Which statement about neurocognitive disorder in adults older than 85 years is true?

The key distinction between major and mild neurocognitive disorder is that individuals with major neurocognitive disorder experience a substantial decline in function that includes a loss of independence as a result of profound cognitive impairment, whereas individuals with mild neurocognitive disorder experience only a modest cognitive decline and, as a result, function relatively independently.

Neurocognitive disorders involve impairments in cognitive abilities such as memory, problem solving and perception. Cognitive deficits are acquired rather than developmental. Although cognitive impairments are present in many mental disorders (e.g., schizophrenia, bipolar disorders), only disorders whose core features are cognitive are included in neurocognitive disorders. Neurocognitive disorders represent impairment in cognition that has not been present since birth or the early developmental period. Thus, individuals with this disorder experience a decline from a previously attained level of functioning.

Neurocognitive disorders most commonly occur in older adults, but they can affect younger people as well. Reduced cognitive capacity may include problems with complex attention, executive functioning, learning and memory, expressive and receptive language, perceptual-motor abilities, changes in behavior, and trouble performing everyday tasks. These symptoms may be caused by a neurodegenerative condition, such as Alzheimer’s disease, dementia, frontotemporal lobar degeneration, or Lewy body disease. They can also be caused by illnesses such as Parkinson's or Huntington's disease, or traumatic brain injury or stroke.  Neurocognitive disorders can also develop as a result of substance abuse or HIV infection.

How common is dementia?

Of those at least 65 years of age, there is an estimated 5.0 million adults with dementia in 2014 and projected to be nearly 14 million by 2060.

Isn’t dementia part of normal aging?

No, many older adults live their entire lives without developing dementia. Normal aging may include weakening muscles and bones, stiffening of arteries and vessels, and some age-related memory changes that may show as:

• Occasionally misplacing car keys
• Struggling to find a word but remembering it later
• Forgetting the name of an acquaintance
• Forgetting the most recent events

Normally, knowledge and experiences built over years, old memories, and language would stay intact.

What are the signs and symptoms of dementia?

Because dementia is a general term, its symptoms can vary widely from person to person. People with dementia have problems with:

• Memory
• Attention
• Communication
• Reasoning, judgment, and problem solving
• Visual perception beyond typical age-related changes in vision

Signs that may point to dementia include:

• Getting lost in a familiar neighborhood
• Using unusual words to refer to familiar objects
• Forgetting the name of a close family member or friend
• Forgetting old memories
• Not being able to complete tasks independently

What increases the risk for dementia?

• Age
  The strongest known risk factor for dementia is increasing age, with most cases affecting those of 65 years and older

• Family history
  Those who have parents or siblings with dementia are more likely to develop dementia themselves.

• Race/ethnicity
  Older African Americans are twice more likely to have dementia than whites. Hispanics 1.5 times more likely to have dementia than whites.

• Poor heart health
  High blood pressure, high cholesterol, and smoking increase the risk of dementia if not treated properly.

• Traumatic brain injury
  Head injuries can increase the risk of dementia, especially if they are severe or occur repeatedly.

How is dementia diagnosed?

A healthcare provider can perform tests on attention, memory, problem solving and other cognitive abilities to see if there is cause for concern. A physical exam, blood tests, and brain scans like a CT or MRI can help determine an underlying cause.

What are the most common types of dementia?

• Alzheimer’s disease. This is the most common cause of dementia, accounting for 60 to 80 percent of cases. It is caused by specific changes in the brain. The trademark symptom is trouble remembering recent events, such as a conversation that occurred minutes or hours ago, while difficulty remembering more distant memories occurs later in the disease. Other concerns like difficulty with walking or talking or personality changes also come later. Family history is the most important risk factor. Having a first-degree relative with Alzheimer’s disease increases the risk of developing it by 10 to 30 percent.

• Vascular dementia. About 10 percent of dementia cases are linked to strokes or other issues with blood flow to the brain. Diabetes, high blood pressure and high cholesterol are also risk factors. Symptoms vary depending on the area and size of the brain impacted. The disease progresses in a step-wise fashion, meaning symptoms will suddenly get worse as the individual gets more strokes or mini-strokes.

• Lewy body dementia. In addition to more typical symptoms like memory loss, people with this form of dementia may have movement or balance problems like stiffness or trembling. Many people also experience changes in alertness including daytime sleepiness, confusion or staring spells. They may also have trouble sleeping at night or may experience visual hallucinations (seeing people, objects or shapes that are not actually there).

• Fronto-temporal dementia. This type of dementia most often leads to changes in personality and behavior because of the part of the brain it affects. People with this condition may embarrass themselves or behave inappropriately. For instance, a previously cautious person may make offensive comments and neglect responsibilities at home or work. There may also be problems with language skills like speaking or understanding.

• Mixed dementia. Sometimes more than one type of dementia is present in the brain at the same time, especially in people aged 80 and older. For example, a person may have Alzheimer’s disease and vascular dementia. It is not always obvious that a person has mixed dementia since the symptoms of one type of dementia may be most prominent or may overlap with symptoms of another type. Disease progression may be faster than with one kind of dementia.

• Reversible causes. People who have dementia may have a reversible underlying cause such as side effect of medication, increased pressure in the brain, vitamin deficiency, and thyroid hormone imbalance. Medical providers should screen for reversible causes in patients who are concerning for dementia.

How is dementia treated?

Treatment of dementia depends on the underlying cause. Neurodegenerative dementias, like Alzheimer’s disease, have no cure, though there are medications that can help protect the brain or manage symptoms such as anxiety or behavior changes. Research to develop more treatment options is ongoing.

Leading a healthy lifestyle, including regular exercise, healthy eating, and maintaining social contacts, decreases chances of developing chronic diseases and may reduce number of people with dementia.

What to do if a loved one is suspicious of having dementia?

• Discuss with loved one. Talk about seeing a medical provider about the observed changes soon. Talk about the issue of driving and always carrying an ID.
• Medical assessment. Be with a provider that you are comfortable with. Ask about the Medicare Annual Wellness exam.
• Family Meeting. Start planning, and gather documents like the Health Care Directive, Durable Power of Attorney for Health Care, Estate Plan.

What percentage of individuals over the age of 85 have a neurocognitive disorder?

What is the most common neurocognitive disorder in the elderly?

How common are neurocognitive disorders among the elderly?

What are the psychosocial implications of neurocognitive disorders to the elderly?