mental health ch 13

mild NCD

mild cognitive impairment, focus of early intervention

major NCD (dementia)

progressive neurodegenerative condition, has different stages

reversible NCD is also called

temporary dementia

causes of reversible NCD

stroke, depression, med side effects, nutrient deficiencies, metabolic disorders

AD stage 1

no symptoms, maybe unnoticeable issues with memory and routine

AD stage 2

very mild, lose things, short term memory loss, aware of decline and may be ashamed

AD stage 3

mild cognitive decline, changes in thinking/reasoning are noticeable by others and interfere with life, may forget names/words

AD stage 4

moderate cognitive decline, forget child's bday, lose ability to shop, cook, and manage finances, may have depression

AD stage 5

moderately severe cognitive decline, lose ability for some ADLs independently, may need to go to memory care unit

AD stage 6

severe cognitive decline, SUNDOWNING, unable to recall spouse, disorientation, delusions, probably institutionalized

AD stage 7

very severe cognitive decline, terminal end stage, body starts to shut down, aphasic, unable to recognize family

AD causative factors

• neurotransmitter alterations

• plaques & tangles

• head trauma

• genetics

what neurotransmitter is involved in AD

acetylcholine decreases

how does low acetylcholine impact AD development

ACh is supposed to break down plaques and tangles, so low levels means more damage

how do cholinesterase inhibitors help AD

slow degradation of ACh

how do NMDA receptor antagonists help with AD

slow neuronal degradation

vascular NCD

blocked blood flow to brain -> neuro deterioration, more abrupt onset than AD, may have small strokes

vascular NCD factors & etiologies

hypertension, cerebral emboli, cerebral thrombosis

NCD due to parkinson's

loss of nerve cells in substantia nigra (in brain) and decrease in dopamine (causes decreased mobility), can resemble AD

NCD due to lewy bodies

similar to AD, progresses faster, often misdiagnosed as AD

second most common cause of NCD

lewy bodies, 25% of NCD cases

substance induced NCD

result of reactions to or overuse/abuse of substances

causes of substance induced NCD

alcohol, inhalants, sedatives, toxins, meds that cause anticholinergic side effects

NCD due to huntingtons

genetic disease, damages cerebral cortex and basal ganglia, usually declines into dementia and ataxia

what affects the course of NCD due to huntingtons

age of onset (juvenile onset and late onset are the shortest course)

delirium

disturbance in level of awareness and a change in cognition, develops rapidly over short period

delirium common causes

infection, electrolyte imbalance, hypoxia

delirium symptoms

distracted, rambling, impaired reasoning and goal directed behavior, disorientation to time and place

delirium autonomic manifestations

tachycardia, sweating, flushed face, dilated pupils, high BP

is delirium reversible

usually yes, resolve underlying etiology

4 types of delirium

1. substance intoxication delirium

2. substance withdrawal delirium

3. medication induced delirium

4. delirium due to another medical condition or multiple etiologies

primary NCD

disorder is directly caused by brain disease, not other illness

secondary NCD

caused or related to another disease or condition

most common NCD

Alzheimer's

aphasia

inability to speak

apraxia

impaired ability to carry out motor activities despite intact motor function

NCD due to prion disease predisposing factors

due to prion disease (duh), onset is usually between age 40 and 60, progression from diagnosis to death in 2 years, sometimes genetic components

other conditions that can cause NCD examples

hypothyroidism, brain tumor, pernicious anemia, MS, lupus

NCD diagnostics

EEG, CT, PET, MRI, lumbar puncture, blood or urine test

how do drugs help with NCD

help with cognitive impairment, agitation, aggression, hallucinations, thought disturbances, wandering, depression, anxiety, sleep