neurocognitive disorders

Neurocognitive disorders

temporary or permanent damage to neurons 

Types of cognitive impairment disorders

delirium, dementia, amnestic disorders 

Delirium according to DSM-5

disturbance in attention and awareness (reduced orientation to environment)

• Disturbance develops over short period of time, represents an acute change from baseline and tends to fluctuate in severity during the course of a day

Delirium develops over a short time and is

reversible if underlying cause is identified and treated quickly

Pts with delirum experience

Changes in cognition and mental status → pt doesn’t know where they are, may not recognize familiar objects, or unable to carry a conversation

Risk factor for delirium

AIDS, pneumonia, bone fracture, meds, preexisting dementia, advanced age 

Drugs that cause delirium

1. Perscription drugs

2. Sedative hypnotics (benzodiazepines), anticonvulsants (barbiturates), antiparkinsonian agents (benzotropine)

3. Analgesics → narcotics, NSAIDS

4. Antihistamines 

5. Abx 

6. Antinauseants → scopolamine, dimenhydrinate

7. Psychotropic meds → lithium

8. Cardiac meds → digitalis

9. GI meds → H2-blockers

other meds that cause delirium

Liquid meds containing alcohol, mandrake, henbane, jimson weed, atropa belladonna extract 

When doing physical assessment on pt with delirum always

Consider medical first

Physical assessment

• Substance use hx 

• Interview caregivers

• Hx of onset, duration, range, and intensity (always consider medical first)

• Meds (cold meds can cause confusion) 

• Neuro assessment to rule out TIA 

• Assess for infections, labs 

Physiological needs for delirum

Respiratory and cardiovascular

Safety/behavioral for delirum

They have combative behavior so de-escalation is a priority

Nursing interventions for delirum

• Safe therapeutic environment

• Maintenance of fluid and electrolyte balance

• Prevention of aspiration, skin breakdown 

Psychosocial interventions

• Frequent interaction and support

• Encouragement to express fears and discomforts 

• environment al control → adequate lighting, reasonable noise level, easy-to-read calendars and clocks

• Frequent verbal orientation

Alzheimer disease 2 subtypes

Early onset and late onset

Early onset is

Age 65 yrs and younger, more rapid progression

Late onset is

Age older than 65 yrs, more common

Risk factors for AD

Genetics, metabolic syndrome, down syndrome

Amyloid precursor protein

peptides can accumulate as amyloid plaques, promoting neurodegeneration

Beta-amyloid plaques

clump together in the brain and destroy cholinergic neurons

Neurofibrillary tangles

when microtubules disintegrate, the neuron’s transport system collapses, resulting in cell death

Synpatic micron RNA and neurotransmission

several major neurotransmitters are affected such as ACh, norepi, serotonin

Etiology of AD

Amyloid precursor protein, Beta-amyloid plaques, Neurofibrillary tangles, Synpatic micron RNA and neurotransmission, Oxidative stress, free radicals, mitochondrial dysfunction, Inflammation, Gut-brain axis alteration

Gut-brain axis alteration

exposure to exotoxins that pass BBB

AD

degenerative, progressive, neuropsychiatric disorder, cognitive impairment, emotional and behavioral changes, physical and functional decline

s/sx of AD

memory loss, recent, remote, disorientation, decreased ability to concentrate or learn new material, difficulty making decisions, poor judgement 

Aphasia

alterations in language

Apraxia

inability to execute motor activities despite intact motor function 

Agnosia

failure to recognize objects despite intact sensory function

Hyperorality

excessive, compulsive preoccupation with oral sensations involving putting objects in the mouth, chewing, sucking, biting, or smacking lips 

Pharm interventions for AD

acetylcholinesterase inhibitors, NMDA antagonists, memantine and donepezil combination, mood stabilizers, antianxiety meds, antidepressants

Donepezil

prevents breakdown of ach in the brain

Galantamine

Prevents breakdown of acetylcholine and modulates nicotinic receptors that release ach in the brain

Memantine

Blocks toxic effects of excess glutamate and regulates glutamate activation