Delirium, also known as acute confusional state, organic brain syndrome, brain failure, and encephalopathy, is a common occurrence among medical and surgical patients and causes extensive morbidity and mortality. This chapter provides an updated review of delirium, including pathophysiological correlates, clinical features, diagnostic considerations, and contemporary treatment options. The defining features of delirium include an acute change in mental status characterized by altered consciousness, cognition, and fluctuations. The chapter explores the risk factors for delirium. These can be divided into two categories: predisposing factors and precipitating factors. Imbalances in the synthesis, release, and degradation in gamma-aminobutyric acid (GABA), glutamate, acetylcholine, and the monoamines have also been hypothesized to have roles in delirium. GABA is the primary inhibitory neurotransmitter in the central nervous system (CNS) and medications such as benzodiazepines and propofol have known actions at GABA receptors and have been associated with delirium.

Alzheimer’s disease (AD) presents one of the most urgent health care issues of our time. AD is a disease of the brain and mind, and as such, neuropsychology has an essential and evolving role to play in addressing this growing public health concern. Measurement of key cognitive functions, such as delayed recall of recently presented information, is crucial in the diagnosis and monitoring of the disease. In addition to the importance of advancing scientifically informed disease-specific measurement of cognition, neuropsychology has a growing role to play in the design and implementation of nonpharmacological interventions for AD. The neuropathological hallmarks of AD are senile plaques (SP), neurofibrillary tangles (NFTs), and cell and synapse loss in multiple brain areas. Granulovacuolar degeneration (GVD) has long been recognized to be present in the brains of AD patients.

This chapter describes an overview of the procedures that a neuropsychologist may apply to a range of similar referrals in the area of civil capacities. It explores the presentation of a framework developed by the American Bar Association/American Psychological Association (ABA/APA) working group on capacity issues and provides more specific guidance regarding assessment tools. Decision making is a complex cognitive process that involves multiple brain regions and brain systems. Injuries to the prefrontal cortex are common in dementia and are often linked to changes in decision-making abilities. Key differences between clinical assessments and those for capacity evaluations include knowledge of relevant legal and ethical issues, a functional assessment, and an ability to present neuropsychological data to lay readers. Research on medical consent capacity and financial capacity highlight the importance of the assessment of calculation, executive function, and verbal memory as part of any test battery.

Old age brings with it unique challenges in diagnosis, treatment, and care; dementia complicates these issues even more. Improving the management and care of persons with dementia has positive implications for patients, caregivers, and physicians alike. Two types of secondary complications can be analyzed in relation to dementia: conditions that arise outside of the dementia and then conditions that appear to develop due to the neurological degeneration inherent in dementia. Examples of psychiatric complications include depression, anxiety, and psychosis. Medical problems consist of issues such as stroke, cardiovascular problems, cancer, infections, orthopedic issues, diabetes, nutritional disorders, vision and hearing problems, as well as general pain. The high comorbidity of dementias with other psychiatric and medical issues can complicate the diagnosis and treatment of patients with dementia. Issues in the central nervous system (CNS) have long been looked at as possible predictors of dementia.

With the elderly population rapidly increasing worldwide, neuropsychologists are often called upon to conduct assessments of possible neurodegenerative disorders. This chapter provides an overview of the differential diagnostics via neuropsychological methods of cortical dementia syndromes. Over the last several decades, clinicians have seen significant changes with regard to daily practice in interprofessional settings, which are becoming more commonplace for practicing neuropsychologists. The chapter provides guidance/input/assistance for practitioners working in such settings. Mini-Mental State Examination (MMSE) is the most commonly administered psychometric screening assessment of global cognitive functioning. The Clinical Dementia Rating scale (CDR) is a widely used rating scale for measuring dementia severity. Alzheimer’s disease (AD) is characteristic of a progressive decline in memory, executive functioning, visuospatial abilities, language, and behaviors as a result of neurodegeneration in the brain. Progressive supranuclear palsy (PSP) is a neurodegenerative akinetic rigid disorder.

The Transmissible spongiform encephalopathies (TSEs) form a group of illnesses, characterized by a pathological form of the native prion protein, which results in a rapidly progressive neurodegenerative illness. They also are responsible for Gerstmann-Strâussler-Scheinker (GSS) syndrome and fatal familial insomnia (FFI), and they have been produced experimentally in several other animals. Creutzfeldt-Jakob disease (CJD) is the most common TSE in humans. Human prion diseases have three etiologies: (a) sporadic, (b) genetic, and (c) acquired. Human prion diseases are important to understand because of their underlying pathophysiology, public health implications, and clinical features that often result in misdiagnosis. This chapter reviews the historical discovery of prion diseases and the formulation of the prion hypothesis. It explores prion hypothesis and the neuropathogenesis of prion diseases. The chapter ends with a description of the diagnosis, prognosis, and experimental treatment of human prion diseases.

Frontotemporal dementia (FTD) is the third leading cause of dementia in large pathological series but tends to have an earlier age of onset than Alzheimer’s disease (AD) and Lewy body dementia, the most frequent and second most frequent forms of dementia. Semantic dementia (SD) includes impairment in the understanding of the meanings of words and difficulty in identifying objects. Semantic primary progressive aphasia, also known as SD, includes difficulties with naming and single-word comprehension although grammar and fluency are often spared. SD is a disorder that involves loss of semantic memory, anomia, receptive aphasia, and an actual loss of word meaning. The chapter presents some assessment tools that are those conducted by a psychologist or a neuropsychologist. Such an evaluation should include a clinical interview and neuropsychological examination. SD has been associated with ubiquitin-positive, TAR-DNA-binding protein-43 (TDP-43)-positive, tau-negative inclusions.

Alzheimer’s disease (AD) and related cortical dementias are a major health problem. Patients with AD and related dementia have more hospital stays, have more skilled nursing home stays, and utilize more home health care visits compared to older adults without dementia. This chapter discusses the role of family caregivers and how they interact with in-home assistance, day care, assisted living, and nursing homes in the care of an individual with dementia. It also discuss important transitions in the trajectory of dementia care, including diagnosis, treatment decision making, home and day care issues, long-term care placement, and death. It highlights the importance of caregiver assessment, education, and intervention as part of the care process. Dementia caregivers are at risk of a variety of negative mental health consequences. Another important moderating variable for dementia caregiver distress is self-efficacy.

This chapter suggests that the dysexecutive syndrome associated with vascular dementia (VaD) is caused by impairment in separate but related cognitive concepts; that is, pathological inertia, mental bradyphrenia, disengagement, and temporal reordering. During the late 19th and early 20th centuries, cerebrovascular dementia was a well-established clinical syndrome. Multi-infarct dementia (MID) generally became associated with all types of vascular syndromes. Recent research suggests the presence of considerable overlap between the neuropathology underlying Alzheimer’s disease (AD) and VaD. Patients diagnosed with VaD tend to produce hyperkinetic/interminable perseverations, suggesting an inability to appropriately terminate a motor response. Other aspects of the dysexecutive syndrome associated with VaD revolve around constructs related to interference inhibition, flexibility of response selection, and sustained attention. From the view point of diagnosis, the neuropathology of VaD often differentially impacts the frontal lobes, whereas the neuropathology associated with AD revolves more around circumscribed temporal lobe involvement.

Dementia is chronic and causes widespread dysfunction in multiple neuropsychological domains. While cognitive symptoms vary across different types of dementia based on their underlying neuropathology, impairments in attention, memory, and comprehension predominate. This chapter briefly discusses the research on the efficacy of various cognitive and behavioral interventions aimed to improve the neuropsychological symptoms in patients with dementia. Cognitive reserve has been shown to be influenced by various premorbid factors. Cognitive training refers to nonpharmacological interventions aimed to improve a patient’s cognitive function and is specifically designed to improve the patient’s functional capacity. Cognitive training generally includes a combination of cognitive stimulation, memory rehabilitation, reality orientation, and neuropsychological rehabilitation. Cognitive interventions have been shown to improve global cognitive functioning and abilities of daily living, reduce behavioral disturbances, and have positive effects on quality of life in patients with dementia.