Neurocognitive disorders

Question 1

Overview Neurocognitive

Answer 1

• Cognitition shifts over time Vocab stays constant, the mental speed slows down
• Neurocog disorders more significantly affect memory learning language and motor behavior
• Later in life
• Deterioration of functioning
• Few treatments to revers damage

Question 2

Delirium Overview

Answer 2

• Nature of delirium
  
  • Impairs consciousness and cognition
  • Rapid onset
  • memory and language deficits
  • confused
• Stats
  
  • 30% indivs in ER-hospital
  • More likely in
    
    • Older adults
    • Medical procedures
    • AIDS and cancer patients
  • Full recovery in 6 weeks
    *

Question 3

Medical conditions related to delirium

Answer 3

• dementia (50% have temp delirium)
• infections
• head injury
• sleep deprivation

Question 4

Delirium Treatment and prevention

Answer 4

• Treatment
  
  • Psychosocial
    
    • Coping strategies
    • reassurance
    • inclusion in treatment decisions
  • Underlying causes
• Prevention
  
  • appropriate medical care for illnesses
  • promote proper medication use
  • exercise and hydration

Question 5

Mild and Major Neurocog disorders

Answer 5

• Major Neurogonitive disorder
  
  • New DSM term for dementia
• Mild Neurocognitive disorder
  
  • ​Start of cognitive decline
  • Individual able to function independently with a little help

Question 6

Major Neurocognitive Disorder overview

Answer 6

• Group of disorders involving gradual deterioration of brain
  
  • Judgement memory language problem solving
  • Early sign = loss of memory of recent events
• Determination based on
  
  • Observation by Informant close to patient, clinician or individual themselves
  • Impairment
• Not only in context of delirium
• Many cuases and irreversible

Question 7

Major Neurocognitive Disorder Prevalence and Statistics

Answer 7

• Onset
  
  • Common in elderly
• Prevalence
  
  • 20% in 85+
  • rise predicted by 2050 as people expected to live longer
• Equally in men and women
• equally across SES and educational level

Question 8

Progression Neurocognitive disorders

Answer 8

• Initial stages
  
  • Agnosia (inability to recognise everyday objects)
  • Facial agnosia (inability to recognize familiar faces
  • Memory impairments
  • Other symptoms
    
    • Delusions, apathy, depression (but consider contributions from other disorders)
• Later stages
  
  • Need help to complete everyday tasks
  • Increase chance of early death bc inactivity leads to
  • Cognitive decline

Question 9

Causes of neurocognitive disorders

Answer 9

• Alzeihmers
• Parkinsons
• Traumatic Brain injury
• Substance/medication use
• Vascular Disease
• Multiple etiologies

Question 11

Neurocognitive disorder due to alziehmers

Answer 11

• onset 60s or 70s
• Maybe in less-educated individuals
• Slightly more in women
• Post diagnosis survival = 8 years
• BUT continued use of brain can protect against symptoms
  
  • 1/3 of brains from nuns had full-blown Alzheimers with no symptoms
  • Brain can develop “shortcuts” to account for what it loses

Question 12

Traumatic Brain Injury

Answer 12

• Leading cause = accidents
  
  • Athletes (football)
• Combat related activities (bomb blasts)
• Affects felt immediately
• Symptoms last at least a week with impairments in cog functioning, memory, and learning
  
  • Memory loss most common

Question 13

Parkinsons

Answer 13

• Loss of motor control
  
  • Speech, tremors, walking
• Dopamine damage
• 1/1000 affected worldwide
• Not all will develop neurocognitive disorder
• 75% survive 10+ years after diagnosis

Question 14

Substance medication induced

Answer 14

• 50%-70% chronic heavy alcohol users show cognitive impairment
• could be caused by the constant use of alcohol, sedative or inhalants or poor associated diet
• Symptoms similar to Alzheimer’s
  
  • Facial agnosia
  • Agnosia
  • Memory impairment
  • Poor executive functioning (learning, planning, problem-solving)
• Potentially permanent brain damage

Question 15

Neurocog due to Vascular

Answer 15

• Blockage to damaged blood vessels
• Second leading cause of neurocognitive disorder
• Sudden onset (e.g. stroke)
• Patterns of impairment variable
• Most require formal care in later stages

Question 16

Biological causes: Alzheimers

Answer 16

• Neurofibrillary tangles: Twisted protein fibres
• Amyloid Plaques: protein deposits accumulate outside neurons
• Together interfere with intracellular communication

Question 17

Psychosocial factors in Neurocog disorders

Answer 17

• Do not directly contribute
• but coping skills and education could affect onset and course
• Lifestyle: exercise drug use
• Cultural factors:
  
  • High hypertension in African Americans >> leading factor in Alzheimers

Question 18

Biological Treatment

Answer 18

• No way to stop it: only slow down
• Drugs for cognitivedecline
  
  • Cholinesterase inhibitors memory awareness and ability to function
  • Long term effects not demonstrated
• Drugs to treat associated symptoms
  
  • SSRIs depression and anxiety
  • Antipsychotics agitation
• Experimental
  
  • Ginko biloba improves memory = mixed findings
  • Vaccines being tested

Question 19

Psychosocial Treatment

Answer 19

• Aims
  
  • to enhance the lives of patients
  • Teach compensatory skills
  • Memory enhancement tools
    
    • “memory wallets”: “my name is ___ i may have demensia please contact this person… etc”
  • Cognitive stimulation can prevent severe symptoms
• Caregivers get instructions to handle
  
  • wandering
  • Inappropriate behavior
  • Agressive behavior
  • So caregiver doesn’t lash out
• Caregivers also get stress relief therapy

Question 20

Prevention

Answer 20

• Treatment of CV disease
  
  • Healthy Lifestyle
  • Social life
• Other prevention efforts
  
  • Identifying precursors to prevent further damage
  • increase safety from head trauma
  • reduce exposure to neurotoxins and drugs