Neurocognitive Disorders in Society

Neurocognitive Disorders in Society

Throughout history, there has been a debate of where the seat of intelligence and cognition lives, with Hippocratic doctors arguing in favor of the brain, while Aristotle argued in favor of the heart as the dominant organ for sensation, cognition, and movement. Over time, the brain’s dominant role in cognition has become more apparent, and this has been depicted in the history of the arts. With the association of the front of the brain and higher intellectual faculties, classical portraits of gods, heroes, and famous writers and artists usually show a high forehead, in contrast to both lower-class individuals and women, both of whom were usually depicted to have retreating foreheads. We obviously know today there is no difference in intelligence or IQ between genders; however, it is interesting that research has shown that men and women use different areas of their brains to perform certain cognitive functions.

Episodic Memory

Cognition involves a combination of higher-level functions in the brain. One common function people often have complaints about is memory. We have a number of types of memory. Episodic memory refers to memory of specific events of the past, such as what you did this morning. Episodic memory is often a defining feature of early-stage typical Alzheimer’s disease, and is also frequently observed in non-Alzheimer dementias. Episodic memory is the most common reported problem in a cognitive disorders clinic. Episodic memory can also be divided into retrograde and anterograde memory. Retrograde memory is the ability to remember past events, while anterograde memory is the ability to acquire new memories. Except for rare examples of highly restricted medial temporal lobe lesions causing pure anterograde deficits, both anterograde and retrograde memory are affected simultaneously in most disorders impacting memory, including Alzheimer’s disease. Conversely, semantic memory refers to knowledge of facts, concepts, and objects. For example, that London is the capital city of England, or that a dog says bark, are examples of semantic memory.

Someone in the world develops dementia every 3 seconds. Worldwide, an estimated 50 million people are living with dementia. These numbers are projected to reach 82 million by the year 2030 and 152 million by 2050, with the majority of individuals coming from low- and middle-income countries. In the United States, approximately 6 million people are living with dementia, with Alzheimer’s disease accounting for up to 70% of these cases, followed by vascular dementia. While the number of adults living with dementia around the world is expected to grow exponentially by 2050 with increased life expectancy, cases of dementia for adults under the age of 65 has been significantly decreasing.

A number of aspects of cognition can be negatively impacted by dementia, such as attention, learning and memory, reasoning and executive functioning, perceptual abilities, language, as well as behavioral and psychosocial. The signs and symptoms of dementia can differ depending on the cause and stage of dementia. For example, individuals with behavioral variants of frontotemporal dementia and Huntington’s disease may experience behavioral changes and depression; individuals with primary progressive aphasia experience gradual loss of language function but with relatively preserved memory, and individuals with vascular dementia often have symptoms such as dysarthria and dysphagia.

Symptoms of Dementia

In general, one of the earliest complaints patients with dementia have is difficulty with memory. difficulties. However, many people, as they age, have some form of memory difficulty that does not progress to dementia. Common signs and symptoms of early dementia are:

  • Easily distracted
  • Decreased processing speed
  • Difficulty multitasking
  • Episodic and working memory problems
  • Difficulty learning new information
  • Difficulty setting goals and plans
  • Poor judgment and impaired reasoning/problem-solving ability
  • Lack of social inhibition/appropriateness
  • Lack of mental flexibility
  • Inability to recognize common objects or faces
  • Visuo-spatial difficulties
  • Language difficulties
  • Anger and aggression
  • Increase in anxiety
  • Repetitive actions
  • Sleep disorders
  • Mood swings
  • Loss of motivation

There is an increasing demand for health care providers to increase their competency in detection of neurocognitive disorders. Most testing required to assess for cognitive decline is easily accessible and easy to perform at the bedside. While some causes of dementia are nonmodifiable, such as genetics and age, many risk factors of dementia can be decreased by lifestyle modifications, such as appropriate diet and exercise. The earlier we can detect subtle signs of cognitive decline, the earlier we can implement strategies to try to improve the modifiable risk factors of dementia.

As we continue to learn and understand the science of neuroplasticity in its relationship to neurodegenerative disorders, our hope in the future is we can directly perform treatments to the brain to both slow down and reverse the brain’s degeneration process.

References:

  1. Alzheimer’s Association. (2018). 2018 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, 14, 367– 429.
  2. Alzheimer’s Disease International. (2015). World Alzheimer Report 2015: The global impact of dementia. London, United Kingdom: Alzheimer’s Disease International.
  3. Finger, S. History of neuropsychology. Neuropsychology Handbook of Perception and Cognition. 1994,1-28.
  4. Stern, Y. (2012). Cognitive reserve in ageing and Alzheimer’s disease. The Lancet Neurology, 11, 1006–1012.
  5. Woods, B., Aguirre, E., Spector, A. E., & Orrell, M. (2012). Cognitive stimulation to improve functioning in people with dementia. Cochrane Database of Systematic Reviews, 2012(2), 1–81.
  6. World Health Organization. (2017). Dementia: Fact sheet. Retrieved from
  7. http://www.who.int/mediacentre/factsheets/fs362/en/
  8. World Health Organization and Alzheimer’s Disease International. (2012). Dementia: A public health priority. Geneva, Switzerland: World Health Organization.
  9. http://apps.who.int/iris/bitstream/handle/10665/75263/9789241564458_eng.pdf? sequence=1

About Author

David Traster, DC, MS, DACNB, FABBIR, FABVR, CCSP, PAK

Dr. Traster is a globally recognized expert in the field of neurological rehabilitation. He lectures and consults for doctors of all specialties across the world relating to patients with a variety of neurological disorders. He is most noted for working with patients suffering from head injuries, dizziness, balance disorders, and chronic pain. Dr Traster is a licensed chiropractor that holds a Master’s Degree in Sports Health Science. Assistant professor for the Carrick Institute for graduate studies and 2018 Instuctor of the Year. Has received a Diplomate in Chiropractic Neurology by the American Chiropractic Neurology Board as well as a Fellow in Brain Injury and Rehabilitation by the American College of Functional Neurology. Developed and taught the Vestibular Rehabilitation Fellowship Program through the American College of Functional Neurology. Certified Chirorpactic Sports Physician. Certified practitioner in Applied Kinesiology. Certified personal trainer with specialties in performance enhancement and corrective enhancement through NASM. Has been a co-author on over 55 case study publications in the journal of Frontiers Neurology. Currently a co-owner of the Neurologic Wellness Institute in Downtown Chicago and Wood Dale Illinois. The Neurologic Wellness Institute is an integrative brain rehabilitation center for a variety of neurological conditions such as concussion, dizziness, dysautonomia, chronic pain, ADHD, anxiety, Parkinson's disease, and balance disorders.

About Author

George Michalopoulos, DC, DACNB,FABBIR, FABCDD, FABVR

Dr. George Michalopoulos has been in practice for 28 years in Addison and Wood Dale and strives to restore his patient’s health in the shortest period of time. He utilizes a multi-disciplinary approach including, brain-based rehabilitation, physical therapy, diet, and education of the patient’s existing problems. Along with completing his post-graduate diplomate status at the prestigious Carrick Institute for Graduate Studies and becoming 1 of only 14 Chiropractic Neurologist in the State of Illinois and 1 of only 355 Chiropractic Neurologists in the United States, he is also Fellowship trained in Brain Injury and Rehabilitation and concentrates on complex neurologic injuries but mainly focuses on mTBI and protracted concussion rehabilitation. Dr. George is Fellowship trained in Childhood Developmental disorder and is certified in electrodiagnosis studies including needle EMG, NCV, and SSEP. He is also certified in QEEG and neurofeedback treatment. He is the only triple board-certified Chiropractic Neurologist in Illinois. Has been a co-author on over 13 case study publications in the journal of Frontiers Neurology. Born in Toronto, Ontario, Canada, he did his undergraduate studies in Queen’s University in Kingston, Ontario. Dr. George still plays competitive hockey and is a die-hard Toronto Maple Leaf fan. He has dedicated much of his time and effort to educate industry and community in the care and prevention of low back, neck, work, and sports injuries along with treatment of complicated neurologic disorders. He has treated many professional athletes including numerous hockey players from the NHL, and is active in the charitable organization of the Chicago Blackhawks hockey club. Dr. George Michalopoulos is also a mentor of scholarship winners for the Keith Magnuson and Jack Fitzsimmons Chicago Blackhawk Scholarships. Professional memberships and charity organizations include, a charter member of the International Association of Functional Neurology and Rehabilitation, Member of the Functional Neurology Society, Society for Pain and Practice Management, Multi-disciplinary Academy of Affiliated Medical Arts (M.A.A.M.A.), and Chicago Blackhawks Hockey Club Alumni Association. Neurologic Wellness Institute (Wood Dale 630-766-1552 and Chicago 312-265-0919)

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