adversely affect performance of daily activities (Vollmer et al., 2016). A neuropsychological evaluation should sample all domains of cognition. However, the evaluation also should be relatively brief (i.e., less than three hours) because persons with MS are easily fatigued. Common areas of cognitive impairment are in executive functions, processing speed, visuospatial construction, and retrieving information from memory (Benedict et al., 2020). Executive dysfunction includes problems with working memory, or holding information “online” in mental space and Symptoms of depression and anxiety in multiple sclerosis It is estimated that as many as 50% of persons with MS suffer from clinically significant symptoms of depression (Solaro et al., 2018). Additionally, the rates of psychopathology such as anxiety disorders and bipolar disorder appear to be increased in persons Diagnosis and causes of Alzheimer’s disease Alzheimer’s disease is diagnosed when the criteria for major or mild neurocognitive disorder are met, “there is insidious onset and gradual progression of impairment” of cognition, and the “criteria are met for probable or possible Alzheimer’s disease” (APA, 2013, p. 611). Probable major neurocognitive disorder due to Alzheimer’s disease is diagnosed when either of the following criteria are met: (1) genetic testing indicates the presence of a causative gene for Alzheimer’s disease or (2) the presence of each of the following: (a) decline in memory and learning, and in at least one other cognitive domain, (b) there is evidence of a steady progression of the decline, and (c) there is no evidence of mixed etiology, such as evidence of cerebrovascular disease. If a patient falls short of these criteria, possible Alzheimer’s disease would be diagnosed. The criteria for mild neurocognitive disorder are similar but a decline in an additional cognitive domain besides memory is not required. Probable mild neurocognitive disorder due to Alzheimer’s disease is diagnosed when genetic testing or family history indicate the presence of a causative gene for Alzheimer’s disease; possible mild neurocognitive disorder due to Alzheimer’s disease is diagnosed when there is no evidence of a genetic contribution to the symptoms and each the following
manipulating the information, and in performing complex tasks requiring divided attention or quick visual scanning. Learning may be reduced due to inefficiencies in processing information, but retention of information is usually intact. Visuospatial deficits also can be common, as well as changes in reasoning, personality, and judgment. If MS causes cognitive decline, and cognitive deficits interfere with functioning, a DSM-5 diagnosis of major or mild neurocognitive disorder due to multiple sclerosis may be warranted (APA, 2013).
with MS (Murphy et al., 2017). Treatment of these psychiatric symptoms is critical to optimize functioning. Cognitive- behavioral therapies or medications can be useful (Patten et al., 2017).
NEUROCOGNITIVE DISORDER DUE TO ALZHEIMER’S DISEASE
is present: (a) decline in memory and learning, (b) steady progression, and (c) there is no evidence of mixed etiology. The onset of neurocognitive disorder due to Alzheimer’s disease is insidious, and sometimes, early in the disorder, it is hard to tell if memory problems are due to normal aging or to a disease process. The course of Alzheimer’s disease is gradually progressive and, over time, the memory and cognitive impairments clearly become greater and more severe than the cognitive changes associated with normal aging (Veitch et al., 2019). The neuropathology of Alzheimer’s disease is well understood. Plaques and tangles of abnormal proteins accumulate in and around neurons in the cortex and lead to the death or dysfunction of neurons. There also is general atrophy or shrinkage of brain tissue, far greater than is evident in normal aging. Thus, brain scans are often useful in the diagnosis of Alzheimer’s disease. Some parts of the brain are affected more than others in Alzheimer’s disease, but the neuropathology affects the cerebral cortex to a significant degree and particularly the frontal and temporal lobes (Bayram et al., 2018).
Prevalence and course of neurocognitive disorder due to Alzheimer’s disease Neurocognitive disorders due to neurological decline occurring in later life affect about 1.5% of persons aged 65 and 30% or more of persons by age 80 (Lopez & Kuller, 2019). Alzheimer’s disease is estimated to account for 60% to 90% of these cases. Alzheimer’s disease is more common in women than men and in Black than White individuals (Matthews et al., 2019). Neuropsychological evaluation of neurocognitive disorder due to Alzheimer’s disease Neuropsychologists are asked to conduct evaluations for
Neurocognitive disorder due to Alzheimer’s disease is gradually progressive, and “the mean duration of survival after diagnosis is 10 years” (APA, 2013, pp. 612-613). In later stages, persons with neurocognitive disorder due to Alzheimer’s disease become mute and bedridden.
cognition that are different from cognitive impairment caused by Alzheimer’s disease. For example, persons with depressive disorders will more often reply “I don’t know” to cognitive test items without trying than will persons with neurocognitive disorder due to Alzheimer’s disease. Individuals with depressive disorders also tend to perform inconsistently on memory tasks, whereas those with neurocognitive disorder due to Alzheimer’s disease are consistently impaired. Further, people with neurocognitive disorder due to Alzheimer’s disease tend to lose recent memories first and then slowly lose access to more remote memories. Those with depressive disorders have more inconsistent loss of memory for recent and remote events (Leyhe et al., 2016). The neuropsychological evaluation should be comprehensive and sample all major domains of cognition, as well as behavioral disturbance. The length of the evaluation will vary depending on the referral question and the severity of the patient’s impairments; people with milder impairments will likely need more testing to uncover patterns of strengths and weaknesses. Further, patients with milder impairments will have more stamina
neurocognitive disorder due to Alzheimer’s disease for a variety of reasons. A referral source might want to know whether a patient has evidence of cognitive impairment greater than would be expected based on their age. That is, is their cognitive presentation consistent with normal aging or is there evidence of a progressive, degenerative process? Neuropsychological testing may also be requested to determine cognitive strengths and weaknesses, establish a baseline to track future changes or responses to treatment, make treatment recommendations, or assist in differential diagnosis (e.g., Does the patient have neurocognitive disorder due to Alzheimer’s disease or neurocognitive disorder due to Lewy bodies?). Another common referral question pertains to the distinction between depressive disorders and neurocognitive disorders because both can cause cognitive impairment and they can co-occur (Leyhe et al., 2017). Differentiating depressive disorders from neurocognitive disorder due to Alzheimer’s disease can be challenging, but there is a sound base of research upon which neuropsychologists can rely. Depressive disorders tend to cause particular effects on
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