Chapter 15 Flashcards
delirium
impaired consciousness and cognition
* Develops rapidly over several hours or days
* Appear confused, disoriented, and inattentive
* Marked memory and language deficits
* Drugs such as Ecstasy, “Molly,” and “bath salts” can cause substance - induced delirium
delerium prevalence and course
- Affects up 20% of adults in acute care facilities (e.g., ER)
- More prevalent in certain populations, including:
- Older adults
- Those undergoing medical procedures
- People with AIDS or cancer
- People in hospitals/critical care
- Full recovery often occurs within several weeks
what percentage of dementia cases involve delirium?
50% of cases involve temporary delirium
medical conditions related to delirium
- Drug intoxication, poisons, withdrawal from drugs
- Infections
- Head injury and several forms of brain trauma
sleep deprivation, immobility, and excessive stress
treatment and prevention for delirium
Treatment
* Attention to underlying causes
* Psychosocial interventions
* Reassurance/comfort, coping strategies, inclusion of patients in
treatment decisions
Prevention
* Address proper medical care for illnesses, proper use of, and adherence
to therapeutic drugs
Nature of dementia
- Gradual deterioration of brain functioning
- Deterioration in judgment and memory
- Deterioration in language and advanced cognitive processes
- Has many causes and may be irreversible
how often is a new neurocognitive disorder identified?
every 7 seconds
prevalence of neurocognitive disorder
5% prevalence in adults 65+; 20% prevalence in adults 90+
how many people have major neurocognitive disorder in the US?
5 million
Are Alzheimer’s cases increasing as the years go on?
yes dramatic rise in cases predicted through 2050
neurocognitive disorder due to Alzheimers disease
- Clinical features
- Typically develop gradually and steadily
- Memory, orientation, judgment, and reasoning deficits
- Additional symptoms may include
- Agitation, confusion, or combativeness
- Depression and/or anxiety
prevalence of neurocognitive disorder due to alzheimers
- More common in less educated individuals but people who attain a higher level of education decline more rapidly once the symptoms become more severe
- Slightly more common in women (Possibly because women lose estrogen as they age; estrogen may be protective.)
what is the cognitive reserve hypothesis?
the more synapses a person develops throughout life, the more neuronal death must take place before the signs of dementia are obvious
neurocognitive disorder due to alzheimers post-diagnosis survival
8 years
onset of neurocognitive disorder due to alzheimers
60s or 70s (early onset 40s to 50s)
what percentage of the cases of neurocognitive disorder result from Alzheimer’s?
60-70%
aphasia
difficulty with language (seen in alzheimers)
apraxia
impaired motor functioning (seen in alzheimers)
agnosia
failure to recognize objects (seen in alzheimers)
vascular neurocognitive disorder
Caused by blockage or damage to blood vessels
* Onset is often sudden (e.g., stroke)
* Patterns of impairment are variable
* Most require formal care in later stages
- Risk slightly higher in men
what is the second leading cause of neurocognitive disorder?
vascular neurocognitive disorder
prevalance of vascular neurocognitive disorder
- Prevalence 1.5% in people 70 to 75 and 15% for people over 80
Is vascular neurocognitive disorder seen more commonly in men or women?
men
Frontoteporal neurocognitive disorder
Broadly refers to damage to the frontal or temporal regions of the
brain, affecting
* Personality
* Language
* Behavior
two types of impairment: frontotemporal neurocognitive disorder
Declines in appropriate behavior
* Declines in language
Picks disease
a frontotemporal neurocognitive disorder, produces a cortical dementia like Alzheimer’s
* Occurs relatively early in life (around 40s or 50s)
Neurocognitive Disorder Due to Traumatic Brain injury
- Accidents are leading cause
- Symptoms last for at least one week after head injury, including
problems with executive function, learning, memory - Memory loss is the most common symptom
- Risk factors include age (most common among teens and young
adults), excessive alcohol use, and lower socioeconomic status
Neurocognitive Disorder Due to Lewy Body Disease
- Lewy bodies are microscopic protein deposits that damage the brain over time
- Symptoms onset gradually
- Symptoms include impaired attention and alertness, visual
hallucinations, motor impairment
Neurocognitive Disorder Due to Parkinson’s Disease
Degenerative brain disorder
* Dopamine pathway damage
* 1 out of 1,000 people are affected worldwide
* Chief difficulty: motor problems
* Tremors, posture, walking, speech
* Not all with PD will develop dementia
* 75% survive 10+ years after diagnosis
Neurocognitive Disorder due to HIV
Infection
- HIV-1 can cause neurological impairments and dementia in some
individuals - Cognitive slowness, impaired attention, and forgetfulness
- Apathy and social withdrawal
- Typically occurs in later disease stages
- Now occurs in <10% of individuals with HIV; HAART decreases risk
Neurocognitive Disorder Due to
Huntington’s Disease
- Huntington’s Disease = genetic autosomal dominant disorder
- Caused by a gene on chromosome 4
- Manifests initially as involuntary limb movements (chorea), usually later in life
- Somewhere between 20% and 80% display neurocognitive disorder
- Dementia follows a subcortical pattern
Neurocognitive Disorder Due to Prion Disease
- Disorder of proteins in the brain that reproduce and cause damage
- No known treatment, always fatal
- Can only be acquired through cannibalism or accidental transmission
(e.g., contaminated blood transfusion) - Example: Creutzfeldt-Jakob disease*
- Affects 1 out of 1,000,000 people
- Linked to mad cow disease
Substance/Medication-Induced
Neurocognitive Disorder
- Memory impairment
- Aphasia, apraxia, agnosia
- Disturbed executive functioning
50% to 70% of chronic heavy alcohol users show some cognitive
impairment; 7% of those meet criteria for neurocognitive disorder
- Results from prolonged drug use, especially in combination with poor
diet - May be caused by alcohol, sedative, hypnotic, anxiolytic, or inhalant drugs
- Brain damage may be permanent
Causes of Neurocognitive Disorder: The Example of Alzheimer’s Disease
Features of brains with Alzheimer’s disease
* Neurofibrillary tangles (strand-like filaments)
* Amyloid plaques (gummy deposits between neurons)
* Brains of people with Alzheimer’s tend to atrophy
* Multiple genes are involved in Alzheimer’s disease
* Chromosome 14: Associated with early-onset Alzheimer’s
* Chromosome 19: Associated with late-onset Alzheimer’s
Deterministic genes causes of neurocognitive disorder: the example of alzheimers
Rare genes that inevitably lead to Alzheimer’s
* Beta-amyloid precursor gene
* Presenilin-1 and Presenilin-2 genes
susceptibility genes causes of neurocognitive disorder: the example of alzheimers
- Make it more likely but not certain to develop Alzheimer’s
- ApoE4 gene is located on chromosome 19 and associated with late onset
Alzheimer’s
The Contributions of Psychosocial Factors in Neurocognitive Disorders
- Psychosocial factors such as education, coping skills, and social
support do not cause dementia directly - May influence onset and course
- Lifestyle factors include drug use, diet, exercise, stress
- Risk for certain conditions vary by ethnicity
Medical Treatment of Neurocognitive Disorders
- Few primary treatments exist
- Most treatments attempt to slow progression of deterioration, but
cannot stop it
Future directions
* Glial cell-derived neurotrophic factor, stem cells: may slow deterioration
* Some drugs target cognitive deficits. Cholinesterase-inhibitors
* Long-term effects not well demonstrated
Psychosocial Treatment of Neurocognitive Disorders
- Aims of psychosocial treatments
- Enhance lives of patients and their families
- Teach compensatory skills
- Use memory enhancement devices, if needed
Example: “Memory wallets” containing statements about one’s life - Cognitive stimulation can delay onset of more severe symptoms
Psychosocial Treatment of Neurocognitive Disorders: Caregivers
- Caregivers get instructions on how to handle problematic behavior,
including - Wandering
- Socially inappropriate behavior
- Aggressive or rebellious behavior
- Impact of care on their own health
- Caregivers are also under great deal of stress and may need mental health treatment
Prevention of Neurocognitive Disorders
- Reducing risk in older adults
- Control blood pressure
- Don’t smoke
- Lead active physical and social life
