NCD Flashcards
Primary ncd
ncd itself
secondary ncd
caused by or r/t another condition
ex hiv
mild ncd
Mild to moderate loss of previous
level of cognitive, executive and
memory functioning
* Does not interfere with independence
(may need assistance but NOT
dependent)
* Early intervention to prevent
progression
major ncd
Significant cognitive decline
interferes with independence
* Not due to delirium
* Not due to other mental disorder
vascular ncd
2nd most common
progressive
more men than women
affects speech and gait
cell death
diseased bv’s
vascular ncd etiology
Caused by cerebrovascular disease
* Internal (TIAs or strokes), external (possible past head
injury)
* More abrupt onset (more motor problems initially)
* Progression is variable and symptoms occurs in steps
* Symptoms may clear up & then experience suddenly decline
dementia pugilistica
NCD due to Traumatic Head Trauma
impulsivity
emotional lability
repeated head trauma typically
ncd d/t parkinsons
slowly progressive
cells are destroyed in certain areas of brainstem
decreased dopamine
language not impacted
ncd d/t huntington’s
inheritable
can begin at any age (30-50 more common)
lack of coordination- jerky mvmnts
usually death s caused by another disease
frontotemporal NCD: pick’s disease
PERSONALITY CHANGE
unknown etiology
presents 45-65 yo
similar to alz: destroys neurons
tau proteins accululate
creutzfeldt-jakob
mad-cow
40-70 yo
ncd dt lewy body
protein deposits
develop in neurons
affects thinking, mem, mvmnts
gradually declines
aphasia
hallucinations
simiar to alz and park
amnestic disorders
Causes: Head trauma, CVA, substance
intoxication
Inability to learn new information
Normal attention span
Inability to recall previously learned info
Abstract thinking intact
No personality change
Disorientation to time and place
Confabulate events
screening tool for NCD
montreal cognitive assessment (MOCA)
look at trends
physician and speech therapy can do it
mini-mental state exam
more is better
less is worse
donepezil
cholinesterase inhibitor: reversable indirect acting cholinergic
frontline drug
can cause bradycardia and heart disease
used for mild, moderate or severe NCD
memantine
N-Methyl-D-Aspartate Receptor
Antagonist
used when pt cant tolerate donepezil
used for moderate-severe ncd
donepezil and memantine
take once a day
extended release
aducanumab
IV- monthly infusions
pre-administration MRI d/t hemorrhagic strokes
attacks beta amyloid plaques: proteins
slows progression of alz
considerations for NCD
do not continuously reorient
thier short-term mem dissapears
instead of telling them their spouse is dead, ask about their spouse
talk ab happy mems, music
create calming environment: low light
sit close to nsg station
holiday decor
bed alarm
pictures at bedside
clock in sihgt
hearing aids and glasses
alz
Most common type of NCD
* A progressive type of NCD (usually 8-10 years)
* Affects memory, thinking, and behavior
possible alz
Can’t remember a person later
Forgetting a meal prepared
Incomprehensible language
Getting lost on own street
Forgetting there is a child
Putting watch in sugar bowl
Drastic change in personality
Not knowing work needs done
Knowing what the numbers mean
Having rapid shifts in mood 37
etiology of alz
slow onset
genetics and early onset
Cholinergic Hypothesis
* Reduced acetylcholine
(needed for learning &
memory)
* Degeneration of cholinergic
neurons- decreased
cognition
* Glutamate Hypothesis-
Glutamate is excitatory
neurotransmitter
* Stimulates NMDA receptors,
calcium ions= degeneration
of cells
* Plaques-Beta amyloids outside
the neuron
* Tangles-neurofibrillary tau
proteins twist inside the neuron
More common in men
educated people at risk
alz assessment and diagnostics
History & Physical, Labs
* Psychological tests
* CT/MRI, PET, Single photon emission CT scan,
EEG
prevention of alz
NSAIDS
* Estrogen replacement
* Antioxidants like Vitamin E
* Antihypertensive agents
* Exercise
early alz stage
FORGETFULNESS
Forgets which bills are paid
* Forgets phone numbers
* Becomes less outgoing
* Loss of initiative
* Sporadic loss of words
* Arrives at appointments at
the wrong time or place
* Forgets to put a coat on
* Forgets what was just said
Middle stage alz
CONFUSION STAGE
Can’t calculate numbers
* ADLS: wears same clothes
* Can’t follow simple instruction
* Wanders & gets lost
* Suspicious- lost items are
“stolen”
late stage alz
DEPENDENT
Can’t recognize self in mirror
* No short term, poor long term
* Mostly bed bound
* Diminished communication
stage 1 alz
no apparent symptoms
stage 2 alz
forgetfulness
stage 3 alz
mild: interference with performance
decreased social
stage 4 alz
confusion- forget day
confabulation: make up stories
risk of wandering
cant sleep
stage 5 alz
moderate: early dementia
deulsions and paranoia
loss of ald abilities
stage 6 alz
moderate: severe dementia
sundowning
stage 7 alz
Severe cognitive decline: late
dementia:
Bedrest, often dies from pneumonia
agnosia alz
recognition/perception
dont understand what a stop sign means
cant notice stimuli
apraxia alz
motor mvmnets
shuffling gait
aphasia
cant speak
speech, naming
amnesia
forget new or recent mems
what could be causing confusion
UROSEPSIS
