Substance and Medication-Induced Neurocognitive Disorder: DSM-5 EPPP Lecture Video

The video below is the section for Substance and Medication-Induced Major or Mild Neurocognitive Disorder from Part 3 of TSM’s lecture series on DSM-5 and the EPPP, followed by a transcript. This lecture series aims to equip those preparing for the EPPP with everything you need to know about the impact DSM-5 will be having on the EPPP. To watch all of Part 3, click HERE. To watch Part 1 and 2, or register for our webinar series on DSM-5 and the EPPP, click HERE.

Transcript of DSM-5 EPPP Lecture Video: Substance and Medication-Induced Neurocognitive Disorder

NARRATIVE DEFINITION: Substance/Medication-Induced Major or Mild Neurocognitive Disorder

Substance/Medication-Induced Major or Mild Neurocognitive Disorder (previously Substance-Induced Persisting Dementia) can be specifically coded for alcohol if this substance is the cause of the neurocognitive symptoms.  In addition to listing the specific substance (e.g., alcohol), the DSM-5 specifies whether the symptoms are Persistent – the neurocognitive impairment continues even after the substance use has ceased.


Major Neurocognitive Disorder (major NCD) is diagnosed when there is significant cognitive decline from a previous level of performance, as noted by a knowledgeable informant or by documentation from standardized neuropsychological testing.  This decline is substantial enough to interfer with complex activities of daily living, such as paying bills, holding a job, managing medications, etc.

Mild Neurocognitive Disorder (mild NCD) contrasts with Major NCD by level of severity.  Knowledgeable informants note a mild decline, or neuropsychological testing finds some modest impairment from previous levels.  Mild NCD does not necessarily interfer with activities of daily living, but more effort is put forth to accomplish these activities.

Neither Mild nor Major NCD is better explained by delirium or some other mental disorder.

The rate of mild NCD is approximately 30-40% in the first 2 months of alcohol abstinence.  Mild persistent NCD is more likely in individuals who achieve abstinence after the age of 50.  Nutritional deficits are one complication that increases the likelihood of major NCD after alcohol abuse.  Associated with major NCD due to prolonged alcohol use is a tendancy to confabulate  experiences that actually did not take place.

Symptoms of alcohol related mild or major NCD include memory impairments, executive dysfunction (e.g., difficulty in organizing or planning), and visuospatial deficits in spite of intact sensory function. Individuals with alcohol induced major or mild NCD are less likely to demonstrate aphasia (i.e., language impairments) than are individuals with other forms of dementia.   In some instances, suspending alcohol use leads to improvements in cognitive functioning; oftentimes, however, the damage is permanent and irreversible.
FLASHCARD:

Alcohol-Induced Major or Mild Neurocognitive Disorder

1. Indicates a neurocognitive disorder (dementia) linked to the long-lasting effects of alcohol on brain functioning

2. The neurocognitive-related symptoms must persist beyond usual duration of Alcohol Intoxication or Alcohol Withdrawal (specify as Persistent)

Symptoms involve

1. Memory impairment

2. One or more of the following: ataxia, apraxia, agnosia, or executive function deficits

3. Significant impairment in social or occupational functioning and decline from prior functioning

4. However, aphasia is less likely to appear in Alcohol-Induced NCD than in other dementias but confabulation is more likely

Associated with

1. Frontal lobe atrophy, malnutrition, vitamin deficiencies (especially vitamin B1 or thiamine), head trauma, Wernicke’s encephalopathy, and cirrhosis of the liver. Most often, damage is permanent, even if alcohol use stopped

 

QUESTION:

Bob, a 60-year-old man, has been diagnosed with Neurocognitive Disorder substance/medication abuse. Which of the following statements is least likely to characterize Bob’s functioning?

ANSWERS:

A. Bob is suffering from memory impairments.

B. Bob demonstrates disturbances in his use and understanding of language.

C. Bob is unable to effectively engage in abstraction.

D. Bob has difficulties in sustaining and shifting attention.
RATIONALE: B is correct, as Neurocognitive Disorder substance/medication use (previously known as alcohol-induced persisting dementia) is not typically associated with deficits in the ability to use and understand language. Memory impairments (A) are a hallmark of dementias; C and D (abstraction, sustaining and shifting attention) are executive dysfunctions, highly likely to be implicated in Neurocognitive Disorder substance/medication use.

 

 

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