Major Neurocognitive Disorder Due to Traumatic Brain Injury
Week 8: Neurocognitive Disorders
My mother used to be a teacher—an elementary school teacher. We were all so proud of her when she completed her PhD when she was 50. Now she is 75 and has begun to have times when she does not know what day it is. We found her wandering around the neighborhood because she could not find her way home. Once, she forgot where she parked her car at the grocery store. She thought someone had stolen it. The manager was so kind to drive her around the parking lot until she recognized her car. We are afraid she might get hurt or lost.
Gary, age 50, son of Dorothy, age 75
The neurocognitive disorders are unique among the other psychiatric disorders you have studied in that the diseases that are to blame for the neurocognitive manifestations that have been extensively studied. Additionally, these conditions are also acquired and represent a decline from a previous level of functioning. The neurocognitive disorders present a diagnostic challenge to the PMHNP in that many of the signs and symptoms overlap.
This week, you will explore evidence-based psychotherapy and psychopharmacologic treatment for neurocognitive disorders.
Learning Resources
Required Readings
Acadia Pharmaceuticals. (2017). Transform the treatment of Parkinson’s disease psychosis with NUPLAZID. Retrieved from https://www.nuplazidhcp.com/?gclid=CIHS5auvwtMCFQkaaQodrU0FGQ
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
“Neurocognitive Disorders”
Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.
Chapter 63, “Delirium”
Chapter 64, “Neurocognitive Disorder Due to Alzheimer’s Disease”
Chapter 65, “Frontotemporal Neurocognitive Disorder”
Chapter 66, “Vascular Neurocognitive Disorder”
Chapter 67, “Neurocognitive Disorder Due to Parkinson’s Disease”
Hopkins, S. A., & Chan, D. (2016). Key emerging issues in frontotemporal dementia. Journal of Neurology, 263(2), 407–413. doi:10.1007/s00415-015-7880-7
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 21, “Neurocognitive Disorders” (pp. 694–741)
Stahl, S. M. (2017). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (6th ed.). New York, NY: Cambridge University Press.
To access information on specific medications, click on The Prescriber’s Guide, 6th Ed. tab on the Stahl Online website and select the appropriate medication.
Alzheimer disease Delirium Dementia Parkinson’s disease dementia
caprylidene
donepezil
galantamine
memantine
rivastigmine
haloperidol (adjunct)
lorazepam (adjunct) donepezil
galantamine
memantine
rivastigmine rivastigmine
pimavanserin
Note: For more information on Pimavanserin, see:
U.S. Food and Drug Administration. (n. d.). Highlights of prescribing information: Nuplazid. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/207318lbl.pdf
Walker, Z., Possin, K. L., Boeve, B. F., & Aarsland, D. (2015). Lewy body dementias. The Lancet, 386(10004), 1683-1697.
Required Media
Bolin, P. (2015, December 31). Neurocognitive disorders – CRASH! Medical review series [Video file]. Retrieved from https://www.youtube.com/watch?v=bQXOPITY9XM
Note: The approximate length of this media piece is 57 minutes.
Optional Resources
Kota, L. N., Bharath, S., Purushottam, M., Moily, N. S., Sivakumar, P. T., Varghese, M., . . . Jain, S. (2015). Reduced telomere length in neurodegenerative disorders may suggest shared biology. The Journal of Neuropsychiatry and Clinical Neurosciences, 27(2), e92–e96. doi:10.1176/appi.neuropsych.13100240
Lepkowsky, C. M. (2016). Neurocognitive disorder with Lewy bodies: Evidence-based diagnosis and treatment. Practice Innovations, 1(4), 234–242. doi:10.1037/pri0000031
Oltra-Cucarella, J., Pérez-Elvira, R., Espert, R., & Sohn McCormick, A. (2016). Are cognitive interventions effective in Alzheimer’s disease? A controlled meta-analysis of the effects of bias. Neuropsychology, 30(5), 631–652. doi:10.1037/neu0000283
Discussion: Treatment of Neurocognitive Disorders
Neurocognitive disorders (NCD) such as delirium, dementia, and amnestic disorders are more prevalent in older adults. As the population ages and as life expectancy in the United States continues to increase, the incidence of these disorders will continue to increase. Cognitive functioning such as memory, language, orientation, judgment, and problem solving are affected in clients with NCDs. Caring for someone with a neurocognitive disorder is not only challenging for the clinician, but also stressful for the family. The PMHNP needs to consider not only the client but also the “family as client.” Collaboration with primary care providers and specialty providers is essential. Anticipatory guidance also becomes extremely important.
In this Discussion, you will integrate several sources of knowledge specific to NCDs as you discuss evidenced-based therapies used to treat these disorders.
Learning Objectives
Students will:
Analyze diagnostic criteria for neurocognitive disorders
Analyze evidence-based psychotherapy and psychopharmacologic treatment for neurocognitive disorders
Evaluate benefits and risks of neurocognitive therapies
Compare differential diagnostic features of neurocognitive disordersPost:
Explain the diagnostic criteria for your assigned neurocognitive disorder.
Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned neurocognitive disorder.
Identify the risks of different types of therapy and explain how the benefits of the therapy that might be achieved might outweigh the risks.
Support your rationale with references to the Learning Resources or other academic resource.
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