Saludos Psychology Group
Dr. Kimberly Fitzgerald González
Florida Licensed Clinical Psychologist · License #PY10967 · Clinical and Forensic Psychology · Telehealth across Florida
Mental Health Education
When the Mind Begins to Fade
Neurocognitive disorders involve a significant decline in one or more areas of cognitive function — memory, attention, language, or the ability to plan and reason. They are not a normal part of aging. They are medical conditions that affect millions of families, and understanding them is the first step toward getting the right help.
On this page
- Delirium — sudden, acute confusion
- Mild Neurocognitive Disorder — early decline that doesn't yet impair independence
- Major Neurocognitive Disorder — significant decline affecting daily functioning
- Alzheimer's Disease — the most common cause of dementia
- Vascular Neurocognitive Disorder — cognitive decline from reduced blood flow
- Lewy Body Dementia — dementia with hallucinations and movement symptoms
- Frontotemporal Neurocognitive Disorder — personality and language changes first
- Why Dr. Fitzgerald González's expertise matters — 51,000 hours of clinical and research experience
- Why it matters for you — an accurate diagnosis and evidence-based treatment changes everything
Neurocognitive Disorders
Conditions involving significant decline in cognitive abilities that affect daily life
Neurocognitive Disorders
Delirium
Sudden, acute confusion — often medical in origin
Delirium is a sudden, severe disturbance in mental function — a rapid onset of confusion, disorientation, and fluctuating awareness that develops over hours or days. Unlike dementia, which is gradual and progressive, delirium comes on fast. It is almost always caused by an underlying medical condition — infection, medication, surgery, organ failure, or withdrawal from substances.
Delirium is one of the most common and most underrecognized medical emergencies, particularly in older adults and in hospital settings. It is not just "confusion" — it is a signal that something is seriously wrong medically, and it requires urgent evaluation. Unfortunately, it is frequently mistaken for dementia, depression, or simply "getting old," leading to dangerous delays in treatment.
"My father was fine when we dropped him off for surgery. Two days later he didn't know where he was or who I was. The nurses said it was normal. It wasn't."
Delirium is reversible when the underlying cause is identified and treated — but it can cause lasting cognitive effects, particularly in vulnerable individuals. Family members who notice sudden changes in a loved one's mental status should treat it as a medical emergency.
Common signs families and caregivers describe
- Sudden onset of confusion — develops over hours or days
- Fluctuating level of consciousness — worse at night ("sundowning")
- Disorientation — not knowing where they are or what time it is
- Difficulty focusing or sustaining attention
- Agitation, restlessness, or conversely extreme sleepiness
- Hallucinations — seeing or hearing things that aren't there
- Incoherent or rambling speech
- Represents a change from the person's baseline — this is key
Neurocognitive Disorders
Mild Neurocognitive Disorder
Early cognitive decline that doesn't yet impair independence
Mild Neurocognitive Disorder — sometimes called Mild Cognitive Impairment or MCI — describes a level of cognitive decline greater than normal for a person's age and education level, but not yet severe enough to significantly interfere with daily functioning. The person can still manage their affairs independently, but they or those close to them notice that something has changed.
Mild NCD sits at a crucial juncture — for some people it remains stable or even improves; for others it progresses to major neurocognitive disorder. Early identification opens the door to intervention, monitoring, and planning while the person still has full capacity to participate in those decisions.
"She was still doing everything herself. But she'd ask the same question three times in an hour. We knew something had shifted."
Common experiences people and families describe
- Forgetting recent events or conversations more than before
- Losing track of the date or recent appointments
- Taking longer to complete familiar tasks
- Difficulty finding the right word mid-sentence
- Still able to manage daily life independently
- Concern expressed by family before the person themselves notices
Neurocognitive Disorders
Major Neurocognitive Disorder
Previously called: dementia
Major Neurocognitive Disorder — the DSM-5 term for what most people call dementia — involves significant cognitive decline that interferes with independence in everyday activities. It is not a single disease but a syndrome caused by various underlying conditions, the most common of which is Alzheimer's disease.
It affects not only the person diagnosed but everyone who loves them. The caregiver burden associated with major NCD is profound and often invisible to the outside world. While there is currently no cure for most causes, a great deal can be done to support quality of life and care for both the person and their family.
"The hardest part wasn't the forgetting. It was watching her become someone I didn't recognize — and knowing she didn't recognize me either."
Common experiences families describe
- Significant memory loss — forgetting recent events, names, familiar faces
- Getting lost in previously familiar environments
- Difficulty with language — word-finding problems, repetitive speech
- Changes in personality, mood, or behavior
- Increasing dependence on others for daily functioning
- In later stages — loss of recognition of loved ones
Neurocognitive Disorders
Alzheimer's Disease
The most common cause of dementia
Alzheimer's disease accounts for 60 to 80 percent of all dementia cases. It is a progressive neurological disease involving the accumulation of amyloid plaques and tau tangles in the brain, beginning in the hippocampus and spreading outward over time. The course typically spans 8 to 10 years from diagnosis.
Early diagnosis matters — it allows the person to participate in care planning and spend meaningful time with family while they still can.
"He remembered everything from fifty years ago in vivid detail. He couldn't remember what he had for breakfast."
Early warning signs families often notice first
- Memory loss that disrupts daily life — especially recent events
- Asking the same questions or telling the same stories repeatedly
- Difficulty planning or solving familiar problems
- New problems with words — stopping mid-sentence, calling things by wrong names
- Withdrawal from social activities or hobbies
- Changes in mood or personality — increased anxiety, suspicion, or depression
Neurocognitive Disorders
Vascular Neurocognitive Disorder
Cognitive decline from reduced or blocked blood flow to the brain
Vascular NCD is caused by conditions that damage blood vessels in the brain — most commonly strokes — that reduce blood flow and deprive brain tissue of oxygen. It is the second most common cause of dementia after Alzheimer's, and the two frequently co-occur.
Unlike Alzheimer's, vascular NCD often progresses in a stepwise pattern — periods of stability followed by sudden declines. Executive function, processing speed, and attention are often affected early, while memory may be relatively spared.
"After the stroke his thinking was slower, he had trouble planning. The doctors focused on his arm. Nobody talked about his mind."
Common experiences people and families describe
- Slowed thinking and processing speed
- Difficulty with planning, organizing, or multitasking
- Stepwise decline — sudden worsening following a vascular event
- Depression, which is particularly common in vascular NCD
- History of stroke, heart disease, diabetes, or high blood pressure
Neurocognitive Disorders
Lewy Body Dementia
Dementia with hallucinations, movement symptoms, and fluctuating cognition
Lewy body dementia is the third most common cause of dementia and one of the most frequently misdiagnosed. Its combination of cognitive decline, vivid visual hallucinations, Parkinsonian movement symptoms, and dramatic fluctuations in alertness make it clinically distinctive.
An important clinical note: people with Lewy body dementia can have severe and potentially dangerous reactions to antipsychotic medications. Accurate diagnosis is critically important — not just academically but for safety.
"She saw a little girl sitting in the corner every evening. The same dress, the same hair. She knew it probably wasn't real. She saw her anyway."
Distinctive features
- Recurrent, detailed visual hallucinations — often people or animals
- Fluctuating cognition — alertness and attention vary dramatically
- Parkinsonian motor features — tremor, rigidity, shuffling gait
- REM sleep behavior disorder — acting out dreams
- Sensitivity to antipsychotic medications — dangerous reactions
Neurocognitive Disorders
Frontotemporal Neurocognitive Disorder
Previously called: Pick's disease or frontotemporal dementia
Frontotemporal NCD affects the frontal and temporal lobes — the areas governing personality, behavior, and language. Unlike Alzheimer's, memory is often relatively intact early. What changes first is who the person is.
Families spend years watching a loved one behave rudely, make socially inappropriate comments, or show a startling lack of empathy — often misdiagnosed as psychiatric illness. The average time to diagnosis is three to four years. It tends to affect people in their 50s or 60s.
"He made a crude joke at a funeral. He started shoplifting for no reason. The doctors kept saying it was depression. It wasn't depression."
Common experiences families describe
- Dramatic personality changes — apathy, disinhibition, loss of empathy
- Socially inappropriate behavior
- Compulsive or repetitive behaviors
- Relatively preserved memory in early stages
- Often misdiagnosed as psychiatric illness for years
Clinical Expertise
Why Dr. Fitzgerald González's expertise matters
51,000 hours of clinical and research experience including neurocognitive presentations
Dr. Fitzgerald González has assessed neurocognitive disorders across clinical settings where accurate differential diagnosis is most consequential — distinguishing delirium from dementia, vascular NCD from Alzheimer's, frontotemporal NCD from psychiatric illness. These distinctions determine the treatment approach, the level of care, and the clinical communication with families navigating an overwhelming and often invisible burden.
Neurocognitive disorders also require a clinician trained across the full lifespan — one who understands the developmental trajectory of cognitive aging and the clinical picture that deviates from it. A lifespan-trained clinical psychologist reads those differences and builds care accordingly.
Clinical Relevance
Why it matters for you
The right diagnosis changes everything that follows
If you or someone you love is experiencing cognitive changes — memory, language, personality, or reasoning — accurate evaluation is the foundation of everything that follows. Not every cognitive change is dementia. Not every dementia is Alzheimer's. Getting the diagnosis right determines the treatment approach, the care plan, and how the family is supported through what comes next.
An accurate diagnosis and evidence-based treatment changes everything.
Saludos Psychology Group provides services via telehealth. Schedule directly with Dr. Fitzgerald González — no referral required.
Schedule with Dr. Fitzgerald González →This page is for educational purposes only. It is not a substitute for professional mental health assessment, diagnosis, or treatment. If you are in crisis, please immediately call or text 988 or go to the nearest emergency room.
Schedule directly with Dr. Fitzgerald González — no referral required. Schedule with Dr. Fitzgerald González →This page is for educational purposes only. It is not a substitute for professional medical or mental health assessment, diagnosis, or treatment. If you are in crisis, please immediately call or text 988 or go to the nearest emergency room.