Neurocognitive Disorders Flashcards
Neurocognitive Disorders
syndromes for which the underlying pathology, and frequently the etiology as well, can potentially be determined
affects: complex attention, executive function, learning and memory, language, perceptual-motor, and social cognition
Delirium
requires:
a) disturbance in attention and awareness that develops over a short period of time (ordinarily hours to a few days), represents a change from baseline functioning, and tends to fluctuate in severity over the course of a day (often worsening in the evening and at night)
b) at least one additional disturbance in cognition (impaired memory, disorientation, impaired language, deficits in visuospatial ability, or perceptual distortions
must be evidence that symptoms are the direct physiological consequences of a medical condition, substance intoxication or withdrawal, and/or exposure to a toxin
Etiology of Delirium
5 at risk groups:
a) older adults
b) people with decreased cerebral reserve due, for example, to dementia, a stroke, or HIV disease
c) postcardiotomy patients
d) burn patients
e) people with drug dependence (especially dependency on alcohol or a benzodiazepine) who are experiencing withdrawal
General medical conditions that can cause delirium include systemic infections, metabolic disorders, fluid and elecrolyte imbalances, postoperative states, and head trauma
older adults the most risk, followed by children
Treatment for Delirium
2 goals:
- treatment of the underlying cause of the disorder - reduction of agitated behavior
2nd goal addressed by a combination of environmental manipulation (environment that minimizes disorientation) and psychosocial interventions (having a calm, friendly family or staff member stay with the patient)
haloperiodol or other antipsychotic drug may help reduce agitation, delusions, and hallucinations
Mild Neurocognitive Disorder
- includes dementia
- diagnosed when there is evidence of significant decline from a previous level of functioning ine one or more cognitive domains that interferes with the individual’s independence in everyday activities and does not occur only in the context of delirium
includes: Alzheimer’s disease, frontotemporal lobar degeneration, Lewyy body disease, vascular disease, traumatic brain injury, substance/medication use, HIV infection, prion disease, Parkinson’s disease, Huntington’s disease
Alzheimers ordinarily diagnosed only when all other causes of a major or Mild Neurocognitive Disorder have been ruled out
Prevalence/Course of Alzheimer’s
Stage 1 (1-3 years)- anterograde amnesia (Especially for declarative memories), deficits in visuospatial skills (wandering), indifference, irritability, and sadness, and anomia
Stage 2 (2-10 years)- increasing retrograde amnesia; flat or labile mood; restlessness and agitation; delusions; fluent aphasia; acalculia; and ideomotor apraxia (inability to translate an idea into movement)
Stage 3 (8-12 years)- severely deteriorated intellectual functioning; apathy; limb rigidity; and urinary and fecal incontinence
Treatment for Alzheimer’s Disease
often include a combination of group therapy (especially therapy that emphasizes reality orientation and reminiscence)
behavioral techniques and antipsychotic drugs to reduce agitation
antidepressant drugs to alleviate depression
environmental manipulation and pharmacotherapy to enhance memory and cognitive functioning
outcomes are best for patients when they remain at home with their families, and families are less likely to institutionalize a family member with Alzheimer’s disease when families are provided with adequate support, psychoeducation, skills training, and other individual and family interventions
Vascular Neurocognitive Disorder
diagnosed when the criteria for Major or Mild Neurocognitive Disorder are met, the clinical features are consistent with a vascular etiology, and there is evidence of cerebrovascular disease from the individual’s history, a physical examination, and/or neuroimaging that is considered sufficient to account for his/her symptoms
