TOPIC 9 - neurodevelopment & neurocognitive disorders Flashcards
factors related to childhood neurodevelopment disorders
genetics
biochemistry : a genetic imbalance in a nutrient needed for NT synthesis can result in brain chemistry problems
environment : abuse or neglect impacts wellbeing
developmental milestones
Crawling
Walking
Fine motor skills
Physical skills
Problem-solving
Socialization
Language & communication
what is the result of delayed socialization and communication skill development
isolation
deficit in social reciprocity
trouble with how the child responds or reciprocates when socially interactive
deficit in joint attention
trouble with wanting to share an interest
deficit in nonverbal communication
trouble with ability to use or interpret nonverbal cues
deficit in social relationships
trouble making and maintaining relationships
which approach is most effective for autism
interdisciplinary treatment using family centered practice and the use of the community collaboration model
ASD severity level 1
speaks in full sentences, difficulty with conversations
difficulty changing activities, difficulty with organization and planning
minimal support needed
can be managed in classroom
ASD severity level 2
notable deficit in verbal and nonverbal social communication
does not initiate social interactions
repetitive behaviors are observable
change in routine leads to distress
moderate support needed
may require specialized classroom
ASD severity level 3
few spoken words
rarely interacts with others
very resistant to change
need for repetition interferes with daily life
substantial support needed
goal of family centered practice
create a partnership so that the family fully participates in all aspects of the individual’s care
interdisciplinary treatment
behavior management therapy
cognitive therapy
family centered care
community collaboration model
medications for ASD
atypical antipsychotics used for reducing aggressive and or self harm behaviors
SSRI’s and beta blockers for obsessions and anxiety
most effective atypical antipsychotic
risperidone
categories of ADHD
inattentive, hyperactive/impulsive, combined
diagnostic method for ADHD
Vanderbilt Assessment Scale
problem areas with ADHD
concentrating, focusing, inattentiveness, not listening, lack of follow through, organization, time management, forgetfulness
school observations in children with ADHD
fidgeting in seat, inappropriately running or climbing, blurt out answers, interrupt or talk excessively, inconsistent or messy assignments
interdisciplinary treatments for ADHD
Behavioral Modification/Behavioral Therapy
Parent Training
School Accommodations
medications for ADHD
Increase frontal lobe activity in the brain
Increase attention span
Decrease impulsive behavior, restlessness & hyperactivity
CNS stimulant medications
Non-stimulant medications
stimulant medications
highly effective treatments that have been safely used for decades.
EX : methylphenidate, amphetamines, dexmethylphenidate, lisdexamfetamine
non stimulant medications
EX : atomoxetine, guanfacine, clonidine
alternatives for those who do not respond well to stimulants or if a non-stimulant is preferred.
when to give methylphenidate
6-8 hours before bedtime
what to monitor with methylphenidate
insomnia
when to give methylphenidate ER
12 hours prior to bedtime
what to monitor with atomoxetine
can stunt growth (monitor height and weight)
primary encopresis disorder
the person have had continuous soiling throughout their lives, without any period in which they were successfully toilet trained
secondary encopresis disorder
may develop after toilet training has occurred usually due to encountering stressful experiences such as upon entering school or encountering other experiences that might be stressful
retentive encopresis disorder
overflow incontinence due to constipation. If not treated, serious complications such as megalocolon can occur, which may affect colon peristalsis
nonretentive encopresis
refers to soiling without evidence of fecal constipation and retention. This form ofencopresis is characteristics include fecal incontinence accompanied by daily bowel movements that are normal in size and consistency
enuresis symptoms are normal up to what age
5
encopresis symptoms are normal up to what age
4
enuresis definition
repeated urinary incontinence
Involuntary or intentional voiding in clothing, bed, etc.
Nocturnal, diurnal, or both
encopresis definition
repeated incontinence of feces into inappropriate places
Involuntary or intentional voiding (places may include clothing, on floors, in waste receptacles, etc.)
Primary, secondary, retentive, and nonretentive types
assessment of elimination disorders
distended abdomen
poor appetite
incontinent episodes past expected toilet training age
interventions for elimination disorders
Parent education
Toileting schedules (even during the night for enuresis)
Specialist referrals if needed
Behavior training / therapies
Medication
medications for enuresis
imipramine
desmopressin
oxybutynin
indomethacin
SSRIs
interventions for enuresis
parent education
toileting schedule
limit fluids before bed
positive reinforcement
bell and pad methods
bladder training
school EP
interventions for encopresis
parent education
referral to gastroenterologist
increase dietary fiber and fluid
toileting schedule
enhanced toilet accessibility
CBT
Meds : suppository, enema, laxative
structural changes to functional areas of the brain in dementia
atrophy
ventricle enlargement
plaques
tangles
damaged brain cells
neurodegeneration
what must you rule out or treat first before dementia diagnosis
medical conditions
substance use / abuse
cumulative anticholinergic drug effects
diagnostic assessments for dementia
electroencephalography (EEG)
neuroimaging (MRI, CT)
laboratory testing
MMSE, mini-cog, mental status exams
DSM5 diagnostic criteria for mild cognitive impairment
Cognitive decline from a previous level of functioning in one or more cognitive domains.
Major symptom: Memory impairment
Excludes people with dementia or age-related memory impairment
Cognitive impairment do not interfere with independent day-to-day activities, and socialization
path to diagnosing mild cognitive impairment
Standardized neuropsychological test indicate modest impairment.
Mental status exam
Reports from family, friends, or clinicians
MCI assessment
Forgetfulness- important events or appointments
Difficulty following conversations
Difficulty following a plot in books or movies
Have trouble navigating familiar places
Becomes overwhelmed by previously easy task
Require greater effort and time to perform task (use to be performed effortlessly)
defense mechanisms of MCI
Denial- hiding memory deficits
Confabulation- making-up stories or answers to maintain self esteem when something is forgotten
Perseveration- repetition of phrases or behavior
Avoidance- avoid answering questions
primary dementia
Irreversible
Progressive (four stages)
Not secondary to any other disease process
Example: Alzheimer’s disease (AD)
secondary dementia
Result of some other pathologic process
Example: Acquired immunodeficiency syndrome (AIDS)/HIV, (older adults remain sexually active), vascular dementia, Pick’s disease, Huntington’s disease
Depression often mimics signs/symptoms of dementia
when you see fluctuating levels of alertness what should you suspect
delirium NOT dementia
risk factors for alzheimers
Age and gender: (Affects women more than men)
Incidence doubles after age 65
Older African Americans (twice as likely to develop AD)
Hispanic Americans (1.5 times more likely)
prodromal phase of alzheimers disease
brain changes occur 10-20 years prior to symptoms
4 A’s
Amnesia - Amnesia/memory impairment
Aphasia - Initially has difficulty finding correct word, then only uses a few words, finally babbling or mutism
Apraxia - Loss of purposeful movement (e.g.,walking, dressing self)
Agnosia - Loss of ability to recognize sounds (auditory agnosia), recognize objects (visual or tactile agnosia)
stage 1 of alzheimers disease
Short-term memory loss: loses things, forgets things
Difficulty learning new things
Occupational abilities may be intact, often able to work
Behavioral problems: depression, apathy
Impaired activities: grocery shopping, managing finances
stage 2 of alzheimers disease
memory gaps related to persons history
obvious ADL deficits
labile mood, paranoia, anger, aggression, jealousy
altered sleep pattern
driving hazard
around the clock care and supervision needed
activity and social withdrawl
defense mechanism : denial
stage 3 of alzheimers disease (severe)
Severe agnosia: unable to identify people (spouse, family members, friends)
Advanced apraxia: requires repeated instructions for simple tasks
Severe memory loss (e.g., location of toilet, leads to incontinence)
Behavior/mood: agitation, violence, paranoia, and delusions, wandering
Institutionalization may be necessary due to :
Wandering
Danger to self or others
Incontinence
Behavior affect the sleep and general health of others
Total dependence on others for ADLs
stage 4 (final stage)
agraphia : may lose ability to read and write
hyperorality : a need to taste or chew, puts everything in mouth
hypermetamorphosis : a need to touch everything
severe apraxia : lose ability to walk
dysphagia : difficulty swallowing
aphasia : inability to speak
seizures
weight loss
insomnia
stupor
coma
death
dementia interventions
always introduce yourself and refer to client by name
speak slowly
use short, simple words and phrases
maintain 1 or 2 arms distance
if delusional : acknowledge feelings and reinforce reality
if verbally aggressive : acknowledge feelings and change topics
health maintenance with dementia
Encourage client participation with care
Allow client to preform all task within his/her capabilities
Always allow client to wear their own clothing
Use clothing with elastic, and replace buttons and zipper with Velcro
Give step-by-step instructions (allow time to perform task)
If resistive to care, return at a later time
nutrition for dementia
Monitor food and fluid intake
Offer finger foods
Weigh once a week
During period of Hyperorality: watch for client eating non food items (i.e. artificial fruits, soaps)
elimination interventions for dementia
Implement bowel and bladder training program
Use incontinent supplies (e.g., pads or briefs)
sleep interventions for dementia
Keep room lights on
Keep room clutter free
Maintain calm environment throughout the day
home safety for dementia patients
gradually restrict driving
remove throw rugs
minimize sensory stimulation
label rooms
install safety bars in bathroom
interventions for wandering clients with dementia
Place mattress on the floor at night
Have client wear a medic alert and provide local police with a recent picture
Use complex locks, place locks at top of doors
major neurotransmitters involved in alzheimers
acetylcholine and glutamate
cholinesterase inhibitors : slows progression in mild to moderate stages
donepezil (Aricept)
rivastigmine (Exelon)
galantamine(Razadyne)
NMDA receptor antagonist : slow progression in moderate to severe stages
memantine
combination drugs : for moderate to severe stages
Namzaric (memantine hydrochloride extended-release (ER) combined with donepezil
drugs to treat co occurring depressive disorders
SSRIs - lower side effect, ordered for depression
mirtazapine (Remeron), side effects of weight gain and sedation are often beneficial
non pharm treatment
CBT
maintain comfort levels
behavioral interventions
physical exercise
picture magazines
compensatory memory aids
reality orientation
reminiscence/memory therapy
simple group activity
