Neurodevelopment and Neurocognitive Disorders- PSYCH EXAM 2

Neurocognitive Disorder (NCD):

Chronic, progressive decline in cognitive function affecting memory, thinking, and behavior.

What are people with NCDs vulnerable to?

Delirium, which may accelerate cognitive decline

Delirium

Sudden, reversible cognitive impairment, Often secondary to an underlying medical condition

What can increase symptoms of delirium?

Longer hospital stays

Risk Factors for Delirium

- Advanced age

- Dementia or cognitive impairment

Medical/Environmental- Polypharmacy (psychoactive meds)

- Acute illness or infection

- Metabolic or electrolyte imbalance

- Sleep deprivation or immobilization

Symptoms of Delirium

Cognitive Changes- Acute onset with fluctuations- Impaired attention- Disorientation- Memory impairment•

Behavioral & Physical• Hallucinations or delusions• Agitation or lethargy• Sleep disturbances• Emotional changes

What assessment do you use for patients with delirium?

CAM or CAM-ICU

Nursing Considerations for Delirium

Ensure safety

Identify and treat the underlying Cause

Promote Orientation and cognitive support

Avoid Deliriogenic Medications

Encourage Family involvement

Promote sleep: reduce noise/lights at night

Ensure glasses/hearing aids are used

Encourage mobility and hydration

Frontal Lobe

associated with reasoning, planning, parts of speech, movement, emotions, and problem solving

parietal lobe

portion of the cerebral cortex lying at the top of the head and toward the rear; receives sensory input for touch and body position

temporal lobe

A region of the cerebral cortex responsible for hearing and language.

occipital lobe

A region of the cerebral cortex that processes visual information

Cerebellum

the "little brain" at the rear of the brainstem; functions include processing sensory input and coordinating movement output and balance

Dementia

Chronic Decline that interferes with daily functioning and marked by at least 2 impairments to cognitive functioning

Cortical Dementia

changes in cerebral cortex (Alzheimer's disease, Pick's disease)

Subcortical Dementia

Parkinson's and Huntington's disease caused by damage to basal ganglia.

Early Onset Dementia is diagnosed when?

Before 65 yrs.

Vascular dementia are

Parkinson's and Huntingtons

Alzheimer's Disease

a progressive and irreversible brain disorder characterized by gradual deterioration of memory, reasoning, language, and, finally, physical functioning

What is the average lifespan after being diagnosed with Alzheimers?

8-10 yrs

Tau Tangles

Twisted fibers in neurons linked to Alzheimer's.

Amyloid Plaques

fragments of the protein beta-amyloid that accumulate into insoluble plaques that inhibit communication between neurons

Symptoms of Dementia

Memory impairment, apparent changes in intellect, impaired judgment, spatial disorientation (wandering), emotional changes

Mild Stage of Dementia

•Short-term memory loss interferes with everyday activities (driving, balancing checkbook)

•Moderate difficulty with orientation

•Unable to function independently in community affairs (may still be engaged)

•Moderate difficulty in handling problems

-Social judgment maintained

•Mild impairment of function at home (with regards to chores and hobbies)

Moderate stage of dementia

more frequent and extensive forgetfulness and confusion, increase in irritability and difficulty in behaviour, lack of food intake and hygeine

Severe stage of dementia

- Severe memory loss; Only fragments

- Oriented to person only

- No independent function outside the home

- Unable to make judgments or solve problems

- No significant function in the home

-Unable to perform ADLs

Cholinesterase inhibitors

Donepezil

Rivastigmine

Galantamine

Diminishing - Donepezil

Recall - Rivastigmine

Grows - Galantamine

Namenda (memantine)

Regulates the activity of glutamate in the brain, prolongs life of someone with dementia

Aducanumab

Beta-amyloid antibody- Reduce and remove the formation of beta-amyloidplaques in the brain

Home Safety for Alzheimers

no scatter rugs, install door locks good lighting especially around stairs, colored tape on edge of stairs, remove clutter, mattress on floor to prevent falls

Developmental Delay affects what?

Attention, cognitive, language, affect, social or behavior

ADHD

Neurobehavioral condition, diagnosed in childhood and often lasts into adulthood. Diagnosed during childhood based on school behavior, parents' reports, and direct observation. Trouble paying attention, controlling impulsive behaviors, or being overly active.

Causes of ADHD

genes, prenatal environment, and brain differences, toxins

Inattentive ADHD

Difficulty paying attention in the classroom, unable to concentrate on schoolwork, poor problem-solving

Hyperactivity/Impulsive ADHD

• Fidgetiness, squirming in seat

• Excessive climbing or running where inappropriate

• **Difficulty engaging in leisure activities

• Parents:

• "always losing things"

• "...like they're a hamster on a wheel."

• "driven by a motor that wont stop"

Diagnostic Criteria for ADHD

6 or more symptoms present from either the Attention or the Hyperactive/Impulsive catagories for at least 6 months. Symptoms present in at least 2 environments.

Stimulant Medications for ADHD

•methylphenidate

•dexmethylphenidate

•amphetamine

Non-stimulant medications for ADHD

Atomoxetine

Bupropion hydrochloride

Clonidine

Guanfacine

Autism

Developmental Disorder that impacts social skills, repetitive behaviors, communication

Levels of Autism

Mild, Moderate, and Severe

Intellectual Disability

IQ less than 70