Major or mild neurocognitive disorders (dementia)

Rationale

Neurocognitive disorder (dementia) is a decline in cognition in the setting of a stable level of consciousness. It is a major concern for families and caregivers and is increasing in prevalence with the aging population. Alzheimer disease is by far the most common form of neurocognitive disorder (dementia) in older adults. Preventive screening in older adults for risk factors and possible reversible disorders should be done routinely.

See also Objectives Frailty in older adults and Immunization.

Causal Conditions

(list not exhaustive)

1. Alzheimer disease
2. Vascular dementia (e.g., multi-infarct, lacunar infarcts)
3. Brain trauma (e.g., postconcussive, anoxia)
4. Drugs (e.g., alcohol use disorder, substance use disorder)
5. Toxins (e.g., heavy metals, organic toxins)
6. Neurodegenerative disorders (e.g., Parkinson disease, Lewy body dementia, Huntington disease)
7. Normal-pressure hydrocephalus
8. Intracranial masses (e.g., tumours, subdural masses, brain abscesses)
9. Infections (e.g., HIV, neurosyphilis)
10. Endocrine, metabolic, or nutritional disorders (e.g., hypothyroidism, vitamin B₁₂ deficiency)

Key Objectives

Given a patient who may be presenting with cognitive decline, the candidate will identify potential causes, severity, and complications, and will initiate an appropriate management plan. In particular, the candidate will identify deterioration in cognitive function and look for reversible risk factors. The candidate will differentiate early Alzheimer disease from other causes.

Enabling Objectives

Given a patient who may be presenting with cognitive decline, the candidate will

1. list and interpret critical clinical findings, including those based on
   1. a history from the patient and other collateral information to determine whether cognitive decline has occurred and if so, its time course, as well as possible risk factors (e.g., drugs, toxins),
   2. a differentiation of neurocognitive disorder (dementia) from psychiatric disorders (e.g., depression), and
   3. the determination of the patient’s mental status as well as the Mini–Mental State Examination;
2. list and interpret critical investigations (e.g., thyrotropin [thyroid-stimulating hormone] level, vitamin B₁₂ level, Venereal Disease Research Laboratory [VDRL] test);
3. construct an effective initial management plan, including
   1. treating reversible underlying conditions,
   2. initiating appropriate pharmacotherapy (e.g., cholinesterase inhibitors),
   3. counselling the patient and family (e.g., prognosis, alternate decision-making and support services), and
   4. determining whether a referral to specialized services (e.g., occupational therapy, substance use disorder treatment) is required.