Neurocognitive Disorders

Question 1

Delirium Description and Definitions

Answer 1

• Disturbance in attention with ↓ ability to focus, sustain, or shift attention
• Change in cognition or the dev of perceptual disturbance
• Disturbance quickly develops; severity of symptoms fluctuate throughout the course
• Disturbance caused by a medical condition or developed during intoxication / withdrawal from a substance
• Caused by one or more underlying medical conditions
• Fever can facilitate

Question 2

Delirium Risk Factors

Answer 2

• Increase severity of physical illness
• Prescription medications
• Recovery from hip fractures
• AIDS
• Terminal cancer

Question 3

Delirium Incidence and Prevalence

Answer 3

• Often untreated / overlooked
• 1% adults aged 55 and older
• 10% emergency dept patients
• 80% critical care patients
• 80% patients in end of life care
• 60% in nursing homes or post-acute care settings

Question 4

Delirium Signs and Symptoms

Answer 4

• Prodromal; restlessness, anxiety, sleep disturbance, & irritability
• Altered anxiety
• Illusions, delirium, or hallucinations
• Dysgraphia
• Constructional apraxia
• Muscles spasms
• Dysnomic aphasia
• Reflex/tone changes
• 3 Subtypes: (1) Hyperactive, (2) Hypoactive, (3) Mixed

Question 5

Delirium Course and Prognosis

Answer 5

• Rapid onset
• Most meet criteria within 48 hrs of symptoms
• Course fluctuates; days or hours
• Symptoms generally worsen at night (sundowning)
• < 1 week duration
• Symptoms will persist if causing condition is present
• Condition treated: 3-7 days symptoms recede

Question 6

Delirium Medical Management

Answer 6

• Treating any underlying cause
• Neuroleptic haloperidol
• Antipsychotics
• Safe and Quiet Environment
• Frequent contact with family or loved ones

Question 7

Dementia Description and Definition

Answer 7

• Cognitive impairment
• Cause is poorly understood
• Neurofibrillary tangles / beta-amyloid plaques shrink brain structure
• Beta-amyloid plaques caused by defective breakdown of amyloid precursor protein
• Plaques collect outside and around the neurons; neuronal death
• Neurofibrillary tangles; contaminated tau protein
• Tau serves as connectors throughout cell body; transports nutrients & molecules
• Abundance of abnormal structures of beta-amyloid plaques and neurofibrillary tangles
• These structural changes do not cause AD, but are end products of a pathological process
• Not caused by a single gene mutation
• Early onset: Before age 65
• Late onset: At or after age 65
• Down’s syndrome is a risk factor
• Neurotransmitter abnormalities
• Risk for developing cardiovascular disease

Question 8

Dementia Incidence and Prevelance

Answer 8

~ 5.3 million Americans
~ 200,000 individuals > age 65
-By 2050 18 million Americans with NCD (14 million NCD due to AD)
-Higher incidence in women

Question 9

Dementia Risk Factors

Answer 9

• Low educational level
• History of depression
• Alcohol abuse
• Analgesic abuse
• Long-standing physical inactivity
• High waist-to-hip ratio
• Type II diabetes
• Black or Hispanic ethnicity

Question 10

Mild Stage of Dementia

Answer 10

• Lasts 2 to 3 yrs
• Takes longer to perform familiar tasks
• Begins making mistakes
• Difficulty following written directions
• Short-term memory significantly impaired
• Procedural memory will remain intact
• Aphasia appears
• Circumlocution
• Visuospatial abilities decline; getting lost
• More ridged & irritable
• Depression
• Delusional thinking

Question 11

Moderate Stage of Dementia

Answer 11

• Can last 2 to 10 yrs
• Severe impact on function
• No longer able to problem-solve
• Recent & remote memory decrease
• Disorientation to place/time
• Prosopagnosia
• Thinking is concrete
• Loses fluent language
• Verbalizations may be impulsive/inappropriate
• Loss of ability to judge depth/distance
• Little or no awareness of social standards
• Anxiety/depression
• Visual/Auditory hallucinations
• Frequent nighttime wakefulness
• Wandering and agitation
• Loss of disinhibition

Question 12

Severe Stage of Dementia

Answer 12

• Last 8 or more years
• Fully dependent
• May only respond to pain, hunger, & fear
• Seriously impaired problem-solving skills
• Little or no recognition of close family members
• Speech is limited to one or two words
• No longer smiles or communicates with facial expression
• Instances of moaning or crying
• Impaired receptive language
• Risk for falling
• Bedbound
• Incontinence of bladder & bowel
• Dysphagia
• Hallucinations persist for some
• 60% of time sleeping

Question 13

Dementia Medical Management

Answer 13

• Supportive care for the family and/or caregiver
• Disease Treatment
• Symptom Treatment
• Pharmacotherapy
• Behavioral & environmental management
• DICE Approach

Question 14

Non-Alzheimer’s Dementia

Answer 14

• Vascular dementia
• Frontotemporal dementia
• Dementia with Lewy bodies
• Reversible neurocognitive disorder

Question 15

Neurocognitive Impact on Occupational Performance

Answer 15

• Compensatory techniques
• Independence
• Education
• Dependency on caregivers
• Positioning