Decoding Neurocognitive Disorders in Older Adults: Assessment & Evidence-Based Treatments-View Presentation

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In a recent talk on neurocognitive disorders among older adults, psychiatrist Pallavi Joshi discussed the prevalence, assessment, and treatment options for these conditions, focusing on Alzheimer’s disease as a primary example. Neurocognitive disorders, as defined by DSM-5, are categorized into delirium, mild, and major neurocognitive disorders. Mild neurocognitive disorder is identified by a modest decline in cognitive performance not severely impacting daily life, unlike major neurocognitive disorder, commonly referred to as dementia, which does affect independence.<br /><br />Alzheimer's disease remains the leading cause of dementia, with its prevalence expected to rise significantly. Despite this, many cases go undiagnosed. Common risk factors include advancing age, vascular conditions, obesity, brain injuries, smoking, and poor sleep, while the APOE gene is linked to increased risk.<br /><br />Evaluation for these disorders involves comprehensive clinical assessments including history taking, cognitive testing, often using the MOCA or SLUMS tests, and sometimes neuroimaging to rule out other causes. Although Alzheimer's diagnosis can be supplemented by biomarkers, these are currently not widely used in practice.<br /><br />Treatment aims to manage symptoms and improve quality of life through a combination of medications like cholinesterase inhibitors and memantine, which slow progression albeit modestly, and non-pharmacological approaches focusing on behavioral management. Emerging therapies, such as anti-amyloid agents, show promise but face limitations regarding accessibility and clearly defined benefits in everyday functioning. Dr. Joshi emphasized the importance of individualizing care, supporting caregivers, and considering both pharmaceutical and behavioral strategies to address the complexities of these disorders.

Keywords

neurocognitive disorders

Alzheimer's disease

DSM-5

dementia

APOE gene

cognitive assessment

cholinesterase inhibitors

memantine

anti-amyloid agents

caregiver support