Dementia
Carole K. H. Bartoo
Definition
The following are Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) guidelines for defining neurocognitive disorders:
a.Types of neurocognitive disorders:
i.Alzheimer’s disease.
ii.Frontotemporal lobar degeneration.
iii.Lewy body disease.
iv.Vascular disease.
v.Traumatic brain injury.
vi.Substance/medication use.
vii.HIV infection.
viii.Prion disease.
ix.Parkinson’s disease.
x.Huntington’s disease.
A.Impairment occurs in the following domains:
1.Neurocognitive domains:
a.Language—expressive language, wordfinding, naming, fluency, grammar.
b.Perceptual—motor-visual perception, praxis.
c.Social cognition—recognition of emotions, social appropriateness.
2.Complex attention:
a.Major—difficulty with multiple stimuli, easily distracted, difficulty with multistep tasks.
b.Mild—tasks take longer, needs to double check more often.
3.Executive functioning:
a.Major—must rely upon others for planning daily activities or making decisions.
b.Mild—complains about extra effort required to plan, organize, and make decisions.
4.Learning and memory:
a.Major—repeats self often, requires frequent reorientation, reminders.
b.Mild—difficulty recalling recent events, relies more on written lists, reminders.
5.Language:
a.Major—significant impairment in understanding or expressing language, difficulty naming, reduced output of spoken communication.
b.Mild—word finding difficulty, subtle grammatical errors.
6.Perceptual-motor:
a.Major—significant difficulty with familiar tasks(driving, use of tools), navigation.
b.Mild—more reliance on others for directions, greater effort needed for assembly, carpentry, and so on.
7.Social cognition:
a.Major—clear unacceptable social behavior in terms of dress, grooming, and topics of conversation; no regard or awareness of reaction of others, or safety, no insight.
b.Mild—subtle changes in personality, less able to recognize social cues.
Screening
In the primary care setting, there are several simple tools that are commonly used to determine presence or severity of cognitive impairment.
1.The Brief Interview for Mental Status (BIMS) is a performance-based assessment of cognitive functioning that is scored 0 to 15, with scores below 7 indicating severe cognitive impairment (Saliba et al., 2012).
2.The Cognitive Performance Scale (CPS) includes five items: Cognitive skills for daily decision making, short-term memory problems, procedural memory problems, making self understood, and eating.
3.Mini-Mental State Examination (MMSE, www.uml.edu/docs/Mini%20Mental%20State%20Exam_tcm18-169319.pdf ).
4.Functional Assessment Staging (FAST) of Alzheimer’s disease (www.pbm.va.gov/PBM/clinicalguidance/drugmonitoring/FunctionalAssessmentStagingFAST73108.doc).