Neuro-Cognitive Disorders (NUR 322)

Cognition

The brain’s ability to (1) process, (2) retain, and (3) use information; abilities related to cognition include reasoning/judgement, perception/comprehension, attention, and memory

Cognitive Disorder

Disruption or impairment of the higher-level functions (cognitive abilities) of the brain; often results in devastating effects on the ability to function daily

4 Categories of Neurocognitive Disorders (NCDs)

1.) Delirium

2.) Major Neurocognitive Disorder (NCD)

3.) Mild Neurocognitive Disorder (NCD)

4.) Dementia

Delirium

Neurocognitive syndrome that involves a disturbance of consciousness accompanied by altered cognition; usually develops over a short period and fluctuates throughout the day

3 Causes of Delirium

Delirium almost always results from an identifiable physiological, metabolic, or cerebral disturbance…

1.) Physiological/Metabolic → hypoxemia, electrolyte disturbances, renal/hepatic failure, hypoglycemia/hyperglycemia, dehydration, sleep deprivation, thyroid/glucocorticoid disturbances, vitamin deficiency, protein deficiency, cardiovascular shock, brain tumor, head injury

2.) Infection → Systemic: sepsis, UTI, pneumonia; Cerebral: meningitis, encephalitis, HIV, syphilis

3.) Drugs → Intoxication: anticholinergics, lithium, alcohol, sedatives, hypnotics; Withdrawal: anesthesia reactions, prescription medication, illicit substances

Delirium is considered a transient condition that effectively clears with successful treatment of the underlying cause. True or False?

True; however, some causes such as head injury or encephalitis may leave clients with cognitive, behavioral, or emotional impairments

9 Delirium Assessment Findings

1.) History → pertinent medical history or known substance use

2.) General Appearance/Behavior → disturbed psychomotor behavior (i.e. restless/hyperactive, uncoordinated, lethargic); disturbed speech (i.e. rambling, incoherent, pressured)

3.) Mood/Affect → rapid/unpredictable shifts in mood

4.) Thought Process/Content → altered cognition; disorganized/fragmented thought, possible delusions

5.) Sensorium/Intellectual Processes → altered level of consciousness (fluctuates), ↓ awareness of environment; impaired immediate memory, illusions/hallucinations

6.) Judgement/Insight → impaired; insight is dependent on severity

7.) Self-Concept → often feel frightened or threatened, helplessness/powerlessness (dependent on awareness)

8.) Roles/Relationships → inability to fulfill roles; often regained

9.) Physiological/Self-Care Concerns → sleep problems, ignore or fail to perceive internal body cues (i.e. hunger, thirst, urge)

Dementia

Disease process marked by progressive cognitive impairment with no altered level of consciousness; involves multiple cognitive deficits (initially recent memory)

5 Cognitive Disturbances of Dementia

1.) Impaired Memory → difficulty with recall or memory retention

2.) Aphasia → deterioration of language function

3.) Apraxia → impaired ability to execute motor functions

4.) Agnosia → inability to recognize or name objects (despite sensory ability)

5.) Impaired Executive Functioning → inability to think abstractly and to plan; inability to control complex behavior

Echolalia

Echoing what is heard; correlated with aphasia

Palilalia

Repeating words/sounds over and over; correlated with aphasia

3 Stages of Dementia

The course of dementia is usually progressive…

1.) Mild → forgetfulness is the hallmark sign; difficulty finding words, frequently loses objects, and begins to experience secondary anxiety; occupational/social settings are less enjoyable

2.) Moderate → confusion is apparent with progressive memory loss; inability to perform complex tasks but remains oriented to person/place; toward the end of this stage the person loses the ability to live independently and requires assistance because of disorientation

3.) Severe → personality/emotional changes occur; person may experience delusions, night wandering, forgetting familiar names, and assistance with ADLs; most are living in nursing facilities

8 Common Types of Dementia

1.) Alzheimer’s Disease

2.) Lewy Body Dementia

3.) Vascular Dementia

4.) Frontotemporal Lobar Degradation

5.) Creutzfeldt-Jakob Disease

6.) Parkinson’s Disease

7.) Huntington’s Disease

8.) Chronic Traumatic Encephalopathy