 Delirium Diagnostic Criteria A. A disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment). B. The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day. C. An additional disturbance in cognition (e.g., memory deficit, disorientation, language, visuospatial ability, or perception). D. The disturbances in Criteria A and C are not better explained by another preexisting, established, or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal, such as coma. E. There is evidence from the history, physical examination, or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal (i.e., due to a drug of abuse or to a medication), or exposure to a toxin, or is due to multiple etiologies.

6 Major and Minor Neurocognitive Disorders Diagnostic Criteria Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition) based on: 1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a significant decline in cognitive function; and 2. A substantial impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment. The cognitive deficits interfere with independence in everyday activities (i.e., at a minimum, requiring assistance with complex instrumental activities of daily living such as paying bills or managing medications). The cognitive deficits do not occur exclusively in the context of a delirium. The cognitive deficits are not better explained by another mental disorder (e.g., major depressive disorder, schizophrenia).

7 Major and Minor Neurocognitive Disorders 2 Specify whether due to: Alzheimer s disease (pp ) Frontotemporal lobar degeneration (pp ) Lewy body disease (pp ) Vascular disease (pp ) Traumatic brain injury (pp ) Substance/medication use (pp ) HIV infection (pp ) Prion disease (pp ) Parkinson s disease (pp ) Huntington s disease (pp ) Another medical condition (pp ) Multiple etiologies (pp ) Unspecified (p. 643)

8 Major and Minor Neurocognitive Disorders 3 Specify: Without behavioral disturbance: If the cognitive disturbance is not accompanied by any clinically significant behavioral disturbance. With behavioral disturbance (specify disturbance): If the cognitive disturbance is accompanied by a clinically significant behavioral disturbance (e.g., psychotic symptoms, mood disturbance, agitation, apathy, or other behavioral symptoms). Specify current severity: Mild: Difficulties with instrumental activities of daily living (e.g., housework, managing money). Moderate: Difficulties with basic activities of daily living (e.g., feeding, dressing). Severe: Fully dependent.

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