随着全球老龄化日益突出,神经认知障碍(NCD)发病率增加。NCD患者通常在一个或多个认知领域有损害,如注意力,规划,抑制,学习,记忆,语言,视觉感知,和空间或社交技能。研究表明,这些成年人中有50-80%会出现神经精神症状(NPS),比如冷漠,抑郁症,焦虑,去抑制,妄想,幻觉,和异常的运动行为。NCD和随后的NPS的发展需要训练有素的医疗专业人员和家庭成员的极大照顾。行为症状通常比认知变化更令人痛苦,导致护理人员痛苦/抑郁,更多的急诊室就诊和住院,甚至更早的制度化。这意味着需要早期识别NPS风险较高的个体,了解他们NCD的发展轨迹,探索治疗方式。在这种情况下的报告和审查,我们介绍了一名82岁的男性,因抑郁症的新发作症状而入院。焦虑,和迫害妄想.他没有明显的精神病史,他的病史对于需要多次手术和两次脑血管意外(CVA)的广泛缺血性血管疾病具有重要意义。在进一步评估中,病人被诊断患有严重NCD,血管亚型。我们讨论了NCD的鉴别诊断和NPS的发展,以解释临床医生对早期发现和了解NCD预后进行更彻底评估的重要性。
As global aging becomes more prominent, neurocognitive disorders (NCD) incidence has increased. Patients with NCD usually have an impairment in one or more cognitive domains, such as attention, planning, inhibition, learning, memory, language, visual perception, and spatial or social skills. Studies indicate that 50-80% of these adults will develop neuropsychiatric symptoms (NPS), such as apathy, depression, anxiety, disinhibition, delusions,
hallucinations, and aberrant motor behavior. The progression of NCD and subsequent NPS requires tremendous care from trained medical professionals and family members. The behavioral symptoms are often more distressing than cognitive changes, causing caregiver distress/depression, more emergency room visits and hospitalizations, and even earlier institutionalization. This signifies the need for early identification of individuals at higher risk of NPS, understanding the trajectory of their NCD, and exploring treatment modalities. In this case report and review, we present an 82-year-old male admitted to our facility for new-onset symptoms of depression, anxiety, and persecutory delusions. He has no significant past psychiatric history, and his medical history is significant for extensive ischemic vascular disease requiring multiple surgeries and two episodes of cerebrovascular accident (CVA). On further evaluation, the patient was diagnosed with major NCD, vascular subtype. We discuss differential diagnoses and development of NPS from NCD in order to explain the significance of more thorough evaluation by clinicians for early detection and understanding of NCD prognosis.