NEUROCOGNITIVE DISORDERS ALZHEIMERS PARKINSONS AMNESIA AND KARSAKOFF PSYCHOSIS

NEUROCOGNITIVE DISORDERS: ALZHEIMER’S, PARKINSON’S, AMNESIA AND KARSAKOFF PSYCHOSIS

Neurocognitive Disorders • Neurocognitive disorders are the group of conditions that frequently lead to impaired mental functions. The term Organic Syndrome is used to describe these conditions, but most commonly used term is neurocognitive disorders. • Neurocognitive disorders most commonly occur in older adults, but they can affect younger people as well. It reduces mental function may include problems with memory, changes in behavior, difficulty in understanding language, confusion, and difficulty in performing daily activities. • These symptoms may be caused by a neurodegenerative conditions, such as Alzheimer’s disease and Dementia. Neurodegenerative disease cause the brain and nerves to deteriorate overtime, resulting in a gradual loss of neurological function. Neurocognitive disorders can also develop as a result of brain trauma and substance abuse.

Continue The most common cause of neurocognitive disorder is a neurodegenerative disease such as Alzheimer’s disease, Parkinson’s disease, Huntington's disease, Multiple sclerosis and so on.

ALZHEIMER’S DISEASE • Alzheimer’s disease initially described by the German neurologist Alois Alzheimer in 1906. Alzheimer’s disease is an irreversible, progressive brain disorder that gradually destroys memory and thinking skills and eventually, the ability to perform simple task. • In Alzheimer’s disease, brain tissue irreversibly deteriorates, and death usually occurs within the 12 years after the onset of symptoms. Late onset first appears in the mid 60 s and early onset occurs between a person’s 30 s and mid 60 s and is very rare. •

Continue • Alzheimer’s disease is the most common cause of dementia among older adults. • Dementia: a continuous decline in thinking, behavioral and social skills that disrupts a person’s ability to function independently. • People with Alzheimer’s disease have several problems such as memory loss, language problem, unpredictable behavior and so on. • People with Alzheimer’s disease have more Plaques (small, round beta amyloid protein deposits that are outside the neuron) and Neurofibrillary Tangles (twisted protein filaments composed largely of the protein , tau, in the cell bodies of neurons).

Continue • The plaques are most densely present in the frontal cortex of people with Alzheimer’s disease and tangles are most densely present in the hippocampus, an area that is important for memory. Plaques and tangles spread through more of the brain as the disease progresses.

Signs and Symptoms of Alzheimer’s Disease • The early signs of the disease may be forgetting recent events or conversations. As the disease progresses, a person with Alzheimer’s disease will develop severe impairment and lose the ability to carry out every day tasks. • Warning signs and symptoms of Alzheimer’s disease: 1) Memory loss that disrupts daily life. 2) Difficulty in planning and problem solving. 3) Difficulty in completing familiar tasks. 4) Problem in speaking or writing.

Continue 5) Confusion with time or place. 6) Difficulty in understanding visual images and spatial relationships. 7) Withdrawal from work and social activities. 8) Changes in mood and personality. 9) Poor judgments.

Causes of Alzheimer’s Disease • The exact cause of Alzheimer’s disease are not completely known, but at its core are problems with brain proteins that fail to function normally, disrupt the work of brain cells (neurons) and unleash a series of toxic events. Neurons are damaged, loose connections to each other and eventually die. • Alzheimer’s disease is caused by many factors including genetic, lifestyle, and environment that affect the brain overtime. Some of the causes are: • Age: increasing age is the highest known risk factors for Alzheimer’s disease.

Continue • family history and genetics: greater risk of developing Alzheimer’s if a first-degree relative- parents and siblings has the disease. • Apolipo protein E gene (APOE)e 4 increases the risk of developing Alzheimer’s disease, but not everyone with this variation of the gene develops the disease. • Rare changes (mutation) in three genes that virtually guarantee a person who inherits one of them will develop Alzheimer’s, but these mutations account for less than 1 percent of people with Alzheimer’s disease.

Continue • Down Syndrome: people with Down Syndrome also have a risk for developing Alzheimer’s disease. This is related having three copies of chromosome 21. The three copies of the gene for the protein that leads to the creation of beta amyloid. Symptoms of Alzheimer’s disease tend to appear 10 to 20 years earlier in people with Down Syndrome as compared to general population. • Gender: women are more prone to develop Alzheimer’s disease because women live longer than men. • Mild cognitive impairment: it is decline in memory or other thinking skills. Mild difficulty does not interfere with the functioning in social or work environment.

Continue • Past head trauma: severe head trauma leads to Alzheimer’s disease. • Poor sleep patterns: difficulty in falling and staying asleep is associated with an increased risk of developing Alzheimer’s disease. • Life style and heart health: • Lack of exercise, obesity, smoking or exposure to second hand smoke, high blood pressure, high cholesterol and so on. .

Treatment of Alzheimer’s Disease • Medications help to reduce or control some behavioral symptoms. • Cognitive Simulation Therapy: taking part in group activities and exercises designed to improve memory and problem solving skills. • Cognitive Rehabilitation: working with trained professionals such as an occupational therapist , and a relatives or friends to achieve a personal goals such as learning to perform every day task.

PARKINSON’S DISEASE • Parkinson’s disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement. • In the early stage of Parkinson’s disease, people are not able to show facial expression, no arms swings when walk, and speech become soft and slurred. The condition may worsen as the disease progresses overtime. • Parkinson’s disease is a neurodegenerative disorder that affects predominately dopamine-producing (dopaminergic) neurons in a specific area of the brain called substantia nigra, it also affects the nervous system and symptoms become worse overtime.

Symptoms of Parkinson’s Disease • Symptoms often begin with one side of the body and usually remain worse on that side, even after symptoms begin to affect both sides. • Signs and symptoms include: • Tremor: A tremor, or shaking usually begins in a limb, hand, and fingers. Hand may tremor when it’s at rest. • Rigid Muscles: Muscles stiffness may occur in any part of the body. It can be painful.

Continue • Slowed Movement (Bradykinesia): Movement become slow overtime, making simple task difficult and time consuming. Steps may become shorter when walk, and it may difficult to get out of a chair. • Impaired Posture and Balance: Posture may become stopped or have a balance problem. • Loss of Automatic Movements: It reduces the ability to perform unconscious movements, including blinking, smiling and so on. • Speech Changes: Speech become soft and slurry; and may hesitate before talking. • Problems in Writing: It become hard to write.

Causes of Parkinson’s Disease • In Parkinson’s disease, certain nerve cells (neurons) in the brain gradually break down or die. Many of the symptoms are due to loss of neurons that produce a chemical messenger in the brain called dopamine. When dopamine level decreases, it causes abnormal brain activity associated with Parkinson’s disease. • The causes of Parkinson’s disease is unknown, but several factors appears to play a role. • Genes: specific genetic mutations can cause Parkinson’s disease.

Continue • Environmental Triggers: exposure to certain toxins or environmental factors increases the risk of later developing Parkinson’s disease, but the risk is relatively small. • Changes occur in the brain is also one of the cause of Parkinson’s disease. The changes include: • The Presence of Lewy Bodies: clumps of specific substance within the brain cells. • Alpha-Synuclein is found within the Lewy Bodies.

Risk Factors • Risk factors included age, heredity, sex, and exposure to toxins. Treatment of Parkinson’s Disease • Medication therapy. • Surgical Procedure: it included, • Deep brain simulation.

AMNESIA • Amnesia is a general term for a condition in which memory (either stored memories or the process of committing something to memory) is disturbed or lost, to a greater extent than simple everyday forgetting or absent mindedness. • Amnesia may result either from organic or neurological causes (damage to the brain through physical injury, neurological disease or the use of certain drugs) or from functional and psychogenic causes (psychological factors such as mental disorders, post–traumatic stress or psychological defense mechanisms).

Continue • Amnesia is also called “Amnestic Syndrome”. People may have difficulty in learning new information and forming new memories. It is caused by a damaged to the areas of the brain that are vital for memory processing. It refers to a loss of memories such as facts, information, and experiences.

SYMPTOMS OF AMNESIA • The primary symptom of amnesia is memory loss or inability to form new memories. It may have difficulty in recalling facts, events places or specific details.

TYPES OF AMNESIA • There are multiple types of amnesia, including retrograde amnesia, anterograde amnesia, and transient global amnesia. Retrograde amnesia • When you have retrograde amnesia, you lose existing, previously made memories. This type of amnesia tends to affect recently formed memories first. Older memories, such as memories from childhood, are usually affected more slowly. Diseases such as dementia cause gradual retrograde amnesia.

Continue • Anterograde amnesia When you have anterograde amnesia, you can’t form new memories. This effect can be temporary. For example, you can experience it during a blackout caused by too much alcohol. It can also be permanent. You can experience it if the area of your brain known as your hippocampus is damaged. Your hippocampus plays an important role in forming memories. • Transient global amnesia (TGA) is a poorly understood condition. If you develop it, you will experience confusion or agitation that comes and goes repeatedly over the course of several hours. You may experience memory loss in the hours before the attack, and you will probably have no lasting memory of the experience. Scientists think that TGA occurs as the result of seizure-like activity or a brief blockage of the blood vessels supplying your brain. It occurs more frequently in middle-aged and older adults.

Continue • Infantile amnesia Most people can’t remember the first three to five years of life. This common phenomenon is called infantile or childhood amnesia .

Causes of amnesia • Dementia A memory’s location in your brain is thought to depend on its age. To lose old memories, you must have widespread brain deterioration. This can be caused by Alzheimer’s disease or other forms of dementia. People with dementia usually lose more recent memories first and keep older memories longer. • Anoxia A depletion of oxygen levels can also affect your entire brain and lead to memory loss. This condition is called anoxia. If the anoxia isn’t severe enough to cause brain damage, the memory loss can be temporary.

Continue • Damage to the hippocampus Your hippocampus is a part of the brain and limbic system responsible for memory. Its activities include forming memories, organizing memories, and retrieving them when needed. Its cells are some of your brain’s most energy-hungry and fragile. They’re most easily disrupted by anoxia and other threats such toxins. When your hippocampus is impaired, you will have difficulty forming new memories. If your hippocampus is damaged in both halves of your brain, you can develop complete anterograde amnesia.

Continue • Head injuries Traumatic head injuries, as well as stroke, tumours, and infections, can also cause damage to your brain. This damage can include permanent memory problems. Concussions commonly disrupt memories of the hours, days, or weeks before and after you were injured. • Alcohol use Short-term alcohol use can cause blackout. This is a temporary form of anterograde amnesia. Long-term alcoholism can cause Wernicke-Korsakoff syndrome. If you develop this condition, you will have difficulty forming new memories but may not be aware of it.

Treatment • In most cases, amnesia resolves itself without treatment. However, if an underlying physical or mental disorder is present, treatment may be necessary. • Psychotherapy can help some patients. Hypnosis can be an effective way of recalling memories that have been forgotten. • Family support is crucial. Photographs, smells, and music may help. • Treatment often involves techniques and strategies to help compensate for the memory problem. This may involve: • Working with an occupational therapist to acquire new information to replace lost memories, or to use existing memories as a basis for acquiring new information. • Learning strategies for organizing information, to make it easier to store. • Using digital aids, such as smartphones, to help with daily tasks and remind patients about important events, when to take medications, and so on. A contact list with photographs of faces may be helpful.

Korsakoff Syndrome • Korsakoff syndrome or Warnicke’s Syndrome is a chronic memory disorder caused by severe deficiency of thiamine (vitamin B-1). Korsakoff syndrome is most commonly caused by alcohol misuse, but certain other conditions also can cause the syndrome. • Korsakoff's syndrome is a disorder in which memory deficits are disproportionate to other cognitive deficits. It is a form of amnesia which is primarily caused by thiamine depletion that is usually associated with chronic alcoholism, but also occasionally with malnutrition.

Symptoms • Confusion and loss of mental activity that can progress to coma and death. • Loss of muscle coordination (ataxia) that can cause leg tremor. • Vision changes such as abnormal eye movements (back and forth movements called nystagmus), double vision, eyelid drooping. • Alcohol withdrawal.

Causes • WKS is most common among people with alcohol use disorder. Thiamine deficiency is a common effect of heavy, regular alcohol consumption. • Individuals whose bodies do not absorb nutrients efficiently, who are malnourished, or who fast for a long time may experience thiamine deficiency as well. • Heavy drinking is often accompanied by poor diet, but alcohol also interferes with the proper absorption of nutrients from the digestive system. Thiamine is needed by the body to convert food into energy. It is stored in small quantities in the liver, but only for up to 18 days.

Continue • Other risk factors for thiamine deficiency include: • recent surgery for obesity, as this may limit portion size and nutrient absorption • kidney dialysis • hyperemesis, or severe and persistent vomiting • anorexia nervosa, bulimia, and other eating disorders • extreme diets or fasting • stage-3 HIV • chronic infection • cancer that has spread throughout the body