Dementia and major neurocognitive disorder

Also known as Major neurocognitive disorder · Major NCD · Dementia · Alzheimer disease dementia · Vascular dementia · Dementia with Lewy bodies · Frontotemporal dementia · BPSD

Exam-exhaustive fellowship topic on dementia and major neurocognitive disorder — DSM-5-TR and ICD-11 nosology, mild versus major NCD, Alzheimer/vascular/DLB/FTD subtypes, assessment (MMSE, MoCA, NPI, collateral), delirium differential, BPSD and DICE framework, cholinesterase inhibitors and memantine with doses, antipsychotic mortality black-box caution (CATIE-AD, DART-AD, Schneider), capacity (Appelbaum), and disposition. FRANZCP-primary, globally tagged.

high28 referencesUpdated 26 July 202616 min readVerification in progress

Practise this topic

10 MCQs

Meet the patient

A 76-year-old retired plumber is brought in by his wife. For six months he has been seeing small children in the garden — pleasant, silent, and entirely absent. Some days he is sharp; other days he cannot follow a sentence. He shouts and thrashes in his sleep and has done for years. He has fallen twice.[3][4]

Last week a locum started him on haloperidol for the "hallucinations". He is now rigid, barely mobile, and his wife says he has "gone".[3][21]

Two exam questions are live. Which dementia is this? And what did that prescription just do to him? Everything below answers both.[3][21][25]

Psychiatry Fellowship Pro

You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.

References28Show ledger

[1]McKhann GM, Knopman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease Alzheimers Dement, 2011.PMID 21514250
[2]Dubois B, Feldman HH, Jacova C, et al. Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS-ADRDA criteria Lancet Neurol, 2007.PMID 17616482
[3]McKeith IG, Boeve BF, Dickson DW, et al. Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium Neurology, 2017.PMID 28592453
[4]McKeith IG, Dickson DW, Lowe J, et al. Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium Neurology, 2005.PMID 16237129
[5]Rascovsky K, Hodges JR, Knopman D, et al. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia Brain, 2011.PMID 21810890
[6]Gorno-Tempini ML, Hillis AE, Weintraub S, et al. Classification of primary progressive aphasia and its variants Neurology, 2011.PMID 21325651
[7]Román GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop Neurology, 1993.PMID 8094895
[8]Sachdev P, Kalaria R, O'Brien J, et al. Diagnostic criteria for vascular cognitive disorders: a VASCOG statement Alzheimer Dis Assoc Disord, 2014.PMID 24632990
[9]Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission Lancet, 2020.PMID 32738937
[10]Livingston G, Sommerlad A, Orgeta V, et al. Dementia prevention, intervention, and care Lancet, 2017.PMID 28735855
[11]Folstein MF, Folstein SE, McHugh PR "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician J Psychiatr Res, 1975.PMID 1202204
[12]Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment J Am Geriatr Soc, 2005.PMID 15817019
[13]Cummings JL, Mega M, Gray K, et al. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia Neurology, 1994.PMID 7991117
[14]Petersen RC, Smith GE, Waring SC, et al. Mild cognitive impairment: clinical characterization and outcome Arch Neurol, 1999.PMID 10190820
[15]Reisberg B, Doody R, Stöffler A, et al. Memantine in moderate-to-severe Alzheimer's disease N Engl J Med, 2003.PMID 12672860
[16]Tariot PN, Farlow MR, Grossberg GT, et al. Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil: a randomized controlled trial JAMA, 2004.PMID 14734594
[17]Howard R, McShane R, Lindesay J, et al. Donepezil and memantine for moderate-to-severe Alzheimer's disease N Engl J Med, 2012.PMID 22397651
[18]Birks JS, Harvey RJ Donepezil for dementia due to Alzheimer's disease Cochrane Database Syst Rev, 2018.PMID 29923184
[19]McShane R, Westby MJ, Roberts E, et al. Memantine for dementia Cochrane Database Syst Rev, 2019.PMID 30891742
[20]Emre M, Aarsland D, Albanese A, et al. Rivastigmine for dementia associated with Parkinson's disease N Engl J Med, 2004.PMID 15590953
[21]Schneider LS, Dagerman KS, Insel P Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials JAMA, 2005.PMID 16234500
[22]Schneider LS, Tariot PN, Dagerman KS, et al. Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease N Engl J Med, 2006.PMID 17035647
[23]Ballard C, Hanney ML, Theodoulou M, et al. The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial Lancet Neurol, 2009.PMID 19138567
[24]Maust DT, Kim HM, Seyfried LS, et al. Antipsychotics, other psychotropics, and the risk of death in patients with dementia: number needed to harm JAMA Psychiatry, 2015.PMID 25786075
[25]Kales HC, Gitlin LN, Lyketsos CG Assessment and management of behavioral and psychological symptoms of dementia BMJ, 2015.PMID 25731881
[26]Sink KM, Holden KF, Yaffe K Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence JAMA, 2005.PMID 15687315
[27]Appelbaum PS, Grisso T Assessing patients' capacities to consent to treatment N Engl J Med, 1988.PMID 3200278
[28]Rabins PV, Blacker D, Rovner BW, et al. American Psychiatric Association practice guideline for the treatment of patients with Alzheimer's disease and other dementias. Second edition Am J Psychiatry, 2007.PMID 18340692

Dementia and major neurocognitive disorder

Also known as Major neurocognitive disorder · Major NCD · Dementia · Alzheimer disease dementia · Vascular dementia · Dementia with Lewy bodies · Frontotemporal dementia · BPSD

high28 referencesUpdated 26 July 202616 min readVerification in progress

Practise this topic

10 MCQs

Meet the patient

Last week a locum started him on haloperidol for the "hallucinations". He is now rigid, barely mobile, and his wife says he has "gone".[3][21]

Two exam questions are live. Which dementia is this? And what did that prescription just do to him? Everything below answers both.[3][21][25]

Psychiatry Fellowship Pro

You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.

References28Show ledger

[1]McKhann GM, Knopman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease Alzheimers Dement, 2011.PMID 21514250
[2]Dubois B, Feldman HH, Jacova C, et al. Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS-ADRDA criteria Lancet Neurol, 2007.PMID 17616482
[3]McKeith IG, Boeve BF, Dickson DW, et al. Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium Neurology, 2017.PMID 28592453
[4]McKeith IG, Dickson DW, Lowe J, et al. Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium Neurology, 2005.PMID 16237129
[5]Rascovsky K, Hodges JR, Knopman D, et al. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia Brain, 2011.PMID 21810890
[6]Gorno-Tempini ML, Hillis AE, Weintraub S, et al. Classification of primary progressive aphasia and its variants Neurology, 2011.PMID 21325651
[7]Román GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop Neurology, 1993.PMID 8094895
[8]Sachdev P, Kalaria R, O'Brien J, et al. Diagnostic criteria for vascular cognitive disorders: a VASCOG statement Alzheimer Dis Assoc Disord, 2014.PMID 24632990
[9]Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission Lancet, 2020.PMID 32738937
[10]Livingston G, Sommerlad A, Orgeta V, et al. Dementia prevention, intervention, and care Lancet, 2017.PMID 28735855
[11]Folstein MF, Folstein SE, McHugh PR "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician J Psychiatr Res, 1975.PMID 1202204
[12]Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment J Am Geriatr Soc, 2005.PMID 15817019
[13]Cummings JL, Mega M, Gray K, et al. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia Neurology, 1994.PMID 7991117
[14]Petersen RC, Smith GE, Waring SC, et al. Mild cognitive impairment: clinical characterization and outcome Arch Neurol, 1999.PMID 10190820
[15]Reisberg B, Doody R, Stöffler A, et al. Memantine in moderate-to-severe Alzheimer's disease N Engl J Med, 2003.PMID 12672860
[16]Tariot PN, Farlow MR, Grossberg GT, et al. Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil: a randomized controlled trial JAMA, 2004.PMID 14734594
[17]Howard R, McShane R, Lindesay J, et al. Donepezil and memantine for moderate-to-severe Alzheimer's disease N Engl J Med, 2012.PMID 22397651
[18]Birks JS, Harvey RJ Donepezil for dementia due to Alzheimer's disease Cochrane Database Syst Rev, 2018.PMID 29923184
[19]McShane R, Westby MJ, Roberts E, et al. Memantine for dementia Cochrane Database Syst Rev, 2019.PMID 30891742
[20]Emre M, Aarsland D, Albanese A, et al. Rivastigmine for dementia associated with Parkinson's disease N Engl J Med, 2004.PMID 15590953
[21]Schneider LS, Dagerman KS, Insel P Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials JAMA, 2005.PMID 16234500
[22]Schneider LS, Tariot PN, Dagerman KS, et al. Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease N Engl J Med, 2006.PMID 17035647
[23]Ballard C, Hanney ML, Theodoulou M, et al. The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial Lancet Neurol, 2009.PMID 19138567
[24]Maust DT, Kim HM, Seyfried LS, et al. Antipsychotics, other psychotropics, and the risk of death in patients with dementia: number needed to harm JAMA Psychiatry, 2015.PMID 25786075
[25]Kales HC, Gitlin LN, Lyketsos CG Assessment and management of behavioral and psychological symptoms of dementia BMJ, 2015.PMID 25731881
[26]Sink KM, Holden KF, Yaffe K Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence JAMA, 2005.PMID 15687315
[27]Appelbaum PS, Grisso T Assessing patients' capacities to consent to treatment N Engl J Med, 1988.PMID 3200278
[28]Rabins PV, Blacker D, Rovner BW, et al. American Psychiatric Association practice guideline for the treatment of patients with Alzheimer's disease and other dementias. Second edition Am J Psychiatry, 2007.PMID 18340692

Dementia and major neurocognitive disorder

Your progress

Meet the patient

Dementia and major neurocognitive disorder

Your progress

Meet the patient