20 Feb NRNP 6635 – Week 10: Neurocognitive and Neurodevelopmental Disorders

1. Introduction
Neurocognitive disorders (NCDs): Conditions characterized by decline in cognitive function compared to a previous level of performance.

Neurodevelopmental disorders (NDDs): Conditions with onset in the developmental period, typically manifesting before age 18, involving deficits in personal, social, academic, or occupational functioning.

Clinical Importance: Both categories significantly impact quality of life, independence, and family functioning. Early recognition and intervention are critical.

2. Neurocognitive Disorders (NCDs)
Definition
Acquired disorders marked by decline in memory, attention, executive function, language, learning, or social cognition.

Distinguished from developmental disorders by later onset and progressive decline.

Major Types
Delirium: Acute disturbance in attention and awareness, fluctuating course, often due to medical illness or substance intoxication/withdrawal.

Major Neurocognitive Disorder (Dementia): Significant cognitive decline interfering with independence.

Mild Neurocognitive Disorder: Modest decline, does not interfere with independence but requires compensatory strategies.

Etiologies
Alzheimer’s disease.

Vascular disease (multi‑infarct dementia).

Lewy body disease.

Frontotemporal lobar degeneration.

Traumatic brain injury.

Substance/medication‑induced.

HIV infection, prion disease, Parkinson’s, Huntington’s.

Clinical Features
Memory impairment.

Executive dysfunction.

Language deficits (aphasia).

Motor impairment (apraxia).

Recognition deficits (agnosia).

Personality and behavioral changes.

Assessment Tools
MOCA (Montreal Cognitive Assessment).

MMSE (Mini‑Mental State Exam).

Neuropsychological testing.

Functional assessments.

Treatment
Pharmacological: Cholinesterase inhibitors (donepezil, rivastigmine), memantine.

Non‑pharmacological: Cognitive rehabilitation, structured routines, caregiver support.

Prevention: Control vascular risk factors, healthy lifestyle.

3. Neurodevelopmental Disorders (NDDs)
Definition
Disorders with onset during developmental period, producing impairments in personal, social, academic, or occupational functioning.

Major Types
Intellectual Disability (ID): Deficits in intellectual and adaptive functioning.

Autism Spectrum Disorder (ASD): Deficits in social communication and restricted, repetitive behaviors.

Attention‑Deficit/Hyperactivity Disorder (ADHD): Persistent inattention and/or hyperactivity‑impulsivity.

Specific Learning Disorders: Difficulties in reading, writing, or mathematics.

Communication Disorders: Language disorder, speech sound disorder, stuttering.

Motor Disorders: Developmental coordination disorder, stereotypic movement disorder, tic disorders (Tourette’s).

Clinical Features
Early onset (childhood).

Impairments in school performance.

Social difficulties.

Behavioral dysregulation.

Often comorbid with anxiety, depression, or conduct disorders.

Assessment Tools
ASRS (Adult ADHD Self‑Report Scale).

Conners Rating Scales.

Vanderbilt Assessment Scales.

ADOS‑2 (Autism Diagnostic Observation Schedule).

IQ testing (WISC, WAIS).

Adaptive behavior scales.

Treatment
Pharmacological:

ADHD: Stimulants (methylphenidate, amphetamines), non‑stimulants (atomoxetine, guanfacine).

ASD: Antipsychotics for irritability (risperidone, aripiprazole).

Psychotherapy: Behavioral therapy, CBT, parent training.

Educational Interventions: IEPs, special education services.

Lifestyle: Structured routines, social skills training, occupational therapy.

4. Comparison: NCDs vs. NDDs
Feature Neurocognitive Disorders Neurodevelopmental Disorders
Onset Later life (adulthood/aging) Childhood/adolescence
Course Progressive decline Lifelong, developmental deficits
Etiology Neurodegeneration, vascular, trauma, infection Genetic, prenatal, perinatal, neurobiological
Treatment Cognitive enhancers, caregiver support Behavioral therapy, educational support, stimulants
Impact Loss of independence Impaired learning/socialization
5. Case Study Integration
Harold Brown (Training Title 50): 60‑year‑old male with MOCA 28/30, ASRS‑5 21/24.

Suggests mild neurocognitive disorder with attention deficits, possible adult ADHD traits.

Medical comorbidities (HTN, angina, hyperlipidemia, BPH) increase vascular risk.

Management: Optimize medical conditions, cognitive training, ADHD evaluation, lifestyle interventions.

Sarah Higgins (Training Title 48): 11‑year‑old female with difficulty sitting for meals.

Suggests possible ADHD or normal developmental variation.

Management: Behavioral therapy, school support, ADHD screening.

6. Nursing and Clinical Implications
Assessment: Comprehensive history, collateral information, standardized tools.

Intervention: Tailored to disorder type, age, severity.

Family Support: Education, counseling, respite care.

Ethical Issues: Autonomy, confidentiality, consent, stigma.

Cultural Considerations: Respect cultural beliefs about mental illness and development.

7. Summary
Neurocognitive disorders involve acquired decline in cognition, often progressive.

Neurodevelopmental disorders involve early‑onset deficits in learning, communication, or behavior.

Both categories require multidisciplinary management, combining pharmacological, behavioral, educational, and supportive interventions.

Early recognition and intervention improve outcomes and quality of life.

📝 Quiz (15 Questions)
Multiple Choice – Select the best answer.

Which disorder involves acute disturbance in attention and awareness? a) Delirium b) Dementia c) ADHD d) Autism

Which test is commonly used to screen for mild cognitive impairment? a) MOCA b) ADOS‑2 c) Conners d) PHQ‑9

Which neurotransmitter system is targeted by cholinesterase inhibitors in dementia? a) Dopamine b) Serotonin c) Acetylcholine d) GABA

Which neurodevelopmental disorder involves deficits in social communication and restricted behaviors? a) ADHD b) Autism Spectrum Disorder c) Intellectual Disability d) Tourette’s

Which medication is first‑line for ADHD? a) Risperidone b) Methylphenidate c) Clozapine d) Lithium

Which disorder is associated with repetitive motor or vocal tics? a) Tourette’s b) ASD c) ODD d) MCI

Which condition is characterized by modest cognitive decline without loss of independence? a) Major NCD b) Mild NCD c) Delirium d) Intellectual Disability

Which tool is used to assess autism? a) ADOS‑2 b) MOCA c) MMSE d) AIMS

Which lifestyle intervention is important in vascular cognitive impairment? a) Sleep hygiene b) Control of hypertension and lipids c) Social isolation d) High‑fat diet

Which disorder is lifelong and begins in childhood? a) Neurodevelopmental disorder b) Neurocognitive disorder c) Delirium d) Dementia

Which therapy is most effective for behavioral regulation in ADHD? a) CBT and parent training b) Psychoanalysis c) ECT d) Dialysis

Which condition is linked to elevated liver enzymes and substance abuse? a) Substance‑related disorder b) Mild NCD c) ASD d) Intellectual Disability

Which family support measure is critical in dementia care? a) Respite care and education b) Ignoring symptoms c) Isolation d) Punishment

Which disorder involves deficits in intellectual and adaptive functioning? a) Intellectual Disability b) ADHD c) ASD d) Delirium