CASE OF LETICIA

1. Based on the case, site all the signs and symptoms of Leticia. Make a matrix for
comparison purposes and follow this:
Cognitive Domain Signs and Symptoms
Perceptual Motor  Motor skills – difficulty with previous familiar
activities “Sometimes hindi nya alam humawak
kutsara tinidor”
 Perception – Paranoia was the first thing that
stood out.
- When family took trip to amusement park
outside Manila. Laticia was telling her
daughter to go home as she saw something
scary or something, and her eyes darted
around suspiciously.
- When she went to province and came home
she said “May aswang sa ilalim ng kabilang
bahay.”
- Accused her husband of having a affair “Sabi
nya sakin na ang father ko ay may babae.”
Social Cognitive  Personality Change – her personality become
argumentative, “Nakikipag-away [siya] kahit
kanino.”
Learning and Memory  Memory – Forgetting something she use to
know.
- Leticia was forgetting a lot of things, even
when running the store. She would often
forget the right word for something.
- “She doesn’t know how to cook, like ‘yung
ginataan na masarap nyang ginawa, di na
nya alam… kung oano yung ingredients…”
- “hindi na nya alam humawak ng kutsara
tinidor.”
- They would make an effort to help her
remember things in conversation, go over
places and events, and even words, letters,
and numbers in detail.
- “One time, Nawala ang nanay ko. She had a
habit of going out. Nakaligtaan siya ng
kanyang yaya… She had left the house a
little before noon. ‘Pagdating ng hapon, hindi
pa rin naming mahanap”.”
Language  Word finding difficulty – forget the right word
to say “Hindi na nya maalala, ‘ano na nga ito?’”
 Comprehension – She will explain herself pero
 minsan mali mga explanation niya.
Complex Attention  Difficulty computing mentally – She
managed the place (sar-sari store) easily and
even computed sales in her head but within a
few years the store failed due to her
forgetfulness and would often complain out of
frustration that shes “Ang patal ko na”.
Executive Function - Decision making – Leticia husband had a hard
time dealing with her, that their eldest daughter
had to make the decisions for them.

2. Compare and contrast the sign and symptoms with the diagnostic criteria of your
neurocognitive disorders and decide if the diagnosis is major (dementia) or mild
(delirium) neurocognitive disorders. Put your final diagnosis below (since, the subtype is
not clear, just choose between major or mild neurocognitive disorders).

DELIRIUM
A. A disturbance in attention (i.e., reduced ability to direct, focus, ✓
sustain, and shift attention) and awareness (reduced orientation to the
environment).
B. The disturbance develops over a short period of time (usually hours
to a few days), represents a change from baseline attention and
awareness, and tends to fluctuate in severity during the course of a
day.
C. An additional disturbance in cognition (e.g., memory deficit, ✓
disorientation, language, visuospatial ability, or perception).
D. The disturbances in Criteria A and C are not better explained by ✓
another preexisting, established, or evolving neurocognitive disorder
and do not occur in the context of a severely reduced level of arousal,
such as coma
E. There is evidence from the history, physical examination, or
laboratory findings that the disturbance is a direct physiological
consequence of another medical condition, substance intoxication or
withdrawal (i.e., due to a drug of abuse or to a medication), or
exposure to a toxin, or is due to multiple etiologies.

MAJOR NEUROCOGNITIVE DISORDER

A. Evidence of significant cognitive decline from a previous level of ✓
performance in one or more cognitive domains (complex attention,
executive function, learning and memory, language, perceptual motor,
or social cognition) based on:
1. Concern of the individual, a knowledgeable informant, or the
clinician that there has been a mild decline in cognitive function; and
2. A modest impairment in cognitive performance, preferably
 documented by standardized neuropsychological testing or, in its
absence, another quantified clinical assessment.
B. The cognitive deficits do not interfere with capacity for independence ✓
in everyday activities (i.e., complex instrumental activities of daily living
such as paying bills or managing medications are preserved, but
greater effort, compensatory strategies, or accommodation may be
required).
C. The cognitive deficits do not occur exclusively in the context of a ✓
delirium.
D. The cognitive deficits are not better explained by another mental ✓
disorder (e.g., major depressive disorder, schizophrenia ).

Diagnosis: Major Neurocognitive Disorder (Dementia)

3. In the Philippines, what are the psychosocial implications of neurocognitive disorders
to the elderly.
- The severity of cognitive deficiencies in elderly people with neuro-cognitive
disorders (NCDs) varies, and they may be associated to one or more cognitive
ability domains. Memory, orientation, learning, comprehension, judgment,
emotional control, and the incapacity to start or carry out an activity are a few of
these areas. In the Diagnostic and Statistical Manual of Mental Disorders, NCDs
are classified as delirium, dementia, amnesia, and other cognitive disorders. The
primary characteristic is cognitive impairment/decline without impairment in
awareness, including memory impairment, which can be caused by numerous
etiologies, direct effects of degeneration, general medical conditions, persistent
effects of substances, or direct effects of degeneration.
4. As a student and future "sikolohista," how will you advocate the "neurocognitive
disorders" topic and issues to the Filipino people?
- The Philippines and the Filipino people do not really pay much attention towards
cognitive deficits or conditions especially mental health. I can become and
advocate by making sure that I understand the needs and treatments to be
administered to my patients, as well as recognize my tendencies also to make
the same mistakes that other people do. I can also use of modern technology like
social media, as people are becoming more reliant in the advancing technology.
It is very important for us to advocate for their right to be treated and have access
towards to best possible treatment for their condition.