A Complex Case of Major Neurocognitive Disorder: Alzheimer’s Disease

  • Popuri M. KrishnaEmail author
  • Kuppuswami Shivakumar
  • Shabbir Amanullah


Major neurocognitive disorder (MND) is a term that has been incorporated in DSM-5 to replace the term dementia. MND is a clinical syndrome characterized by global cognitive decline from the previous level of functioning as evidenced in the loss of one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptomotor, or social cognition). Occurring in clear sensorium, this decline interferes with the individual’s ability to be independent. MND is a public health issue with significant impact on patients, their families, and the community. Dementia is already an epidemic in the developed countries (Murray and Lopez, The Lancet, 349(9064):1498–1504, 1997). In more than 50% of cases of major neurocognitive disorders, Alzheimer’s disease is the cause (Alzheimer’s Association 2011). The pathology of AD is clearly defined to consist of neuritic plaques (NP), neurofibrillary tangles (NFT), and subsequent neuronal loss, which are present in a typical distribution in the brains of the afflicted patients. The two most common risk factors for AD are advanced age and family history of dementia.

The following case illustrates complex presentation in a female patient with early onset of symptoms from around 49 years of age. The genetic factors and clinical, ethical, and legal challenges will be illustrated.


Alzheimer’s Disease APOE gene Early-onset Alzheimer’s disease Caregiver burden in Alzheimer’s disease 



42-amino acid beta-amyloid


Alzheimer’s disease


Activities of daily living


Apolipoprotein E


Amyloid precursor protein


Cerebrospinal fluid


Computed tomography


Diagnostic and Statistical Manual


Microtubule-associated protein tau


Minimal cognitive impairment


Magnetic resonance imaging


Neurofibrillary tangles


Neuritic plaques


Pittsburgh compound B




Single photon emission computed tomography


Disclosure Statement

“The authors have nothing to disclose.”


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Popuri M. Krishna
    • 1
    Email author
  • Kuppuswami Shivakumar
    • 1
  • Shabbir Amanullah
    • 2
  1. 1.Department of PsychiatryNorthern Ontario School of Medicine Psychiatry DepartmentSudburyCanada
  2. 2.University of Western OntarioWoodstock General Hospital University of Western OntarioWoodstockCanada

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