neurocognitive disorders (329 E2) Flashcards
cognition
system of interrelated abilities such as perception, reasoning, judgment, intuition and memory. allows one to be aware of oneself in relation to others
memory
facet of cognition, retaining and recalling past experiences
delirium
acute cognitive impairment with rapid onset caused by medical condition
dementia
chronic cognitive impairment; differentiated by cause not symptoms
sundowning
the tendency for an individual’s mood to deteriorate and agitation increase in the later part of the day, with the fading of light, or at night
aphasia
loss of language ability
-expressive: cannot find the words to express ideas (broca’s area)
-receptive: cannot interpret what is said (wernicke’s)
apraxia
loss of purposeful movement
agnosia
loss of ability to recognize objects
confabulation
unconscious creation of stories or answers in place of actual memories (maintains self esteem)
preservation
persistent repetition of a work, phrase or gesture
hyperorality
tendency to put everything in the mouth and to taste and chew
clinical picture of delirium
-disturbance in attention and awareness
-acute onset, change from baseline, fluctuates with periods of lucidity over over of 24hrs a day
-there is a direct physiological cause
w/ delirium, may experience
-memory deficit
-disorientation (usually still oriented to self)
-language changes (ex: pressured or mute)
-visuospatial ability
-delusions and hallucinations
-disturbances in sleep wake pattern
delirium is considered
a medical emergency
commonly identified causes of delirium
-meds
-infections
-fluid & electrolyte imbalances
-hypoxia/ischemia
-brain alterations: reduction in cerebral functioning or brain metabolism, increased plasma cortisol level, neurotransmitter imbalance, damage to enzyme systems, blood brain barrier or cell membranes, uti’s in elderly
four cardinal features of delirium
1) acute onset and fluctuating course
2) reduced ability to direct, focus, shift and sustain attention
3) disorganized thinking
4) disturbance of consciousness
illusions vs hallucinations in delirium
illusions can be explained and clarified to the individual, hallucinations cannot be
physical needs of a pt w/ delirium
-trying to get out of bed
-fall risk
-thinks bugs and rats are in there bed
-pulling out IVs and catheters
-help w/ ADLs
medication interventions for delirium
-very small doses of antipsychotics or benzos (lorazepam, watch for opposite action of agitation & use if their is hepatic dysfunction)
-mirtazapine for sleep
-pain control
dementia diagnostic definition
degenerative, progressive neuropsychiatric disorder that results in cognitive impairment, emotional and behavioral changes, physical and functional decline and ultimately death
neurocognitive disorders
-progressive deterioration of cognitive functioning and global impairment of intellect
-no change in consciousness
-the condition is acquired, not developmental
-difficulty w/ memory, problem solving and complex attention
-affects orientation, attention, memory, vocabulary, calculation ability, & abstract thinking
neurocognitive disorders: mild
does not interfere w/ ADLs, does not necessarily progress
neurocognitive disorders: major
interferes w/ daily functioning and independence
Alzheimer’s Disease
-60 to 80% of all dementias
-disturbances in executive functioning
-aphasia
-apraxia
-agnosia (loss of sensory ability to recognize objects or people)
-sundowning
-memory impairment (confabulation)
-perservation
-hyperorality
Alzheimer’s risk factors
-age and family hx
-cardiovascular disease
-social engagement and diet
-head injury and traumatic brain injury
-HTN and dyslipidemia
Alzheimer’s biological factors
-oxidative stress and free radicals
-inflammation
Alzheimer’s hallmarks of dx
tau proteins and beta amyloid plaques create neurofibrillary tangles
-amyloid plaques: sticky clumps between nerve cells
-neurofibrillary tangles: abnormal collections of protein threads inside nerve cells
-brain atrophy
neurotransmitters implicated in Alzheimer’s
-acetylcholine: involved w/ learning, memory and mood. As AD progresses the brain produces less acetylcholine (cholinesterase inhibitors keep the acetylcholinesterase enzyme from breaking down acetylcholine)
-glutamate: involved w/ cell signaling, learning and memory (in AD there is excess). NMDA antagonists help reduce excess calcium by blocking some NMDA receptors
stages of Alzheimer’s: mild
forgetfulness, misplace articles, decreased recall, social withdrawal, frustrated w/ self, changes may not be apparent to others
stages of Alzheimer’s: moderate
decreased for self care, disoriented to time & place, wandering, pacing, delusions or hallucinations, decreased visual perception, leading to accidents (needs supervision), emotional lability - big swings, sx noticeable
stages of Alzheimer’s: severe
cannot care for self, loss use of language; minimal long term memory, constant complete care
dx test for Alzheimer’s
-CT
-PET
-mental status questionnaires
-complete physical & neurological exam
-med & psych hx
-review of sx
Alzheimer’s medication: acetylcholinesterase inhibitors
first line
-galatamine (mild to mod AD)
-donepezil and rivastigmine PO or transdermal (mild to mod)
acetylcholinesterase inhibitors
-used to delay not decrease cognitive decline
-stabilize memory, language and orientation
-SE: N/v
-peaks in 3 months but continues to delay decline
Alzheimer’s medication: NMDA antagonists
-memantine
-modulation of NMDA receptor activity
-restore the function of damaged nerve cells and reduce abnormal excitatory signals of the NT glutamate
-mild side effects of dizziness, confusion, headaches and constipation
medications for behavioral sx of Alzheimer’s
off label, not FDA approved for AD
-antipsychotics (may inc risk of mortality, use w/ extreme caution)
-antidepressants
-anti anxiety
-anticonvulsants
