Mild and Major Neurocognitive Disorders

Geriatric care includes the prevention and diagnosis of diseases, as well as the management of diseases, disabilities, and other health concerns in individuals ≥ 65 years of age. Special consideration is given when addressing multiple aspects that are specific to aging. Preventive measures such as vaccinations as well as cancer and disease screening are essential in this age group because of the high risk for infections and developing cancer and chronic diseases. A majority of older individuals have at least 1 chronic medical condition, which increases the likelihood of polypharmacy and adverse drug reactions. Vision, hearing, cognitive function, gait, and balance are among the functions that decline in the geriatric population. These disease- and age-related factors affect the activities of daily living. Assessing the financial and social resources of the elderly is also important, given the direct impact of these factors on their health. A multidisciplinary approach involving various professionals in the healthcare field is important in achieving comprehensive care for the elderly.

Attention deficit hyperactivity disorder is a neurodevelopmental disorder characterized by a pattern of inattention and/or hyperactivity-impulsivity that occurs in at least 2 different settings for more than 6 months. Although the patient has normal intelligence, the disease causes functional decline. The onset usually occurs before 12 years of age and often persists into adulthood. The 1st line of treatment is stimulant medications but may include non-stimulant medications and behavioral therapy.

Conduct disorder (CD) is a pediatric mental disorder characterized by a recurrent behavior in which patients do not comply with social norms and rules or the basic rights of others. Examples include violence, destruction, theft, lying, and serious breaking of rules present over ≥ 1 year. An important risk factor is parental rejection and neglect. Conduct disorder is difficult to treat and requires a multimodal approach that includes family therapy, behavior modification, and pharmacotherapy.

Oppositional defiant disorder is a pediatric psychiatric disorder characterized by a continuous pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness directed at adults or other authority figures. Symptoms must be present for at least 6 months to make a diagnosis of ODD. Affected individuals do not show aggressive or violent behavior, and they do not impinge on other persons’ rights. The 1st line of management consists of psychotherapy; this can be supported by pharmacotherapy, depending on the severity of symptoms.

Sexual abuse and assault are major public health problems that affect many people from all walks of life, including people of all ages and genders, but it is more prevalent in women and girls, with reports of up to 1 in 3 experiencing sexual assault at some time in their life. In addition to psychological consequences, sexual assault can result in unintended pregnancy, STIs, and physical injury. Management includes proper examination, testing, reporting, and psychological support.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder marked by poor social skills, restricted interests/social interactions, and repetitive/stereotyped behaviors. The condition is termed a “spectrum” because of the wide variability in the severity of symptoms exhibited. Some patients suffer from severe impairment in language and intellectual levels, while others have normal or even advanced intellect. The etiology is not well understood and there is no known cure. Early diagnosis and intervention are important in improving the patient’s symptoms.

A number of changes normally occur in the aging individual. These changes affect neurocognitive function, organ function, senses, metabolism, sexual function, and sleep patterns. Of particular importance in aging adults, physicians need to understand the difference between normal cognitive decline associated with aging and pathologic decline. History, physical examination, imaging, laboratory studies, and neuropsychological testing may help determine possible causes of pathologic decline. Many conditions that cause pathologic cognitive decline have no cure, but symptoms may be managed with medications and a strong support system.

Major neurocognitive disorders (NCDs), also known as dementia, are a group of diseases characterized by decline in a person’s memory and executive function. These disorders are progressive and persistent diseases that are the leading cause of disability among elderly people worldwide. There are several distinct etiologies for major NCDs. While there are known risk factors and measures to prevent major NCDs, there are no effective curative treatments.

Delirium is a medical condition characterized by acute disturbances in attention and awareness. Symptoms may fluctuate during the course of a day and involve memory deficits and disorientation. There are many causes of delirium. Early recognition and accurate diagnosis constitute the 1st steps to adequate management. The primary goal of treatment is to identify and reverse the underlying cause and prevent future episodes. Pharmacotherapy is reserved for the most severe cases of agitation.

Defense mechanisms are normal subconscious means of resolving inner conflicts between an individual’s subjective moral sense and their thoughts, feelings, or actions. Defense mechanisms serve to protect the self from unpleasant feelings (anxiety, shame, and/or guilt) and are divided into pathologic, immature, mature, neurotic, and other types.