Discussion

 PLEASE I NEED RESPONSE TO THIS ASSIGNMENT

2 REFERENCES

A major neurocognitive disorder is used to describe a decline in cognitive function characterized by gradual impairment in memory, speech, mobility, and reasoning. The impairment in mental ability could be severe to the extent of affecting independence and ability to carry out daily/ normal activities (Caccappolo & Marder, 2015).

Diagnostic Criteria

 According to the DSM-5, the diagnostic criterion for major neurocognitive disorder includes a very gradual (“insidious”) onset, and gradual progression. Additionally, the clinical features suggestive of neurocognitive disorder with Lewy bodies are divided into three core diagnostic features, and two suggestive diagnostic features. The core diagnostic features are as follows:

1. Fluctuating cognition including marked variability in attention and alertness.

2. Recurrent, well-formed, and detailed visual hallucinations.

3. Presence of “spontaneous” parkinsonism (i.e., not due to medication side effects) that started AFTER onset of the cognitive decline.

The two suggestive diagnostic features are as follows:

1. Rapid eye movement sleep behavior disorder.

2. Marked sensitivity to side effects of antipsychotic medications.

Furthermore, the diagnosis of neurocognitive disorder (major or mild) with Lewy bodies can be probable or possible. The difference between a probable diagnosis and a possible diagnosis of neurocognitive disorder with Lewy bodies is in what clinical features are present. A probable diagnosis consists of either two core features OR at least one core feature plus at least one suggestive feature. A possible diagnosis consists of one core feature OR one or more suggestive features (American Psychiatric Association, 2013).

Evidenced-Based Psychotherapy and Psychopharmacologic Treatment

As far as psychotherapy is concerned, there is a lack of research concerning non-pharmacological interventions for Lewy Body Dementia (Livingston et al., 2014). Lewy Body Dementia (LBD) is characterized by a deficiency of acetylcholine and a deficiency of dopamine. The cholinergic deficit is implicated in major attention disorders and fluctuations. Acetylcholinesterase inhibitors such as donepezil or rivastigmine were studied in several double-blind placebo-controlled studies (Rolinski et al., 2016). There was moderate benefit on the cognitive level and on some psychiatric manifestations including hallucinations. A disabling parkinsonian syndrome can be treated with L-dopa as in Parkinson’s disease. Hallucinations may require antipsychotic treatment and the best documented drug is clozapine (Rolinski et al., 2016). REM sleep behavior disorders can be improved by melatonin.

Therapy Types and Risks  

 Because antipsychotic drugs can worsen Lewy body dementia symptoms, the best we can do to help limit this is modifying the environment. Reducing clutter and distracting noise can make it easier for someone with dementia to function. Offering reassurance and validation of their concerns especially when they are confused. And finally creating daily routines and keeping tasks simple. There are no risks involved in implementing theses therapies.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Caccappolo, E., & Marder, K. (2015). Epidemiology, diagnosis, and correlates of mild cognitive impairment in Parkinson’s disease. Cognitive Impairment and Dementia in Parkinson’s Disease, 203–222. https://doi.org/10.1093/med/9780199681648.003.0016

Connors, M. H., Quinto, L., McKeith, I., Brodaty, H., Allan, L., Bamford, C., Thomas, A., Taylor, J.-P., & O’Brien, J. T. (2018). Non-pharmacological interventions for Lewy body dementia: a systematic review. Psychological Medicine, 48(11), 1749–1758. https://doi-org.ezp.waldenulibrary.org/10.1017/S0033291717003257

Livingston, G., Kelly, L., Lewis-Holmes, E., Baio, G., Morris, S., Patel, N., Omar, R. Z., Katona, C., & Cooper, C. (2014). Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials. The British Journal of Psychiatry, 205(6), 436–442.

Rolinski, M., Fox, C., Maidment, I., McShane, R., & Rolinski, M. (2016). Cholinesterase inhibitors for dementia with Lewy bodies, Parkinson’s disease dementia and cognitive impairment in Parkinson’s disease. Cochrane Database of Systematic Reviews, 3.

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