Neurocognitive Case Study

Neurocognitive disorders are a range of conditions that affect cognitive function, leading to deficits in memory, attention, language, and executive function. According to American Psychiatric Association (2022b), one such disorder is the major neurocognitive disorder due to vascular disease, or vascular dementia, characterized by a progressive cognitive decline that compromises a person’s ability to carry out daily activities: Neurocognitive Case Study.

The ICD 10 code for this neurocognitive disorder is F.01.05. For Robert Thompson, a 78-year-old male, impairments in memory, disorientation, and difficulty in organizing thoughts indicate a neurocognitive disorder, most likely with vascular etiology in light of his history of transient ischemic attacks (ICD 10 code G45.9) (American Psychiatric Association, 2022a). He has reportedly worsened following such attacks, and concern has been raised for cerebrovascular factors in his cognitive decline.

Neuroanatomy of Major Neurocognitive Disorder Due to Vascular Disease

The neuroanatomy of major neurocognitive disorder due to vascular disease primarily involves structural and functional deterioration in brain regions responsible for cognition and memory. Vascular neurocognitive disorder, as in Robert’s condition, is marked by damage to frontal and subcortical regions from ischemic events (American Association of Psychiatric Pharmacists (AAPP), 2024). Damage to the hippocampus, which is responsible for consolidating memory, can lead to progressive amnesia. White matter lesions and cortical thinning are classic imaging findings, indicating compromised neuronal connectivity.

Physical and Mental Status Examination

The physiological findings in major neurocognitive disorders due to vascular disease include alterations in cerebral blood flow, neuroinflammation, and neurotransmitter imbalances. Robert has a history of transient ischemic attacks, which are characterized by episodes of reduced blood flow to the brain, which may have caused neuronal damage

His key symptoms include high blood pressure, thus the diagnosis of vascular neurocognitive disorder because hypertension (ICD 10 code I10) leads to arterial rigidity and diseases of cerebral circulation (Santisteban et al., 2022). Arteriovenous nicking and cotton wool spots noticed during his funduscopic examination go well in support of his compromised vascular status. These physiological findings support his cognitive symptoms, thus confirming that the etiology is vascular.

The evaluation of mental state examination (MSE) results offers crucial information to answer the case questions regarding Robert’s mental state. Due to his current performance, his recent memory may be considered as being affected because, in five minutes, he was unable to recall three words. He presents with bradyphrenia and deranged cognitive ability, hence fulfilling the criteria for dementia.

His anxious mood and affect are appropriately congruent to demonstrate signs of emotional stress, which can be due to his deteriorating health. Moreover, he is slow in speaking, uses inappropriate words, and repeats words and phrases, indicating a language disorder. However, his knowledge and reasoning ability are good, and he can be affected by the disease, but such changes can be observed with the progression of the disorder.

Cultural, Spiritual, and Biopsychosocial Factors

Cultural, spiritual, and biopsychosocial dimensions influence the diagnosis and management of Robert. Robert’s Hispanic origin may affect his attitude towards illness and seeking treatment. He stated that there are no issues regarding cultural sensitivity, but family support is critical because Hispanic cultures encourage the sharing of caregiving responsibilities among relatives (Office of Minority Health, 2024).

Further, his catholic religion can help him with coping strategies. From the biopsychosocial point of view, he observed poor engagement in activities in the community, hence a deteriorating quality of life. These aspects should be taken into consideration to enhance culturally sensitive healthcare delivery.

Diagnostic Examinations

Imaging studies and other tests are needed to establish the diagnosis of major neurocognitive disorder due to vascular disease and find out the causes. According to Sharma et al. (2021), imaging studies like magnetic resonance imaging (MRI) and computer tomography (CT) scans can help identify pathological white matter lesions or infarcts that show signs of vascular involvement.

According to Wang et al. (2022), Montreal Cognitive Assessment and the mini-mental state examination are crucial in the diagnosis of cognitive impairment and its deterioration. Determining metabolic risk factors regarding cognitive decline thus requires screening the blood glucose and lipid profile disposition. Furthermore, the neuropsychological test can help check other cognitive domains that may be affected by the disorder.

Primary Diagnosis and Differential Diagnoses

The primary diagnosis, in this case, being Major neurocognitive disorder due to vascular disease, is supported by symptoms since Robert is known to have suffered a history of two transient ischemic attacks, complains of memory loss, and inability to perform complex activities. As a consequence of cerebrovascular events, the gradual worsening of this cognitive function indicates a vascular process (American Heart Association, 2024). In addition, he has hypertension (ICD 10 code I10) and hyperlipidemia (ICD 10 code E78.5) that could contribute to cerebrovascular pathology.

There are two possibilities for differential diagnoses: Alzheimer’s disease and mild cognitive impairment (MCI). The ICD-10 code for Alzheimer’s disease is G30.9. Alzheimer’s disease and major neurocognitive disorder due to vascular disease share some resemblance, but they differ in terms of neuroanatomy and the course. Neuroanatomical evident changes in Alzheimer’s disease are cortical atrophy, predominantly in the temporal and parietal lobes with amyloid plaques and neurofibrillary tangles (Kumar et al., 2024).

In contrast, major neurocognitive disorders due to vascular disease affect subcortical white matter and especially the frontal lobe because of ischemic damage. While physiologically, Alzheimer’s is accompanied by neuronal loss and diminished levels of neurotransmitters such as acetylcholine, the major neurocognitive disorder due to vascular disease is characterized by ischemic or hemorrhagic cerebrovascular accidents resulting in a progressive cognitive decline.

Psychiatric assessment is also different. According to Scheltens (2021), Alzheimer’s disease shows apathy, agitation, and severe memory loss, but major neurocognitive disorder due to vascular disease reveals mood changes and executive dysfunction. Culturally, Alzheimer’s disease is well-known, and this shapes caregiving approaches, while major neurocognitive disorder due to vascular disease might be poorly understood in some cultures.

According to Britt et al. (2022), both can be spiritually disturbing, but coping mechanisms may differ from the religion held by the patient. In biopsychosocial aspects, Alzheimer’s disease leads to progressive cognitive dysfunction and social seclusion, whereas major neurocognitive disorder due to vascular disease may cause a loss of social functioning at advanced stages.

Prognosis varies, as Alzheimer’s disease tends to deteriorate over time, whereas major neurocognitive disorder due to vascular disease course is determined by stroke prevention and cardiovascular disease. Alzheimer’s disease is thought to be the differential diagnosis because Robert has developed progressively worsening memory loss, word retrieval, and impairment in executive functioning, which are characteristic of Alzheimer’s. However, the onset of his condition demonstrated a progressive worsening in his cognitive abilities after he developed transient ischemic attacks, which are unlikely enough to be linked to Alzheimer’s disease as its onset is gradual.

MCI represents a transitional stage between normal aging and major neurocognitive disorder due to vascular disease, involving memory deficits without significant functional impairment. The ICD code for this condition is G31.84. Neuroanatomically, MCI has mild hippocampal atrophy. On the other hand, major neurocognitive disorder due to vascular disease has diffuse white matter lesions and sub-cortical injury.

MCI does not show any severe ischemic changes in the brain, but abnormal slight deficits in synaptic transmission are evident (Anand & Schoo, 2024). Under the psychiatric assessment, MCI patients are more likely to have mild memory complaints and retain functional independence as compared to major neurocognitive disorder due to vascular disease, which significantly impairs activities of daily living.

Culturally, MCI may be seen as normal aging, and early treatment is not likely to be sought. From a spiritual point of view, MCI patients may be anxious about cognitive impairment and, therefore, require support. Biopsychosocially, MCI patients maintain social functioning while, in major neurocognitive disorder due to vascular disease, cognitive impairment causes social isolation. The prognosis of MCI is not very clear. However, there is possible progression to dementia, while that of major neurocognitive disorder due to vascular disease is worse with recurrent strokes or non-optimal vascular management.

MCI  is thought to be a differential diagnosis because it reflects an early stage of cognitive impairment, the main symptom of which is impaired memory, but does not impact daily functioning much. However, problems like financial management and medicine regulation point to a rather severe condition, suggesting Major Neurocognitive Disorder Due to Vascular disease than in MCI.

Prognosis

The severity of cerebrovascular damage and management of vascular risks determines the treatment for major neurocognitive disorders due to vascular disease. According to Robert’s history of transient ischemic attacks, his condition will deteriorate unless vascular risks are kept in control (American Heart Association, 2024). Lifestyle modification, antihypertensive, and cognitive therapy can slow disease progression. Multidisciplinary management with medical, psychological, and social interventions is required to optimize his quality and functional autonomy for as long as possible.

References

American Association of Psychiatric Pharmacists (AAPP). (2024). American Association of Psychiatric Pharmacists (AAPP). https://aapp.org/guideline/external/neurocognitive%20

American Heart Association. (2024). Heart failure, atrial fibrillation, and coronary heart disease are linked to cognitive impairment. [News release]. https://newsroom.heart.org/news/heart-failure-atrial-fibrillation-coronary-heart-disease-linked-to-cognitive-impairment

American Psychiatric Association. (2022a). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890425787

American Psychiatric Association. (2022b). Neurocognitive disorders supplement updated excerpts for delirium codes major and mild neurocognitive disorders. https://psychiatryonline.org/pb-assets/dsm/update/DSM-5-TR_Neurocognitive-Disorders-Supplement_2022_APA_Publishing.pdf

Anand, S., & Schoo, C. (2024, January 11). Mild cognitive impairment. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK599514/

Britt, K. C., Kwak, J., Acton, G., Richards, K. C., Hamilton, J., & Radhakrishnan, K. (2022). Measures of religion and spirituality in dementia: An integrative review. Alzheimer’s & Dementia: Translational Research & Clinical Interventions, 8(1). https://doi.org/10.1002/trc2.12352

Kumar, A., Tsao, J. W., Sidhu, J., & Goyal, A. (2024, February 12). Alzheimer disease. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499922/

Office of Minority Health. (2024, November 8). Hispanic/Latino Health. Minorityhealth.hhs.gov. https://minorityhealth.hhs.gov/hispaniclatino-health

Santisteban, M. M., Iadecola, C., & Carnevale, D. (2022). Hypertension, neurovascular dysfunction, and cognitive impairment. Hypertension. https://doi.org/10.1161/hypertensionaha.122.18085

Scheltens, P. (2021). Alzheimer’s disease. The Lancet, 397(10284), 1577–1590. https://doi.org/10.1016/S0140-6736(20)32205-4

Sharma, R., Sekhon, S., & Cascella, M. (2021). White matter lesions. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK562167/

Wang, G., Estrella, A., Hakim, O., Milazzo, P., Patel, S., Pintagro, C., Li, D., Zhao, R., Vance, D. E., & Li, W. (2022). Mini-Mental State examination and Montreal cognitive assessment as tools for following cognitive changes in Alzheimer’s disease neuroimaging initiative participants. Journal of Alzheimer’s Disease, 90(1), 263–270. https://doi.org/10.3233/jad-220397

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Details

Part One – Module One 

• The entire paper is completed on the case study assigned to the student
• Part one of the paper should be three to five pages long (not including title/reference pages), using the current APA formatting requirements with appropriate grammar and spelling. The paper requires at least four peer-reviewed resources, one of which may be the DSM-V-TR. All peer-reviewed resources used in the paper should be less than five years old.
• Part One of the paper must include:
  • Title page in APA format
  • Brief opening description of the neurocognitive disorder suspected
  • Neuroanatomy of the neurocognitive disorder
  • Physiological and mental status examination assessment findings for the neurocognitive disorder
  • Cultural, spiritual, and biopsychosocial factors to consider for the neurocognitive disorder
  • Diagnostic testing recommended for the neurocognitive disorder, including screening tools
  • Formulation of the primary diagnosis for the client with two differential diagnoses. The student must provide detailed information that supports the primary diagnosis and a rationale for each of the two differential diagnoses, contrasting the features of these disorders with those of the primary diagnosis.

When comparing and contrasting your differential diagnoses, make sure to address the following components for each:

• • • • • • neuroanatomy
          • physiological assessment findings
          • psychiatric assessment findings
          • cultural considerations
          • spiritual considerations
          • bio-psychosocial considerations
          • disorder prognosis
  • Anticipated prognosis for the client
  • Reference page with all references in APA format
    

    Neurocognitive Case Study

Criteria

Neurocognitive Disorder Introduction

This is the opening description of the neurocognitive disorder suspected for the client.

Neuroanatomy

The neuroanatomy of the neurocognitive disorder should be thoroughly discussed.

Assessment Findings

The anticipated physiological and mental status examination findings must be comprehensively identified and discussed.

Additional Considerations / Factors

Thoroughly explain the cultural, spiritual, and biopsychosocial factors for the neurocognitive disorder and the assigned client.

Testing Recommendations

Explore the diagnostic testing recommended for the neurocognitive disorder, including screening tools.

Diagnosis

Formulate the primary diagnosis for the client and two differential diagnoses. A detailed explanation that supports the primary diagnosis and a rationale for each of the two differential diagnoses must be provided.

Comparison & Contrast

Contrasting the features of the differential diagnosis with those of the primary diagnosis. Ensure that the following components for each are explored:

-neuroanatomy

-physiological assessment findings

-psychiatric assessment findings

-cultural considerations

-spiritual considerations

-bio-psychosocial considerations

-disorder prognosis

Prognosis

Discuss the anticipated prognosis for the client based on the primary diagnosis suspected.

APA Format & Grammer/Spelling

The paper must contain a title and reference page. The paper must include in-text citations. APA format is required. Appropriate grammar and spelling are required. Four peer-reviewed resources are provided which are each published within the last five years. Paper length is three to five pages.

Resources:

• DSM-5-TR  text