Neurocognitive Disorders

Question 1

Neurocognitive Disorders (NCD)

Answer 1

• Caused by changes in brain
• Leads to disturbances in:
  > orientation
  > memory
  > intellect
  > judgement
  > affect

Question 2

Delirium

symps

Answer 2

• Transient reversible condition
• Symptoms:
  > shifting attention
  > extreme distractibilty
  > disorganized thinking
• Sundowning

Question 3

Delirium Characteristics

Answer 3

• Acute onset
• Disturbances in consciousness
• Distrubed thinking, memory, attention, & perception
• Disorientation & confusion tht fluctuates by minute, hr, day
• Caused by underlying condition
  > temporary or transient
• Main prioirities

Question 4

Neurocognitive Disorders in DSM-5

Answer 4

• Alzheimer’s disease
• Vascular dementia
• Pick’s disease
• Lewy body disease

Question 5

Alzheimer’s Disease

Answer 5

• Stages:
  > stage 1 mild
  > stage 2 moderate
  > stage 3 moderate to severe
  > stage 4 late
• Genetic considerations:
  > early onset AD

Question 6

Lewy Body Disease

Answer 6

• Similar to Alzheimer’s but pregesses more rapidly
• Often begins w/ hallucinations
• Appearance of Lewy bodies in cerebral cortex & brainstem
• Progressive & irreversible

Question 7

Parkinson’s Disease

Answer 7

• Caused by loss of nerve cells located in substantia nigra & a dcr in dopamine activity
• Cerebral changes in NCD d/t Parkinson’s Disease sometimes resemble those of Alzheimer’s disease

Question 8

NCD Assessment

Answer 8

• Defensive behaviors
  > denial, confabulation, perseveration, avoidance of questions
• Cardinal symptoms
  > amnesia, aphasia, apraxia, agnosia, disturbances in executive func
• Diagnostive evaluations
  > EEG, CT, MRI, Lumbar puncture

Question 9

NCD Treatment

alzheimer’s

Answer 9

• Start low & go slow
• No cure
• Alzheimer’s:
  > Cholinesterase inhibitors:
  > delay & prevent symptoms from becoming worse & a limited time
  > useful for mild-moderate
  > prevent breakdown of acetylcholine & stimulate release of more acetylcholine

Question 10

NCD Treatment

Answer 10

• For agitation, aggression, hallucinations, wandering
  > Risperidone (Risperdal), Olanazapine (Zyprexa), Quetiapine (Seroquel)
  > carry fewer anticholinergic & EPS than older antipsychotics
  > Haloperidol (Haldol)
  > still commonly used due to proven efficacy
  > Black Box: all antipsychotics are associated w/ inrd risk of death in elderly pts w/ NCD