Ch. 34: Neurocognitive Disorders: Delirium and Dementia

Question 1

What is Cognition?

Answer 1

system of interrelated abilities, such as perception, reasoning, judgement, intuition, and memory. (allows one to be aware of oneself)

Question 2

What is memory?

Answer 2

facet of cognition, retaining & recalling past experiences

Question 3

What is delirium?

Answer 3

a temporary disorder; acute cognitive impairment caused by medical condition (characterized by fluctuating consciousness & attention)

Question 4

What is dementia?

Answer 4

Chronic, cognitive impairment

Differentiated by cause, not symptoms

Question 5

Most common causes of delirium?

Answer 5

In order of frequency:

1. Medications
2. Infections (UTI, URTI)
3. Fluid & electrolyte imbalance, metabolic disturbances

Question 6

Differentiate between hyperkinetic delirium and hypo kinetic delirium?

Answer 6

Hyperkinetic delirium: psychomotor hyperactivity, excitability, hallucinations

Hypokinetic delirium: lethargic, somnolent, apathetic

Question 7

High priority diagnosis for individuals with delirium?

Answer 7

Risk for injury - low beds, guard rails, careful supervision

Question 8

What is Alzheimer’s Type of Dementia?

Answer 8

degenerative, progressive neuropsychiatric disorder that results in cognitive impairment, emotional & behavioural changes, physical & functional decline and ultimately death

Types:
Early Onset: 65 & younger (rapid progression)
Late Onset: (over 65)

Question 9

Etiology of Alzheimer’s?

Answer 9

• Neuritic plaques
• Neurofibrillary tangles
• Oxidative stress & free radicals
• Inflammation

Question 10

No medication can cure AD, but medications have two goals:
1) Restoration/maintenance of cognitive function
2) Treatment of related psychiatric disturbances that worsen the individual’s functional and/or cognitive status
What are some meds?

Answer 10

Acetylcholinesterase Inhibitors (AChEI) 
(donepezil, rivastigmine, galantamine) 
*Used to delay cognitive decline
Most common side effects: N/V

Question 11

How do you measure Visuospatial impairment using the MMSE?

Answer 11

Inaccurate drawings on the MMSE or clock drawings

Question 12

What is executive functioning?

Answer 12

Judgement, reasoning, and the ability to problem solve or make decisions are impaired in the late stage of AD.

Question 13

What are mood changes associated with AD?

Answer 13

Depression - dysphoric mood
Anxiety
Catastrophic reactions

Question 14

What are behavioural responses associated with Alzheimer’s?

Answer 14

• Apathy & Withdrawal
• Restlessness, agitation & agresison
• Aberrant motor behaviour
• Disinhibition –> acting on thoughts & feelings without exercising appropriate social judgement (i.e. more comfortable naked - so decide to take clothes off)
• Hypersexuality

Question 15

What is Validation Therapy?

Answer 15

Method used for communicating with patients with AD. Nurse does not try to reorient the person but rather respects the individual’s sense of reality

Question 16

What is Lewy bodies dementia?

Answer 16

usually progresses quickly; Diagnosed before or concurrently with parkinsonism (rigidity, tremors, stooped posture) Visual hallucinations common*

Question 17

What is the medical treatment for Parkinson’s…why may this cause issues in Dementia due to Parkinson’s Disease?

Answer 17

Anticholinergics -
Dopamine Agonists
*Anticholinergic meds may cause mental effects (confusion, restlessness)