An overview of differences between the cognitive deficits normal to aging and a neurocognitive disorder.
Transcription after the jump.
Personal experience - TBI
I had a stroke/CVA due to Traumatic Brain Injury as a child. This caused half my body to be temporarily paralyzed and me to have to relearn everything, including speaking, walking, moving the right side of my body, running, writing, using scissors, etc. I also had emotional difficulties because of it including an inability to control my emotions and tears when upset, migraine headaches as often as twice a week, aphasia (difficulty finding words), in addition to switching handedness, and potentially gender identity (as there was a sudden change in the gender I saw myself as between pre-stroke and post-stroke). i have also have depression, anxiety, ADHD, and executive dysfunction, all of which could potentially be exasperated by childhood stroke (and are recommended for screening of children who have had strokes in ongoing care, as they are more common in stroke cases). An Individualized Education Plan was also necessary, as it took me as long as four times as long to complete tests and homework and in-class activities. If anyone has any questions regarding strokes and their affect effects, I can help answer them as I experienced them.
Thank you for sharing your personal experiences! - Shrink
Anonymous asked:
I'm not sure if you're the right blog for this question, but could head trauma feasibly affect someone's sense of direction so badly that they could get lost in a place they're familiar with?
It’s pretty rare, but there are indeed cases of people who have completely lost their sense of direction. This is called “Heading disorientation”, and is part of a group of symptoms termed “topographical disorientation”.
However, it’s almost always caused by lesions on the medial aspect of the occipital lobe - it doesn’t seem like it’s caused by hitting your head.
There is a single case where it was linked to a head trauma (see here), but since no brain imaging was done, we can’t be 100% sure that’s what caused it.
Here’s some further reading:
Personal Experience: TBI
Hopefully everyone knows that a TBI is brain damage. It happens because the brain gets smushed against the skull that should be protecting it.
Most of the TBIs people hear about are the severe ones, with a coma of more than a day. I was only out for about an hour, making mine fit into either the minor or mild category. This means mine is not representative of all experiences, however people who have had a concussion may find similarities, as that is in the same type of TBI. One fact that gets overlooked is that even minor ones can have pretty huge impacts on daily life.
I will be using the terms mostly as they were explained to me, so I apologize if there is any confusion.
Demystifying the DSM-V: Neurocognitive Disorders Part 2
Oof. So now that you’ve seen what the different cognitive domains look like, let’s get to the actual disorders.
...I realize I never actually defined what “Neurocognitive” means. Neuro = brain, cognitive = thoughts. So you got a problem in your brain and how you think.
Delirium
This is a weird, short term / temporary neurocognitive disorder that is the result of another medical problem or substance abuse.
- There has to be a problem in your character’s attention and awareness of their surroundings.
- This problem develops within hours to a few days.
- This is a major change from the character’s normal level of attention and awareness.
- These problems seem to change in how intense they are during the course of a day.
- The character has to have another problem in another cognitive domain (see my earlier post for what this means!)
- The symptoms aren’t because of another neurocognitive disorder.
- The change in awareness isn’t due to a coma (lol. it’s funny to me how they have to specify that)
- There’s evidence from the character’s history, a physical exam, or lab tests that the delirium is a result of another medical condition or drug use.
It can last from a few days, to weeks or even months.
The character can be either hyperactive (increased amount of movement and agitation, and refuses to cooperate with medical care), hypoactive (sluggish, lethargic, stupor), or a mixed level of activity (either normal, or switching from hyperactive to hypoactive).
Major Neurocognitive Disorder
The criteria for Major and Minor Neurocognitive disorder are pretty similar. I’ve bolded the tiny bits that are different between them.
There is a significant cognitive decline from the character’s previous level of functioning in one or more cognitive domains. This is based on both:
- The character, someone close to the character, or the character’s doctor are concerned there’s been a significant cognitive decline
- A substantial amount of difficulty in how well the character can think or perform, ideally documented through testing
The problems in thinking are to the point that they interfere with their ability to do everyday activities.
It’s not a delirium, and not better explained by another mental or medical disorder.
If you know it, you also specify the cause of the neurocognitive disorder. There are a lot of them, but some of the biggies are:
- Alzheimer’s
- Traumatic Brain Injury (TBI)
- Parkingson’s
- Prion disease - which, while technically out of my wheelhouse, I should post about someday because it’s FUCKING FASCINATING
- etc.
There are a few things you have to note:
With behavioral disturbance - psychotic, agitated, etc.
Severity ranges from mild to severe (fully dependent on others for everything).
Mild Neurocognitive Disorder
There is a modest cognitive decline from the character’s previous level of functioning in one or more cognitive domains. This is based on both:
- The character, someone close to the character, or the character’s doctor are concerned there’s been a mild cognitive decline
- A modest amount of difficulty in how well the character can think or perform, ideally documented through testing
The problems in thinking do not interfere with their ability to do everyday activities / be independent.
It’s not a delirium, and not better explained by another mental or medical disorder.
If you know it, you also specify the cause of the neurocognitive disorder.
There are a few things you have to note:
With behavioral disturbance - psychotic, agitated, etc.
There is another version of Major / Mild Neurocognitive Disorder due to Alzheimer’s, but this post is long enough already and it’s pretty similar to the normal versions.
Demystifying the DSM-V: Neurocognitive Disorders Part I -Cognitive Domains
Now we’re dealing with a pretty sad topic. Neurocognitive disorders are the new fancy psychological name for dementia and other cognitive decline. There’s a lot of causes to these disorders, the most common being simple aging.
Basically, in a sentence: people get old, and start to lose their minds. Not in the “going crazy” sense of the phrase, but losing their ability to function and think like they used to.
Before we get to the actual criteria, we need to look at the 6 major areas that your character is going to start having trouble with. I’m going to define the term, and list some examples of what a mild and major impairment in that area looks like.
Complex Attention
Being able to pay attention, keeping your attention on something, and how fast it takes you to think or do things
Mild:
- Normal tasks take a bit longer.
- Making errors in routine things
- Can think easier when there aren’t distracting things around them.
Major:
- Places with a lot of distracting things going on (TV is on, people are talking, music in the background) are extremely difficult for the character to deal with.
- They get easily distracted by the things around them.
- Can’t hold new information, like a phone number or an address, in their brain.
- Has trouble remembering what’s just been said.
- Can’t do math in their head.
- They take a lot longer when thinking about things.
Executive Functioning
Planning, making decisions, correcting themselves, thinking out of the box.
Mild:
- More effort required to complete big projects
- Difficulty multitasking, or resuming a task after being interrupted
- Organizing and planning really take it out of the character
- Has a hard time following shifting conversation topics in social gatherings
Major:
- Abandons complex projects
- Can only focus on one task at a time
- Relies on others to plan things and make decisions
Learning and Memory
Remembering stuff (both short-term and long-term), learning new things.
Mild:
- Trouble remembering recent events
- Relies on making lists / calendars
- Needs some reminders
- Trouble keeping track of characters in a book or movie, etc
- Repeating themselves on occasion
- Can’t remember if bills were paid
Major:
- Repeating themselves within the same conversation
- Can’t keep track of items even with a short shopping list
- Needs frequent reminders to orient themselves
Language
Talking, understanding, grammar, etc.
Mild:
- Trouble thinking of words
- Uses general words instead of specific ones (animal instead of cat)
- Avoids using names of acquaintances
- Subtle shift towards less-correct grammar
Major:
- Frequently uses “that thing” or “you know what it is”
- Uses pronouns, not names
- May not remember names of friends and family
- Frequent grammar errors
- Repeatedly mimics words that others use
- Stops talking altogether
Perceptual-Motor
Visualizing things in their head; eye-hand coordination
Mild:
- Relies on maps or directions
- Follows others to get to places
- Gets lost if not paying attention
- Difficulty parking vehicles
- More effort required for sewing, knitting, carpentry, or other hand-held tasks
Major:
- Severe difficulties with activities such as using tools, driving a car.
- Gets lost in places they know well
- Gets more confused at dusk because shadows alter their perceptions
That last one is pretty important and common. It’s called “sun-downing”.
Social Cognition
Interacting with others, emotions, mind.
Mild:
- Slight changes in personality
- Can’t recognize social cues or read facial expressions very well
- Less empathy towards others
- More or less social than normal
- Less inhibited
Major:
- Incredibly inappropriate behavior
- Ignores social standards of clothing, topics of conversation
- Won’t stop talking about something despite others telling them to stop
- Does things without caring about family / friend reactions
- Makes decisions that are unsafe
For this one, your character won’t be able to tell that they’re behaving any differently. The other ones, they would be able to tell something’s different.
Phew. Now that this is out of the way, stay tuned for part II where the actual criteria of the neurocognitive disorders are discussed.