Mild Frontotemporal Neurocognitive Disorder (FT- NCD)

D.7.1. Terminology in the DSM-5 has been updated with the division of neurocognitive disorders into delirium, mild neurocognitive disorder, and major neurocognitive disorder. Major and mild neurocognitive disorders exist on a spectrum of cognitive and functional impairment.  Furthermore, DSM-5 recognizes specific etiologic subtypes of neurocognitive dysfunction, such as Alzheimer’s disease. In addition to Alzheimer's, these include frontotemporal degeneration, Huntington’s disease, Lewy body disease, traumatic brain injury (TBI), Parkinson’s disease, prion disease, and dementia/neurocognitive issues due to HIV infection. Some can typically affect younger as well as older people. Mild neurocognitive disorder is also called slight cognitive impairment, while major neurocognitive disorder is generally considered full-out dementia.

Students are to read the case study posted below (Mr. D.) and answer the following questions regarding the information presented in the case study.  Provide rationale and evidence based citations to support responses.   

The following components must be addressed in the discussion post:

What is the likely diagnosis?  What assessment data supports your preliminary diagnosis?  

Prevalence of the likely diagnosis?

Is it Permanent or Temporary?

What is the likely cause of disorder?

How is it diagnosed? Are there any labs or screening tools you would use to help in the diagnosis?

Are there any possible Differential Diagnoses and what are they?

What are the treatment options for this disorder?

Case Study:  Mr. D

Mr. D. is a 55-year-old retired school teacher with no prior psychiatric history.  He reports today to the clinic with his wife of 30 years.  The wife indicates that he has undergone a shift in his personality and behavior.  According to his wife, he has always been a very modest, humble, church going man.  However he has engaged in several incidents of inappropriate sexual comments to complete strangers.  They have quit going to church because this behavior has become so problematic.  In fact upon beginning the interview with Mr. D. he told the PMHNP, "Hey, take off that lab coat so I can see what you got underneath.  In fact, you can take it all off."  When asking about the family history, the wife indicates that Mr. D is adopted and they do not know his family history.  In addition, he had to retire early because of his change in personality.  He was even propositioning the children he was teaching.  The symptoms were particularly noticeable about a year ago when he began having problems expressing himself and understanding emails and other correspondence.  

Brief Mental Status Exam

Appearance:  Well-nourished, appropriately dressed

Motor:  No psychomotor retardation or agitation

Speech:  Tangential and circumstantial at times, disorganized, moderate rate/tone/volume, sparse content

Affect:  Blunted

Mood:  "I'm feeling good.  Want to see how I feel?"

Thought process: Somewhat disorganized at times, circumstantial and tangential at times, easily digresses from the current subject to sexual themes

Thought content:  Denies suicidal/homicidal ideations, denies self harm behaviors/thoughts, denies A/V hallucinations, no reaction to internal stimuli observed. No overt delusional comments made during exam. Rarely expanded when asked questions.

Abstraction:  Impaired 

Memory:  Impaired

Concentration:  Impaired

Social History:

First marriage with 2 children

Retired school teacher

Normal Weight, enjoys walking

Does not smoke or drink and has no history of same.  No history of substance abuse.

Wife is supportive

Past Psychiatric History

Unremarkable

Past Medical History

Unremarkable

Current Medications

MVI once a day

Melatonin 10 mg at bedtime prn sleep