Ch.7: Neurocognitive disorders Flashcards
Neurocognitive disorder
- A condition involving impairments in areas such as thinking, remembering, and/or reasoning, which affect a person’s function and safety.
- Dementia has been replaced by this term
6 Neurocognitive domains
- Perceptual-motor function
- Language
- Learning and memory
- Social cognition
- Complex attention
- Executive function
Mild neurocognitive disorder
- “mild” means cognitive decline, but with little impact on daily function.
- still not enough to impact functioning in life
Major neurocognitive disorder
- “major” means cognitive impairment plus functional impairment- the diagnosis pertaining mor eto dementia
What must be identified when diagnosing someone with a neurocognitive disorder?
The underlying disease process must be identified
Ex: when you’re gonna diagnose somebody with neurocognitive disorder, you have to say this is because of alcoholism or vascular disease, or Alzheimer’s, or HIV
2 Types of Alzheimer’s disease
- Sporadic/late onset
- Early onset/Familial
Sporadic/late onset Alzheimer’s disease
- comes on after 65 years old
- due to genes, environment, lifestyle
Early onset/Familial Alzheimer’s disease
- occurs to people younger than 65
- familial background: has to be 3 generations
- very rare (1-5% of ALzheimers)
Clinical features of Alzheimer’s disease
- loss of memory
- language problems
- difficulty in doing simple tasks
- disorientation in time and space
- loss of reasoning capacity
- difficulty having elaborate thoughts
- loss of objects
- mood changes
- behavioral changes
- loss of initiative
The Alzheimer’s disease timeline (5)
- Early brain changes (preclinical)- there’s plaques and tangles that form in the brain but you don’t know it. Not yet impacting your functioning
- Subtle decline in thinking- not impair your functioning yet. Cn still eat by yourself, drive, grocery shopping
- Memory changes, confusion- might get lost in familiar places
- Inability to bathe, dress or eat without help- activities of daily living are impaired
- Loss of ability to communicate and recognize loved ones- procedural memory might still be there’
What increases the risk of developing Alzheimer’s disease?
- Traumatic brain injury
- Mid-life obesity
- Mid-life hypertension
- Current smoking
- Diabetes
- History of depression (lower evidence)
- Sleep disturbances (lower evidence)
- Hyperlipidemia (unclear evidence)
What decreases the risk of developing Alzheimer’s disease?
- Years of formal education
- Physical activity
- Mediterranean diet (moderate evidence)
- Cognitive training
- Moderate alcohol consumption (lower evidence)
- Social engagement (unclear evidence)
What are the two biggest single risk factors for AD
- advanced age
- being a woman
Mild Cognitive Impairment (MCI)
- refers to a decline in thinking abilities more than normal, but not sufficient to cause impairment in functional abilities.
Vascular dementia
- 2nd leading cause of neurocognitive disorder
- 15-20% of all neurocognitive disorder
- can happen due to small vessel disease
- or can be caused by large vessel stroke (you are gonna see a stepwise progression) = you have a stroke -> it impacts your cognitive abilities ->have another stroke
Lewy body dementia
- Dr. Lewy identified that there are protein deposits in the brain. This protein deposits were interrupting the ability of the brain to send messages
- hallucinations
- delusions
- tremors
- rigid muscles- not having fluid motions
Frontotemporal dementia
- occur earlier in life- usually before 65 yrs old
- damage to frontal or temporal lobes
- aphasia might happen
Parkinson’s dementia
- people with Parkinson’s disease may develop Parkinson’s dementia if they live long enough
- problems walking
- difficulty getting in and out of chairs
- tremors
- cluster of motor problems happening
Delirium
- is characterized by acute deterioration of mental status in which an individual exhibits deficits in attention as well as altered levels of consciousness and psychotic features
- temporary but can persist for weeks or months
Features of delirium
- Emotional disturbances
- anxiety
- irritability
- rapid mood shifts
- personality changes
- paranoia
- fear
- apathy - Attention
- can’t stay focused on a topic
- get stuck on a topic
- easily distracted
- little response to the environment - Poor cognition
- poor memory
- impaired ability to read, write, speak coherently, recall words
- disorientation
Quiet Delirium
- not thinking clearly
- have trouble paying attention
- not aware of what’s going on in the immediate surroundings
- may seem out of touch
- avoids making eye contact
- might not know who you are or where they are
- may occasionally see or hear things that are not really there but seem real
- slurred speech
- answering very slowly
- talking about things that don’t make sense
- looking or appearing very sad
Excited delirium
- symptoms are more obvious
- medical emergency (needs professional medical team)
- restlessness
- attempts to get up & move around with no apparent purpose
- aggressive or random behavior with various objects
- fearfulness
- physical attacks on caregivers such as punching & pinching and not recognizing the caregiver
Risk factors for delirium
- increased age
- dementia
- stroke
- infections
- trauma
- surgery
- constipation
- alcohol intoxication/withdrawal
- adverse drug effects
Delirium vs. Dementia
In terms of onset
Delirium: onset occurs withing a short time
Dementia: symptoms gradually worsen over a long time
Delirium vs. Dementia
In terms of attention
Delirium: impaired attention
Dementia: alert in early stages
Delirium vs. Dementia
in terms of Fluctuation
Delirium: frequent and significant fluctuation of behavior
Dementia: thinking and memory relatively consistent- might change a little bit
Delirium prevention and management (PPINCHES ME Kindly)
- Pain
- Infection
- Nutrition & Constipation
- Hydration
- Exercise
- Sleep
- Medication
- Environment
Informal caregiving
not getting paid but providing care
- accounts for more than 80% of the care needed by people with long-term mental or physical conditions
Caregiver burden
the physical, emotional and financial toll of providing care
What makes a person a poor driver?
Having difficulties seeing, thinking, and moving
What are some of the most common negative experiences reported by persons with Alzheimer’s disease
Shame, humiliation, diminished value and self-worth
