Neurocognitive Disorders/ Dementia (Dr. Stuart)

neurocognitive domains

perceptual-motor function

language

executive function

complex

delirium related diagnoses

alzheimers dsease

frontotemporal degeneration

lewy body disease

vascular disease

tbi

substance/ medication induced

hiv infection

prion disease

parkinsons disease

huntingtons disease

alzheimers

onset: insidious

progression: gradual

specific details: starts out with losing executive function and memory, as it progresses they have trouble with ADLs, IADLs, and social skills, lastly it affects all functions including motor

frontotemporal (pick’s disease)

onset: insidious

progression: progressive

specific details: behavioral disinhibition, perseverative, stereotypes or obsessive behavior, dietary changes, social cognition and executive function

lewy body

onset: insidious

progression: progressive

specific deficits: fluctuating cognition, attention/ alertness, visual hallucinations, difficulty maintaining social conventions, parkinsonian tremors and motor deficits

vascular-aneurysm or CVA

onset: abrupt

progression: may or may not progress

specific details: complex attention, executive function, other dependent on site and frequency of lesions

TBI

onset: abrupt

progression: not progressive

specific details: dependent on area of damage

substance/ medication induced

onset: abrupt/ progressive

progression: progressive if continues

specific details: memory, cognition, motor and performance areas are impaired

HIV

onset: insidious

progression: progressive

specific details: impaired memory, apathy, social withdrawal, and difficulty concentrating

parkinsons

onset: insidious

progression: progressive

specific details: motor deficits noted first - pill rolling, tremor, gait disturbance, motor rigidity, anxiety, depression, memory loss

prion (genetic mutation, transmitted)

onset: insidious

progression: progressive (rapid - 1 year until fatal)

specific details: problems with muscular coordination, personality changes (impaired memory, judgement, and thinking) impaired vision, insomnia and depression

huntington’s

onset: insidious

progression: progressive

specific details: irritability, anxiety, depression - progresses to severe dementia, psychotic behavior, involuntary jerky movements

delirium

disturbance in attention and cognition hat develop and often resolve over short periods of time

substance: intoxication/ withdrawal; medication-induced, due to another medical condition, due to multiple etiologies

dementia

group of sustained symptoms; global and progressive loss of cognitive function

depression

disturbances in attention, concentration

apathy, mental slowing

probable alzheimers disease is diagnosed by the DSM V if…

1. there is evidence of a causative alzheimers disease genetic mutation from family history or genetic testing

OR

1. all 3 of the following are present

   1. clear evidence of decline in memory and learning and at least one other cognitive domain

   2. steadily progressive, gradual decline in cognition, without extended plateaus

   3. no evidence of mixed etiology (ex. tbi)

global deterioration stages of alzheimers

1. no cognitive decline

2. very mild decline - some forgetfulness, no vocational decline, appropriately concerned

3. mild cognitive decline - observable performance deficitis, anxiety and denial likely

4. moderate cognitive decline - clear deficits in multiple arenas, withdrawal, denial

5. moderately severe cognitive decline - needs assistance to survive, disorientation

6. severe cognitive decline - disorientation, adl assistance, anxiety, agitation, apathy all common

7. very severe cognitive decline - inability to communicate, total assistance

teepa snow the GEMS brain change model

sapphire (optimal cognition, healthy brain)

diamond

emerald

amber

ruby (deep and strong in color, others stop seeing what is possible)

pearl (hidden within a shell, beautiful moments to behold)

environmental adaptations for dementia

early: use memory aids, low tech applications (labels, signs, picture symbols, alarms, beepers, social supports)

middle: adaptations for safety (safety shutoffs for water, power, gas, home security)

later: positioning, equipment (broda chairs, trunk and head supports, air flow mattress)

behavioral/ enhancement of function intervention for dimentia

early stages: prevent getting lost, address driving

middle stages: structured activity programs for physical exercise, cognitive stimulation, social activities, and respite

later stages: environmental management, sensory stimulation

caregiver education for dementia

1. education about disorder

2. strategies to adapt activities or compensate for declining performance

3. strategies to facilitate interactions

4. promote the participation of loved one

5. plan for future care needs

STGS for dementia should be ____

LTGs for dementia should be ____

1 week; 1-2 months