8.1 Neurocognitive Disorders Flashcards
Neurocognitive Disorders
- Deficit of cognition or memory
Delirium
- Acute disturbance of cognition manifested by short term confusion, excitement, disorientation, clouding of consciousness.
- Hallucinations/illusions are common
- DEVELOPS RAPIDLY OVER A SHORT PERIOD OF TIME
S/S
- Due to extreme distractibility, they must be repeatedly reminded to focus attention.
- Speech is often rambling and irrelevant. Unpredictably switches between subjects
- Awareness may vary between hypervigilant to stupor
- Sleep fluctuates between no sleep to hyper-sleep
- Tremors may be noted
- Emotional instability
- Symptoms start abruptly if caused by an event such as head injury or seizure
- Slower onset can also happen if caused by systemic illness
- Symptoms are short lived, usually disappearing within 3-7 days
DELIRIUM MAY TRANSITION INTO PERMANENT COGNITIVE DISORDER
Causes of Delierium
Due to medical condition
- Infections
- Metabolic disorders
- Fever
- Seizures
- Migraines
- Stroke
- Brain abscess
- Electrolyte imbalance
- Over the age of 65 is high risk for delirium
- Geriatric syndromes such as dementia, depression, falls, and elder abuse often precipitate delirium
Due to substance
- Anticholinergics
- Antihypertensives
- Cocaine
- Lead
- Arsenic
- Carbon monoxide
- Analgesics
Neurocognitive
- Cognitive functions that relate to areas of the brain that control thinking, reasoning, memory, learning, speaking
Mild/Major Cognitive Disorders
Mild
- Focus on early intervention and prevention of progression of disorder
Major
- Dementia
- Progressive neurodegenerative conditions
Primary Neurocognitive Disorder
- Alzheimer’s disease
- The disorder itself is the major sign of brain disease not related to other organic illness
Secondary Neurocognitive Disorder (NCD)
- HIV, Cerebral Trauma
- Caused by another disease
NCD Symptoms
- Impairment in abstract thinking, judgment, impulse control
- Personal appearance is neglected
- Language may be affected
- Conventional rules of social conduct are ignored
- Personality change
- Difficulty naming objects, inappropriate behavior,
- Severe forms may cause aphasia (cannot speak at all)
- Personality changes (a person who was once very social may become isolated)
Reversible Neurocognitive Disorders
- Temporary Dementia
- Occurs from stroke, depression, side effects of medication, nutritional deficiencies, metabolic disorders.
Neurocognitive Progression
- Aphasia (inability to communicate)
- Ataxia (inability to carry out motor functions)
- Incontinence may also occur
Alzheimer’s Disease
Stage 1
- No decline in memory but changes in the brain are beginning
Stage 2
- Individuals may forget names, short term memory loss, individual is aware of decline. Anxiety and shame may worsen condition
- Maintaining organization with lists and structured routines may help with independent life.
Stage 3
- Interference with work performance. Noticeable to co-workers. May get lost while driving and concentration interrupted.
Stage 4
- Forgets major life events in personal history, declined ability to manage life such as cooking or shopping
- May deny the problem exists through confabulation (creating imaginary memories to fill in the gaps)
- REQUIRES ASSISTANCE TO MAINTAIN SAFETY
Stage 5
- Lose ability to preform ADL’s Disoriented to time and place. Frustration is common
Stage 6
- Delusions become apparent, such as needing to go to work when they are no longer employed. Symptoms worsen in the late afternoon and evening (sundowning). Communication becomes difficult
Stage 7
- Unable to recognize family members
- Immobile
Causes of Alzheimer’s
Neurotransmitter Alterations
- Enzyme used to produce acetylcholine is reduced which reduces neurotransmitters released in cortex and hippocampus.
Plaque/Tangles
- Plaque and tangles appear in the brain which causes destruction and death of neurons which leads to memory failure.
Head Trauma
- Puts patients at risk for AD.
Genetics
- Strongly genetic
Vascular Neurocognitive Disorders
- Caused by cerebrovascular disease
- Blood flow to brain is impaired which causes intellectual deterioration.
- More abrupt onset than AD and runs a highly variable course
- SYMPTOMS OCCUR IS STEPS AS OPPOSED TO GRADUAL. At times symptoms may “clear up”
- Caused directly by interruption of blood flow to the brain. (Hypertension, cerebral emboli/thrombosis)
HTN
- Damages lining of blood vessels which can lead to rupture (hemorrhage) and accumulation of fibrin in the vessel which causes clotting.
- Can cause small infarcts (mini strokes)
Frontotemporal Neurocognitive Disorder
- Shrinking of frontal/temporal anterior lobes of the brain.
- Previously called “Pick’s Disease”
- Cause is unknown but could be genetic
S/S
- Behavioral/Personality Changes
- Speech/Language Problems
NEUROCOGNITIVE DISORDERS DUE TO MEDICAL CONDITIONS
