Dementia and Cognitive Disorders

Dementia is a general term for a decline in cognitive function. The term dementia is the customary yet more umbrella-like term for a cognitive disorder and is usually assigned to cognitive decline which affects older adults. However, the term neurocognitive disorder is more specific to anyone with cognitive decline and is used when the underlying disease (and often the root cause) can be identified and diagnosed. Practitioners evaluate a patient based upon level of functioning in the following cognitive domains: complex attention, executive functioning, learning and memory, language, perceptual-motor abilities, and socio-emotional cognition. Many people with dementia may experience personality changes and mood problems, as well as memory issues, but memory problems are not always a sign of dementia. 

Major neurocognitive disorder involves evidence of significant decline in one or more cognitive domains and is dramatic enough to interfere with a person’s daily functioning. Associated causes of Major neurocognitive disorder include Alzheimer’s disease, Frontotemporal lobe degeneration, Lewy body disease, Parkinson’s disease, vascular disease (which includes Strokes), Traumatic Brain injury, Prion disease, Huntingdon’s disease, Substance/medication-induced, or other medical condition(s).  

Mild neurocognitive disorder involves modest (but not as severe) decline in the cognitive domains and, while causing some difficulties in life, may not drastically interfere with a person’s daily functioning and independence. Some persons with mild cognitive impairment never progress to having major impairment, while others progress to a Major neurocognitive disorder. 

While neurocognitive disorders can be progressive and can worsen over time, many are treatable with medications which can help to delay this progression and mitigate severe symptoms. Medication and psychotherapy can help lessen the severity of problems and of coping with mood, personality, frustration-tolerance, and adaptation to various changes in functioning. Because each person is unique, not everyone will have the same combination of symptoms or the same rate of progression. Family members, especially direct caregivers, of those with a cognitive disorder often suffer with their own mood, relational/social, anxiety, sleep, and physical issues as a result of the demands of caregiving and may benefit from the extra support that our clinic can offer. 

A few words about delirium: when the cognitive impairment develops over a short period of time and cannot be explained by a preexisting or evolving neurocognitive disorder, a diagnosis of delirium may be applied. In delirium, the cause of cognitive impairment is typically deemed to be a substance, medication, withdrawal from a substance or medication, or a medical condition. Delirium is usually short-lasting but may last for weeks or months, and many individuals make a full recovery. However, delirium can be a life-threatening condition and may require hospitalization. If a patient with preexisting neurocognitive disorder experiences an episode of delirium which is “superimposed” upon the neurocognitive disorder, the patient may experience a permanent decline in mental (and sometime physical) functioning, even after the delirium has been treated and resolved. 

While neurocognitive disorder is defined as either Mild or Major, many people have become familiar with hearing about the “stages” of dementia/cognitive disorders as either mild, moderate, or severe, and this 3-part categorization helps us all understand a person’s functioning, needs, and abilities and also helps define whether a person has moved from one level of impairment to another. 

Mild Dementia

People with mild dementia or Mild neurocognitive disorder may be able to function relatively independently. Symptoms may include:

  • Some short-term memory lapses
  • Personality changes, including increased anger or apathy 
  • Mood changes, including depression
  • Occasionally misplacing things, some forgetfulness
  • Difficulty with complex tasks or problem solving
  • Struggling to express or describe emotions or explain complex ideas

Moderate dementia

At this stage of dementia, people may need assistance from a loved one or care provider to perform activities of daily living. As well as progression of mental decline, some physical symptoms usually begin to emerge. A person in a “moderate” phase of dementia would likely fit the diagnosis of a Major neurocognitive disorder. Symptoms may include:

  • Poor judgment (e.g., walking on a busy highway, wearing no socks in the snow, giving all funds away to a stranger, eating rotten food, etc)
  • Increasing confusion, which often involves disruptions in Orientation to person, place, time, and/or situation 
  • Increasing frustration and irritability
  • Increasing problems with short-term recall/memory and some problems with long-term memory
  • Needing more help and direction with tasks such as dressing, grooming, and bathing
  • More significant personality changes
  • More problems with language/speech
  • More problems with sleep regulation
  • More problems with “sundowning,” which includes increased confusion and agitation in afternoons and evenings

Severe Dementia

At this late stage of dementia and Major neurocognitive impairment, a person shows more mental and physical decline. Symptoms include:

  • inability to maintain bodily functions, which may include walking, feeding oneself, swallowing, controlling bladder or bowel.  
  • increased sleeping during the day
  • inability to communicate, and inability to understand or follow directions
  • need for full-time assistance with all activities of daily living
  • increased risk for infections, such as urinary tract infections and pneumonia

Remember: people with dementia will progress through the stages of dementia/cognitive disorders at different rates and with different combinations of the above symptoms.


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