Ch 13 Neurocognitive Disorders Flashcards
disorders in which a clinically significant deficit in cognition or memory exists, representing a significant change from previous level of functioning
neurocognitive disorders
disturbance in level of awareness/ change in cognition
develops rapidly over short period
delirium
delirium symptoms
difficulty sustaining attention
extreme distractibility
disorganized thinking
speech that is rambling, irrelevant, pressure and incoherent
impaired reasoning ability and goal directions
delirium symptoms continued
disorientation to time and place impairment of recent memory misperception of environment disturbances in level of consciousness psychomotor fluctuates between agitation, restlessness, and vegetative emotional instability
autonomic manifestations of delirium
tachycardia, sweating, flushed face, dilated pupils, increased BP
what is the duration of delirium
brief and subsides completely on recovery from underlying determinant
predisposing factors of delirium
general medical condition (infection, stroke, electrolyte imbalance, head trauma, abscess, seizure) substance induced (intoxication or withdrawal)- anticholinergics, alcohol, toxins etc
impairment in cognitive functions of thinking, reasoning, memory, learning, and speaking
neurocognitive disorder
NCD can be classified as what
mild or major
mild NCD
mild cognitive impairment
major NCD
previously described in DSM as dementia
disorder ITSELF is the major sign of some organic brain disease, not directly related to another illness
primary NCD
example of primary NCD
Alzheimer’s
behavioral reaction to memory loss, fills memory gaps with events that did not occur
confabulation
caused or related to another disease or condition
secondary NCD
example of secondary NCD
HIV or cerebral trauma
symptoms of NCD
impairment in abstract thinking, judgment, and impulse control
conventional rules of social conduct are disregarded
personal appearance and hygiene are neglected
language may be impaired
personality change is common
what is reversible NCD also called
temporary dementia
temporary dementia can be the result of
stroke, depression, med side effects, nutritional deficiencies, metabolic disorders
as NCD progresses, the symptoms are
aphasia, apraxia irritability, moodiness instability to care for self wandering from home incontinence
this accounts for 50-60% of all cased of NCD
Alzheimer’s disease
stages of alzheimer’s
1-no apparent symptoms 2-forgetfulness 3-mild cognitive decline 4-mild/moderate cognitive decline 5-moderate cognitive decline 6-moderate/severe cognitive decline 7-severe cognitive decline
onset is slow
progressive and deteriorating
NCD due to Alzheimer’s
abrupt onset
result of cerebrovascular
variable pattern of cognitive functioning
vascular NCD
shrinking of frontal and temporal anterior lobes of the brain
AKA Pick’s disease
frontotemporal NCD
amnesia is common
repeated can cause dementia pugilistica
NCD due to traumatic brain injury
symptoms of dementia puglilistica
emotional lability
dysarthria
ataxia
impulsivity
similar to AD but progresses more rapidly
appears in cerebral cortex and brainstem
progressive and irreversible
25 % of all NCD cases
NCD due to Lewy body disease
loss of nerve cells located in the substantia nigra
decrease in dopamine
sometimes resembles AD
NCD due to Parkinson’s
caused by brain infections with opportunistic organisms or by the HIV 1 virus directly
symptoms may range from barely perceptible changes to acute delirium to profound cognitive impairment
NCD due to HIV infection
this is transmitted as a Mendelian dominant gene
client decreases into profound state of dementia and ataxia
course of disease is based on age and onset
NCD due to Huntington’s
attributable to prion disease
onset of symptoms occurs 40-60 yrs
course is extremely rapid with progression from diagnosis to death in less than 2 yrs
NCD due to Prion disease
medical treatment for delirium
staff remain with client
room with low stimuli
low dose of antipsychotic
benzo used if substance withdrawal
meds for cognitive impairment
Cogex, Aricept, Exelon
meds for agitation, aggression, hallucination, thought disturbances, wandering
Risperdal
Olazapine (zyprexa)
meds for short term sleep disturbances
Desyrel
Remeron
Ambien*
meds for depression
SSRI
Tricyclic
Trazodone (Desyrel)
Dopaminergic
meds for anxiety
Librium
Xanax
Ativan
Valium- NOT for prolonged periods
