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14.5: Treatments for Neurocognitive Disorders

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    221830

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    Learning Objectives
    • Describe psychological perspectives and treatments for neurocognitive disorders

    In this course, we have learned to assess and analyze disorders from multiple psychological perspectives, such as the psychodynamic, biological, humanistic, behavioral, and cognitive perspectives. Neurocognitive disorders, by definition, mostly relate to the cognitive perspective, as the cognitive perspective views psychological disorders as originating from an interruption, whether short or long, in our basic cognitive functions, i.e., memory processing, perception, problem-solving, and language. All the neurocognitive disorders have biological causes, as explained in the previous readings, because they are attributed to biological changes caused by Alzheimer’s, Parkinson’s, Huntington’s disease, HIV, traumatic brain injury (TBI), or other illnesses. The focus in understanding and treating neurocognitive disorders lies then in understanding the biological changes and what measures can be taken to slow cognitive decline. There is evidence that some measures are effective in preventing or slowing the progression of cognitive symptoms.

    Recall that major neurocognitive disorder (MND) is a syndrome that progresses with significant deterioration of cognitive domains as compared to previous levels of cognitive performance in memory, speech, reasoning, intellectual function, and/or spatiotemporal perception, and may also be associated with changes in emotional behavior and difficulties at the functional level. The decline is initially noticed by the individual, the family, or the general practitioner (GP) who is usually responsible for the early diagnosis (American Psychiatric Association [APA], 2014).

    MND may result from brain disorders, classified as primary (degenerative), or be a consequence of other conditions (secondary) (Emre, 2009). The most common types of MND are Alzheimer’s disease, vascular dementia (VaD), Lewy body dementia, and frontotemporal dementia (FD). In secondary MND (e.g., alcoholic dementia and infectious diseases), the symptoms may be treated and/or prevented. Therefore, a correct diagnosis is crucial for proper disease management and treatment. This is supported by a detailed collection of the person’s clinical history, neurological and neuropsychological examination, and the comprehensive use of laboratory and imaging tests. In primary MND, early diagnosis is equally crucial either to delay the progression of cognitive symptoms and to control/stabilize psychiatric manifestations (Ribeira et al., 2004).

    Predictive Factors of MND

    MND is likely to develop in a continuous process (Brooks and Loewenstein, 2010). Individual factors affect the likelihood of developing MND and these factors predicting the development of the disease should be known. If known, preventive interventions may prevent or protect people at risk of MND.

    Previous studies have identified predictive factors of MND, which can be grouped into the following:

    • sociodemographic factors (e.g., sex, age, and years spent in education and social isolation)
    • health factors (e.g., hearing loss, cardiovascular diseases, hypertension, diabetes, handgrip strength, and nutritional status)
    • bio-behavioral factors (e.g., smoke, alcohol, and physical activity) (Helzner et al., 2009; Nagai et al., 2010; Polidori et al., 2012; Baumgart et al., 2015; Santana et al., 2015; Schwarzinger et al., 2018)

    Given that most of these factors are all potentially modifiable (e.g., diabetes, cholesterol, depression, or malnutrition; Chen et al., 2017), the individual can play an active role in the prevention or management of MND, which creates the opportunity to allow for more efficient intervention. Primary prevention in the primary health care context is important for the course of MND and should focus on the identification of situations that increase the likelihood of occurrence or worsening of symptoms. However, few studies identify predictive factors associated with the severe stage of MND (Eshkoor et al., 2016).

    A study by Sousa, Laetitia Teixeira, and Constança Paúl identified four predictors of MND including age, years spent in education, physical activity, and hand strength. Physical activity, hand strength, and education play a protective role (“the more the better”). On the other hand and as expected, while age increases, the risk of MND also increases.[1]

    There is extensive and persuasive evidence from mechanistic and well-designed prospective cohort studies that reducing the exposure to high blood pressure and hypertension in mid-life and to diabetes in mid-and late life, reducing tobacco use, and increasing the education level of populations can effectively reduce the dementia risk for populations (Prince et al, 2014).

    Treating Neurocognitive Disorders

    There is no cure for neurocognitive disorders or the diseases that cause them. Pharmacological approaches combined with behavioral and environmental interventions are most successful in treating neurocognitive disorders.

    A person getting their blood pressure checked by a nurse.
    Figure \(\PageIndex{1}\): High blood pressure is a vascular risk factor for developing a neurocognitive disorder.

    Antidepressants, antipsychotics, and other medications that treat memory loss and behavioral symptoms are also available and may help to treat the diseases. Ongoing psychotherapy and psychosocial support for patients and families are usually necessary for clear understanding and proper management of the disorder and to help maintain a better quality of life for caregivers and patients. In addition, speech therapy has been shown to help neurocognitive dementia patients with language impairment.

    Studies suggest that diets with high Omega 3 content and low in saturated fats and sugars, along with regular exercise can increase the level of brain plasticity. Other studies have shown that mental exercise such as newly developed computerized brain training programs can also help build and maintain targeted specific areas of the brain. These studies have been very successful for those diagnosed with schizophrenia and can improve fluid intelligence and the ability to adapt and deal with new problems or challenges the first time encountered; in young people, it can still be effective in later life.

    A person with amnesia may slowly be able to recall their memories or work with an occupational therapist to learn new information to replace what was lost or to use intact memories as a basis for taking in new information. If amnesia is caused by an underlying cause such as Alzheimer’s disease or infections, the cause may be treated but the amnesia may not be.

    1. Sousa, Susana, Laetitia Teixeira, and Constança Paúl. “Assessment of Major Neurocognitive Disorders in Primary Health Care: Predictors of Individual Risk Factors.” Frontiers in Psychology 11 (2020): 1413. https://doi.org/10.3389/fpsyg.2020.01413. ↵
    2. Thakur KT, Albanese E, Giannakopoulos P, et al. Neurological Disorders. In: Patel V, Chisholm D, Dua T, et al., editors. Mental, Neurological, and Substance Use Disorders: Disease Control Priorities, Third Edition (Volume 4). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2016 Mar 14. Chapter 5. Available from: https://www.ncbi.nlm.nih.gov/books/NBK361950/ doi: 10.1596/978-1-4648-0426-7_ch5 ↵
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