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Nursing 301: Situational Transitions > Cognitive Disorders > Flashcards

Cognitive Disorders Flashcards

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1
Q

What does cognition refer to?

A
  • A system of interrelated abilities to perceive, reason, judge, as well as our intuition and memory
  • Allows us to be aware of ourselves and our surroundings
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2
Q

What cognitive disorders results in decreased cognitive functioning?

A

Dementia, delirium and amnestic disorders (head trauma’s, “blacking out” after binge drinking, etc)

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3
Q

What is delirium?

A
  • Acute cognitive impairment
  • Can be hypoactive/mild, hypoactive/severe, hyperactive or mixed (most common)
  • Considered a medical emergency
  • Affects all aspects of cognition
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4
Q

What is delirium caused by?

A
  • Medical conditions (infection, response following surgery, fluid/electrolyte/metabolic disturbances)
  • Substances (prescribed or illicit, polypharmacy, etc.)
  • Unknown factors
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5
Q

What is the difference between hypoactive and hyperactive delirium?

A
  • Hypoactive is when someone may appear depressed, lethargic, disoriented, etc. This has a high mortality rate since it is easy to dismiss
  • Hyperactive is the more common delirium that we think of, like someone being agitated, altered to sleep, disorientated, taking out IV’s, etc.
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6
Q

What is dementia?

A
  • Global, chronic cognitive impairment
  • Pervasive
  • Degeneration disorder of CNS
  • Not an illness, but symptom of an illness
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7
Q

What are the different types of dementia?

A
  • Alzheimer’s (shrinking the cortex of the brain, affecting all parts of the brain)
  • Vascular dementia
  • Dementia related to medical conditions
  • Dementia related to substance uses
  • Dementia with mixed/unknown causes
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8
Q

What is the difference between normal memory loss with age and dementia?

A

Normal memory loss can include difficulty with word finding, losing keys, forgetting names, etc.
- Dementia is more marked, obscure changes, like being unsure what to do with keys, putting milk in the microwave, etc.

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9
Q

What is the hippocampus responsible for?

A

Formation of memories (a hippo coming on campus would be memorable!)

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10
Q

What is the parietal lobe responsible for?

A

Sensation, sensory processing

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11
Q

What is the frontal lobe responsible for?

A

Thought processing, language output, programming of activities, prioritization, personality and behaviour

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12
Q

What is the temporal lobe responsible for?

A

Language, comprehension, learning, short-term memory

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13
Q

What is the cerebellum responsible for?

A

Movement, muscle coordination

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14
Q

Compare and contrast dementia and delirium:

A

DEMENTIA VS DELIRIUM

ONSET: slow vs. sudden
SYMPTOMS: stable with sun downing vs. fluctuates during the day
DURATION: until death vs. hours, days, weeks
ORIENTATION: disorientation persistent vs. disorientation is intermittent
SLEEP WAKE CYCLE: fragmented sleep vs. alert at night, drowsy in day
MEMORY: impaired recent and long term vs. global memory failure

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15
Q

How do we treat delirium?

A
  • Investigation into cause of delirium (assessment, blood tests, medication profile, etc.)
  • Ensure oxygenation of tissues
  • Support normal sleep patterns
  • Ensure nutrition intake
  • Essentially, priorities is to eliminate/correct cause and provide symptomatic and supportive measures
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16
Q

What are risk factors for delirium?

A
  • 80% of people near death experience delirium
  • AIDS and Cancer patients are high risk for delirium
  • 10-30% of hospital patients, regardless of age, will experience delirium (making hospitalization a risk factor)
  • 60% of delirium cases are older adults
  • Pain
  • Cardiac surgery
17
Q

What is the diagnostic criteria for delirium?

A
  • Behavioural changes (agitation?)
  • Onset (quick vs. slow)
  • Fluctuations during the day (are their sleeping patterns altered?)
  • Impaired consciousness
18
Q

What is the presentation of delirium?

A
  • Dependent on type
  • Disorientation
  • Changes to concentration and focus
  • Impacted speech and motor function
  • Difficulty sleeping
  • Poor social cues
19
Q

How do we treat delirium?

A
  • Physiological (support symptoms)
  • Psychological (reduce stimulation)
  • Social
20
Q

What is the prognosis for delirium?

A
  • Reversible if treated

- Often causes complications

21
Q

What is the etiology of dementia?

A
  • Depends on type

- Multiple theories (plaques, cell death, genetics)

22
Q

What are the risk factors or dementia?

A
  • Age (10-15% aged 65+ develop dementia)
  • Lifestyle factors causing stroke and cardiac events, leading to vascular dementia
  • Females
  • Down Syndrome
  • Low socioeconomic status
  • Parkinson’s and Huntington’s
  • Heart disease
23
Q

What is the diagnostic criteria for dementia?

A
  • Memory loss
  • Aphasia (disturbed language)
  • Agnosia (disturbed identification of objects)
  • Apraxia (inability to execute motor functions)
  • Disturbance of executive functioning (ability to think abstractly, plan, prioritize, etc.)
24
Q

What is the presentation for dementia?

A
  • Onset
  • Physiological (changes to mood and behavior)
  • Psychological
  • Social (isolation, change in relationships)
25
Q

What are the priorities in caring for an individual with dementia?

A
  • Depends on stage of illness
  • Delay cognitive decline
  • Support family members
  • Protect patient from harm
  • Attend to physical harm
  • Tx physiological, psychological and social symptoms
26
Q

What are some general tips for working with someone with dementia?

A
  • Treat the PERSON with dementia
  • Enter into their reality
  • Validate emotions
  • Avoid saying “no”
  • Avoid reasoning or arguing
  • Use simple, concrete sentences
  • Avoid saying “do you know…?”
  • Help make family visits meaningful
  • Understand their behaviours
  • Understand their emotional responses
  • Be flexible and modify the environment
27
Q

What is the prognosis for dementia?

A

Essentially a terminal cognitive disorder that occurs over time

28
Q

What are the stages of Alzheimer’s?

A

STAGE 1 [MILD]: mild memory loss, sensory/motor not usually affected, pt recognizes there is a problem, anxiety/confusion, mild behavior problems
STAGE 2 [MODERATE]: behavior problems increase (ex. sun-downing, perseveration, wandering), confusion, incontinence.
STAGE 3 [SEVERE]: total incontinence, choking, emaciation, total care required, progressive gait disturbances that lead to non-ambulatory status

29
Q

What is Alzheimer’s type of dementia?

A
  • Most frequently seen in clinical practice
  • Approximately 80% of dementia related to Alzheimer’s
  • Global memory impairment, especially in the beginning
  • More common in women
  • Difficulty with independently completing ADL’s
30
Q

What is vascular dementia?

A
  • Conditions causing cerebrovascular lesions that can lead to heart disorders, stroke, etc.
  • More sudden onset as it is usually in response to an illness or stroke
  • Presentation depends on portion of brain affected
  • Changes in declined executive functioning happens quicker than in Alzheimer’s disease
31
Q

What is Lewy Body dementia?

A
  • Personality changes
  • More rapid progression compared to Alzheimer’s
  • Fluctuating day-to-day re: behaviour, personality, etc.
  • Motor difficulties (Parkinsonism), making them a risk for falls
  • Memory and cognitive changes occur before motor
  • Can have hallucinations
32
Q

What is Parkinson’s dementia?

A

Motor difficulties occur before any motor decline

33
Q

What is frontotemporal lobe dementia?

A
  • Impulsive, poor insight, and behaviour changes due to impaired executive function
  • Often still have intact memories and are aware of changes that have occurred to them
  • More common in younger patients
  • Slower onset and progression compared to vascular and Lewy Body
34
Q

What medical conditions can lead to dementia over time?

A
  • AIDS
  • Head trauma
  • Parkinson’s
  • Huntington’s
  • Hypothyroidism
  • Meningitis
  • Syphilis
  • Creutzfeldt-Jakob
  • Hydrocephalus
35
Q

How do we assess cognitive functioning?

A
  • MMSE
  • Orientation to person, place and time
  • Asking family and friends about changes
  • MOCA (instrumental assessment pieces)
  • Therapeutic conversion (allows us to see if thoughts are organized, can answer abstract questions, if memory is intact, etc.)
  • Observation while in group activities or with family (for social changes and/or impaired executive functioning)
  • Ask about mood (as it fluctuates with cognitive disorder)

Nursing 301: Situational Transitions (20 decks)

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