Skip to main content

Neurocognitive Disorders and Neuropsychiatric Symptoms

  • Chapter
  • First Online:
Neurocognitive Behavioral Disorders
  • 942 Accesses

Abstract

The focus of this chapter is the prevention, identification, and management of neuropsychiatric symptoms (NPS) in those living with major neurocognitive disorders (MNCD). NPS refers to those behavioral and psychological symptoms that routinely cause suffering for individuals with MNCD, as well those who care for and about them. MNCD, often referred to as dementia, is a cognitive, behavioral, and functional syndrome. This chapter serves as a pragmatic and compassionate guide for management of NPS that commonly afflict individuals living with MNCD. NPS contribute to suffering and comprise the leading cause of quality of life concerns for those living with MNCD and their families. It is the NPS, rather than the NCD itself, that most often leads to placement of individuals in long-term care facilities. The authors of this text posit that the suffering caused by NPS needs to be the major focus of assessment and treatment. Therefore, this chapter will describe types of MNCD in the context of the various NPS that are associated with common dementias.

This chapter describes the predominant MNCDs. Degenerative NCDs include Alzheimer’s dementia (AD), dementia with Lewy bodies (LBD), Parkinson’s-related dementia (PDD), NCD due to Huntington’s disease, and frontotemporal lobe dementia (FTLD). Injury-related NCDs include vascular dementia and NCD due to traumatic brain injury (TBI). This chapter will end with a discussion on delirium, a potentially reversible NCD that is a result of toxic or noxious stimuli. The discussion of these NCDs will include diagnostic criteria, etiology, and treatment considerations, with emphasis on NPSs that accompany each NCD.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 99.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. American Academy of Neurology. Practice parameter: the management of concussion in sports (summary statement). Report of the quality standards subcommittee. Neurology. 1997;48(3):581.

    Article  Google Scholar 

  2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.

    Book  Google Scholar 

  3. American Psychiatric Associations‘ Practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia. 2016. https://doi.org/10.1176/APPI.BOOKS.9780890426807.

  4. Boettgera S, Breitbart W. Phenomenology of the subtypes of delirium: Phenomenological differences between hyperactive and hypoactive delirium. Palliat Supportive Care. 2011;9(2):129–35.

    Google Scholar 

  5. Center for Medicare and Medicaid Services. Yearly “Wellness” visits. 2018. Retrieved from https://www.medicare.gov/coverage/yearly-wellness-visits.

  6. Cohen-Mansfield J, Marx M, Rosenthal A. A description of agitation in a nursing home. J Gerontol. 1989;44(3):M77–84.

    Article  CAS  Google Scholar 

  7. Cozolino L. The neuroscience of psychotherapy: building and rebuilding the human brain. New York: Norton; 2002.

    Google Scholar 

  8. Cummings JL. The neuropsychiatric inventory: assessing psychopathology in dementia patients. Neurology. 1997;48(Supp16):SlO–16.

    Google Scholar 

  9. Cummings JL, et al. The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44:2308–14.

    Article  CAS  Google Scholar 

  10. de Medeiros K, Robert P, Gauthier S, Stella F, Politis A, Leoutsakos J, Taragano F, Kremer J, Brugnolo A, Porsteinsson AP, Geda YE, Brodaty H, Gazdag G, Cummings J, et al. The Neuropsychiatric Inventory-Clinician rating scale (NPI-C): reliability and validity of a revised assessment of neuropsychiatric symptoms in dementia. Int Psychogeriatr. 2010;22(6):984–94.

    Article  Google Scholar 

  11. Early-stage caregiving/Caregiver Center/Alzheimer’s Association; 2018. Retrieved from https://www.alz.operceptual-motorrg/help-support/caregiving/stages-behaviors/hallucinations

  12. Hirtz D, Thurman DJ, Gwinn-Hardy K, Mohamed M, Chaudhuri AR, Zalutsky R. How common are the “common” neurologic disorders? Neurology. 2007;68:32637.

    Article  Google Scholar 

  13. Ho SL, Chorea. The International parkinson and movement disorder society; 2018. Retrieved from https://www.movementdisorders.org/MDS/About/Movement-Disorder-Overviews/Chorea%2D%2DHuntingtons- Disease.htm.

  14. Institute of Medicine (US) Forum on Neuroscience and Nervous System Disorders. Glutamate-related biomarkers in drug development for disorders of the nervous system: workshop summary. Washington, DC: National Academies Press (US); 2011. 2, Overview of the Glutamatergic System. Available from: https://www.ncbi.nlm.nih.gov/books/NBK62187/

  15. Lewy Body Dementia Association. When Parkisonism does not mean Parkinson’s. ScienceDaily. ScienceDaily, 21 January 2015.

    Google Scholar 

  16. Lyketsos CG, Lopez O, Jones B, Fitzpatrick AL, Breitner J, DeKosky S. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment results from the cardiovascular health study. JAMA. 2002;288(12):1475–83. https://doi.org/10.1001/jama.288.12.1475.

    Article  PubMed  Google Scholar 

  17. Lyketsos CG, Carrillo MC, Ryan JM, Khachaturian AS, Trzepacz P, Amatniek J, Cedarbaum J, Brashear R, et al. Neuropsychiatric symptoms in Alzheimer’s disease. Alzheimers Dement. 2011;7(5):532–9.

    Google Scholar 

  18. Marcantonio ER. Delirium in hospitalized older adults. N Engl J Med. 2017;377:1456–66.

    Article  Google Scholar 

  19. McAllister TW, Flashman LA, Maerlender A, Greenwald RM, Beckwith JG, Tosteson TD, Crisco JJ, Brolinson PG, Duma SM, Duhaime AC, Grove MR, Turco JH. Cognitive effects of one season of head impacts in a cohort of collegiate contact sport athletes. Neurology. 2012;78(22):1777–84.

    Article  CAS  Google Scholar 

  20. McCusker EA, Gunn DG, Epping EA, Loy CT, Radford K, Griffith J, Mills JA, Long JD, Paulsen JS. PREDICT-HD investigators of the Huntington study group. Neurology. 2013;81(13):1141–7.

    Article  Google Scholar 

  21. Nash, MC. Lewy who? A discussion of Lewy body dementia. Alzheimer’s Resource of Alaska, Anchorage, Alaska, November 2013.

    Google Scholar 

  22. Nash M, Swantek SS. Neuropsychiatric symptoms of dementia: monotherapy, or combination therapy? Curr Psychiatr Ther. 2018;17(7):21–5.

    Google Scholar 

  23. Paulsen JS. The cognitive disorder. In: Nance M, Paulsen JS, Rosenblatt A, Wheelock V, editors. A Physician’s guide to the management of Huntington’s disease. 3rd ed. New York: Huntington’s Disease Society of America; 2011. p. 51. Retrieved from http://hdsa.org/wp-content/uploads/2015/03/PhysiciansGuide_3rd-Edition.pdf.

  24. Petersen RC. Mild cognitive impairment. N Engl J Med. 2011;364(23):2227.

    Article  CAS  Google Scholar 

  25. Petersen RC, Negash S. Mild cognitive impairment: an overview. CNS Spectr. 2008;13:45–53.

    Article  Google Scholar 

  26. Reisberg B, Auer SR, Monteiro IM. Behavioral pathology in Alzheimer’s disease (BEHAVE–AD) rating scale. Int Psychogeriatr. 1996;8(Suppl 3):301–8, 507–550.

    Google Scholar 

  27. Rose SS. Delirium. In: Mauk K, editor. Gerontological competencies for care. 4th ed. Burlington: Jones & Bartlett; 2018a.

    Google Scholar 

  28. Rose, SS. Geropsych pearls; 2018b. Retrieved from www.geroconsult.org.

  29. Rosen WG, Mohs RC, Davis KL. A new rating scale for Alzheimer’s disease. Am J Psychiatr. 1984;141:1356–64.

    Article  CAS  Google Scholar 

  30. Schore A. Early relational trauma, disorganized attachment and the development of a predisposition to violence. In: Solomon M, Siegel DJ, editors. Healing trauma: attachment, mind, body and brain. New York: Norton; 2003.

    Google Scholar 

  31. Smith GE, Bondi MW. Mild cognitive impairment and dementia: definitions, diagnosis, and treatment. New York: Oxford University Press; 2013.

    Google Scholar 

  32. Steinberg M, Shao H, Zandi P, Lyketsos CG, Welsh-Bohmer KA, Norton MC, Breitner JC, Steffens DC, Tschanz JT, Cache County Investigators. Point and 5-year period prevalence of neuropsychiatric symptoms in dementia: the Cache County Study. Int J Geriatr Psychiatr. 2008;23(2):170–7.

    Article  Google Scholar 

  33. Suchowersky O. Huntington disease: clinical features and diagnosis, UpToDate; 2018. Retrieved November 19, 2018.

    Google Scholar 

  34. Taylor JP, Collerton D. Advances in the treatment of visual hallucinations in neurodegenerative diseases. Future Neurol. 2013;8(4):433–44.

    Article  Google Scholar 

  35. Truman B, Ely EW. Monitoring delirium in critically ill patients. Critical Care Nurse. 2003;23:25–36.

    PubMed  Google Scholar 

  36. Wang HK, Lin SH, Wu MH, Hung KW, Wang LC, Huang CY, Lu K, Chen HJ, Tsai KJ. Population based study on patients with traumatic brain injury suggests increased risk of dementia. J Neurol Neurosurg Psychiatr. 2012;83(11):1080–5.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Rose, S.S. (2019). Neurocognitive Disorders and Neuropsychiatric Symptoms. In: Nash, M., Foidel, S. (eds) Neurocognitive Behavioral Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-11268-4_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-11268-4_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-11267-7

  • Online ISBN: 978-3-030-11268-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics