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Neurocognitive disorder — Clinical Guidelines

Overview

Neurocognitive disorder refers to a decline in cognitive function severe enough to impair daily life and independent living, often associated with aging, neurodegenerative diseases, or other medical conditions. It encompasses various syndromes including dementia and delirium, impacting memory, language, and executive function 1 7 11.

Diagnosis

Clinical Presentation: Cognitive decline affecting memory, language, and executive function 1 7.

Assessment Tools: Cognitive screening tests (e.g., MMSE, MoCA) 1 11.

Laboratory Tests: Blood tests to rule out reversible causes (e.g., vitamin D levels, lead toxicity) 5 4.

Imaging: Neuroimaging (MRI, CT) to identify structural changes or other pathologies 1 3.

Neuropsychological Evaluation: Detailed cognitive profiling to differentiate subtypes 22.

Management

Non-Pharmacological Interventions: Cognitive stimulation, speech-language therapy (e.g., AID-COMp program) 9.

Pharmacological Treatments:

- Antipsychotics: For behavioral symptoms (e.g., agitation) with caution due to side effects 2 12. - Cholinesterase Inhibitors: For Alzheimer’s disease management 10.

Management of Comorbidities: Address polypharmacy, manage chronic conditions (e.g., diabetes, hypertension) 1 10.

Preventive Measures: Reduce risk factors (e.g., control lead exposure, manage vitamin D levels) 5 4.

Special Populations

Elderly: Increased risk of polypharmacy-induced complications (e.g., serotonin syndrome) 1.

Comorbidities: Consider impact of conditions like chronic kidney disease on treatment choices 1.

Pregnancy and Pediatrics: Not directly addressed in provided abstracts.

Key Recommendations

Screen for Cognitive Impairment Preoperatively in older adults to identify risk and implement preventive measures (Evidence: Moderate) 7 11.

Implement Comprehensive Geriatric Assessment (CGA) for older patients with neurocognitive disorders admitted to emergency departments to improve outcomes (Evidence: Moderate) 13.

Monitor and Manage Polypharmacy in patients with neurocognitive disorders to prevent adverse drug interactions and complications (Evidence: Moderate) 1 10.

Use Non-Invasive Sedation Techniques (e.g., intranasal midazolam) cautiously for managing behavioral symptoms in geriatric patients (Evidence: Weak) 8 17.

Educate Family Caregivers through structured therapeutic education programs to enhance care quality and reduce caregiver burden (Evidence: Moderate) 16.

References

1 Shah J, Parsons A, Pathuri S, Lieberman J, Hatten-Powell C. Polypharmacy-induced serotonin syndrome revealing underlying neurocognitive impairment and cervical myelopathy. BMJ case reports 2025. link 2 Cummings J, Sano M, Auer S, Bergh S, Fischer CE, Gerritsen D et al.. Reduction and prevention of agitation in persons with neurocognitive disorders: an international psychogeriatric association consensus algorithm. International psychogeriatrics 2024. link 3 Alhalaseh L, Makahleh H, Al-Saleem B, Al-Omran F, Schoenmakers B. Functional Status in Relation to Common Geriatric Syndromes and Sociodemographic Variables - A Step Forward Towards Healthy Aging. Clinical interventions in aging 2024. link 4 Xiao M, Li L, Zhu W, Wu F, Wu B. Statin-related neurocognitive disorder: a real-world pharmacovigilance study based on the FDA adverse event reporting system. Expert review of clinical pharmacology 2024. link 5 Asante EO, Mai XM, Eldholm RS, Skjellegrind HK, Kolberg M, Brumpton BM et al.. Vitamin D Status Over Time and Cognitive Function in Norwegian Older Adults: A Prospective Cohort of the HUNT Study. The journal of nutrition, health & aging 2023. link 6 Kershner EK, Tobarran N, Chambers A, Wills BK, Cumpston KL. Retained bullets and lead toxicity: a systematic review. Clinical toxicology (Philadelphia, Pa.) 2022. link 7 Vacas S, Canales C, Deiner SG, Cole DJ. Perioperative Brain Health in the Older Adult: A Patient Safety Imperative. Anesthesia and analgesia 2022. link 8 Barends CRM, Absalom AR, Visser A. Intranasal midazolam for the sedation of geriatric patients with care-resistant behaviour during essential dental treatment: An observational study. Gerodontology 2022. link 9 Chesneau S, Mekary M, Chayer N, Le Dorze G. A pilot study of AID-COMp: An innovative speech-language intervention for patients with early-stage major neurocognitive disorder. International journal of language & communication disorders 2022. link 10 Maltais A, Simard M, Vedel I, Sirois C. Changes in Polypharmacy and Psychotropic Medication Use After Diagnosis of Major Neurocognitive Disorders: A Population-based Study in Québec, Canada. Alzheimer disease and associated disorders 2022. link 11 Peden CJ, Miller TR, Deiner SG, Eckenhoff RG, Fleisher LA. Improving perioperative brain health: an expert consensus review of key actions for the perioperative care team. British journal of anaesthesia 2021. link 12 Gervais F, Dauphinot V, Mouchoux C, Krolak-Salmon P. Exposure to Anticholinergic and Sedative Drugs and Healthcare Costs in Older Patients with Neurocognitive Disorders. Journal of Alzheimer's disease : JAD 2021. link 13 Bosetti A, Gayot C, Preux PM, Tchalla A. Effectiveness of a Geriatric Emergency Medicine Unit for the Management of Neurocognitive Disorders in Older Patients: Results of the MUPACog Study. Dementia and geriatric cognitive disorders 2020. link 14 Spiller P, Hibbeln JR, Myers G, Vannice G, Golding J, Crawford MA et al.. An abundance of seafood consumption studies presents new opportunities to evaluate effects on neurocognitive development. Prostaglandins, leukotrienes, and essential fatty acids 2019. link 15 Mahanna-Gabrielli E, Schenning KJ, Eriksson LI, Browndyke JN, Wright CB, Culley DJ et al.. State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018. British journal of anaesthesia 2019. link 16 Monfort E, Mayol A, Lissot C, Couturier P. Evaluation of a therapeutic education program for French family caregivers of elderly people suffering from major neurocognitive disorders: Preliminary study. Gerontology & geriatrics education 2018. link 17 Rignell L, Mikati M, Wertsén M, Hägglin C. Sedation with orally administered midazolam in elderly dental patients with major neurocognitive disorder. Gerodontology 2017. link 18 Caulley L, Quimby AE, Barrowman N, Moreau K, Vaccani JP. Effect of Home-Call on Otolaryngology Resident Education: A Pilot Study. Journal of surgical education 2017. link 19 Hülür G, Gerstorf D. Editorial: subjective perceptions of memory functioning in old age - nature, correlates, and developmental trajectories. Gerontology 2015. link 20 Guillemin GJ. Quinolinic acid: neurotoxicity. The FEBS journal 2012. link 21 Brown A, Shiramizu B, Nath A, Wojna V. Translational research in NeuroAIDS: a neuroimmune pharmacology-related course. Journal of neuroimmune pharmacology : the official journal of the Society on NeuroImmune Pharmacology 2011. link 22 Jamora CW, Ruff RM, Connor BB. Geriatric neuropsychology: implications for front line clinicians. NeuroRehabilitation 2008. link 23 Thompson HS. Otto lowenstein, pioneer pupillographer. Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society 2005. link 24 Vig EK, Hu H. Lead toxicity in older adults. Journal of the American Geriatrics Society 2000. link 25 Benton A. Four neuropsychologists. Neuropsychology review 1994. link 26 Prigatano GP, Redner JE. Uses and abuses of neuropsychological testing in behavioral neurology. Neurologic clinics 1993. link 27 Jarema G. In sensu non in situ: the prodromic cognitivism of Kussmaul. Brain and language 1993. link 28 Smitherman J, Harber P. A case of mistaken identity: herbal medicine as a cause of lead toxicity. American journal of industrial medicine 1991. link 29 Shamberger RJ. Selenium metabolism and function. Clinical physiology and biochemistry 1986. link

Neurocognitive disorder