Frontotemporal Neurocognitive Disorder Essay

The current paper is a discussion on frontotemporal neurocognitive disorder. The diagnostic criteria for this condition will be outlined. The modes of management will be discussed including the pharmacotherapy and psychotherapy approaches. The risks involved with these modes of therapy will be outlined with rationales for choosing such therapies despite such risks. Frontotemporal Neurocognitive Disorder Essay

Criteria for Diagnosis

Criteria A for frontotemporal neurocognitive disorder requires that the major or mild neurocognitive disorder criteria is met (American Psychiatric Association, 2013). In this regard, the criteria for major or mild neurocognitive disorder include:

Evidence of either modest or significant (for mild or major NCD respectively) reduction in a previous functioning level in one or more domains of cognition including carrying out executive tasks, memory/learning, language, perceptual- motor, social cognition, or complex attention as shown by either the individual or an informant report or by neurocognitive testing.
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The disorder interferes with the independence of the individual such as performing activities of daily living. Mild NCD requires that it does not interfere with independence.
The condition does not exist in the context of delirium
The condition is not explained by another medical condition, for example, depression or schizophrenia.
Criteria B requires the condition to be insidious in onset and gradual in progression.

Criteria C classifies it to be either a behavioral or language variant. The behavioral variant includes a decline in social cognition plus three or more of the following: disinhibition in behavior, apathy or inertia, sympathy or empathy loss, ritualistic behavior or compulsions, and changes in diet. Language variant includes a reduction in language ability including forming words, finding words or understanding. Frontotemporal Neurocognitive Disorder Essay

Criteria D requires the sparing of perceptual-motor function, learning, and memory.

Criteria E requires that the changes are not better explained by another condition, be it mental, physical, neurological or cerebrovascular.

Management of frontotemporal neurocognitive disorder

The management involves pharmacology and psychotherapy (Tsai & Boxer, 2016). The condition is essentially incurable and progressive but these measures ensure the patient lives a comfortable life and can cope with daily requirements (Bang, Spina, & Miller, 2015). No medications are FDA approved for FTND and the current pharmacology was used for Alzheimer’s.

The medications that have shown a role in the treatment include selective serotonin reuptake inhibitors (SSRIs), antipsychotics and memantine, an NMDA antagonist (Hugo & Ganguli, 2014). SSRIs have been shown to significantly reduce behavioral symptoms and the drugs used include sertraline, fluoxetine and paroxetine. Antipsychotics have also been used for behavioral symptoms. Psychotherapies and other modes of treatment for this condition include cognitive enhancement therapy, speech therapy, physical and occupational therapy for those with motor deficits (Tsai & Boxer, 2016).

Treatment Risks

Treatment carries its own risks. Drugs such as antipsychotics carry a significant adverse effects profile especially in these patients who are more susceptible to extrapyramidal effects. Their efficacy in reducing symptoms is not proven. These drugs should not be used as the risks outweigh the benefits. However, drugs such as SSRIs have shown excellent symptom relief and should be used despite their side effects (Tsai & Boxer, 2016). Frontotemporal Neurocognitive Disorder Essay

Conclusion

Frontotemporal neurocognitive disorder is a progressive disorder affecting several cognitive domains. Management involves both pharmacotherapy and psychotherapy although they do not reverse the progression of frontotemporal pathology.

References

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

Bang, J., Spina, S., & Miller, B. L. (2015). Frontotemporal dementia. The Lancet, 386(10004), 1672-1682.

Hugo, J., & Ganguli, M. (2014). Dementia and cognitive impairment: epidemiology, diagnosis, and treatment. Clinics in geriatric medicine, 30(3), 421-442.

Tsai, R. M., & Boxer, A. L. (2016). Therapy and clinical trials in frontotemporal dementia: past, present, and future. Journal of neurochemistry, 138, 211-221. Frontotemporal Neurocognitive Disorder Essay

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