Neurocognitive disorders

Delirium

a state of acute mental confusion hallmarked by decreased attention and/or awareness with a rapid onset.

Traces to sever illness, chemical imbalance, medication.

Delusion

Fixed, false beliefs.  Cannot be corrected by logic. Are not consistent with the culture and/or education of the person.

EX. Thinking the t.v. is sending you a personal message.

Delirium

a state of acute mental confusion hallmarked by decreased attention and/or awareness with a rapid onset.

Traces to sever illness, chemical imbalance, medication.

Delusion

Fixed, false beliefs.  Cannot be corrected by logic. Are not consistent with the culture and/or education of the person.

EX. Thinking the t.v. is sending you a personal message.

Illusion

Misperception of a real external stimulus. Occurs most often when consciousness is reduced.

EX. In the dark, a frightened person is more likely to perceive the outline of a bush as that of an attacker.

EX. Thinking someone you know is on TV

Hallucination

False sensory perception experienced without a real external stimulus.

EX. Hearing voices that are not present; seeing things that are not present.

Aphasia (stroke/head injury/brain tumor/neurodegenerative disease/infection)

Caused by damage to specific areas of the brain responsible for language

A total disruption of speech and comprehension:

• Difficulty coming up with words

• Substituting intended words for another word (e.g., chicken for fish)

• Switching sounds (e.g., wish dasher for dishwasher)

• Using made-up words

• Difficulty putting words together to form sentences

• Mixing real words with made-up words

• Difficulty reading and writing

• Difficulty understanding number concepts such as time and money

Dysphasia

Partial/moderate loss that affects communication, without total disruption of speech

• Difficulty understanding

• Difficulty listening

• Difficulty writing or doing calculations

• Delayed language output

• Difficulty with daily tasks such as shopping and answering the phone

Dysarthria

Weak speech muscles; difficulty controlling muscles.

• Slurred speech

• Slow speech

• Inability to speak louder than a whisper or speaking too loudly

• Rapid speech that is difficult to understand

• Nasal, raspy or strained voice

• Uneven or abnormal speech rhythm

• Uneven speech volume

• Monotone speech

• Difficulty moving your tongue or facial muscles

Types of Delirium

Hyperactive:

❖Agitation

❖Restlessness

❖Hallucinations

❖Delusions

Hypoactive:

❖Lethargy

❖Drowsiness

❖Apathy

❖Slow motor skills

Frontotemporal Lobar Degeneration

S/S:

❖Group of disorders that demonstrate atrophy of the frontal and temporal lobes of the brain, with no atrophy in the parietal or occipital lobes

❖Gradual onset of symptoms that are either behavioral or language based

• Signs of disinhibition

• Apathy

• Loss of empathy

• Decline in social cognition

• Decline in language ability

Lewy body Disease

S/S:

❖Progressive degenerative form of dementia

❖Presence of Lewy bodies in the brain

• Clumps of specific proteins (alpha-synuclein and ubiquitin)

❖Characteristics

• Fluctuating cognition, with variation in attention and alertness from day to day, hour to hour

• Visual hallucinations

• PD like motor symptoms

• Visual hallucinations

• Movement disorders

• Poorly regulated body functions

• Cognitive problems

• Sleep difficulties

• Depression

• Apathy

Vascular Disease (block/reduced blood flow to the brain

S/S:

❖Affects many body systems

❖Interrupted blood flow results in damage to bodily systems

❖Step-wise deterioration of function

❖Each time a CVA occurs, there is a sudden notable decline in function, followed by a plateau

Post stroke:

❖Confusion

❖Disorientation

❖Trouble speaking or understanding speech

❖Vision loss

Multi-Infract Dementia (blockage in arteries)

•Most common form of vascular dementia

•Progressive step-wise decline in mental functioning

•Cumulative effects of stroke(s) in the brain

•May co-exist with AD (35%) and PD

•Associated with HTN, cardiovascular disease, and smoking

Substance/Medication induced

S/S:

❖Dx. Is made with evidence of substance abuse or withdrawal

❖Specific symptoms depend on substance

❖Person meets criteria for major or mild neurocognitive disorder

❖Neurocognitive symptoms that continue after intoxication, withdrawal, and subsequent abstinence

Korsakoff syndrome

Brain cells cannot produce enough energy.

•Memory disorder caused by Thiamine (Vitamin B-1) deficiency

Causes:

• Cancer

• AIDS

• Alcoholism

• Poor nutrition

Prion Disease: Creutzfeld-Jakob

Degenerative brain disorder that leads to dementia, progresses rapidly (ppl fall into a Colma)

❖Dx. Criteria

• Insidious onset

• Rapid progression

• Motor features (ataxia, rigidity, myoclonus)

❖Infectious disease transmitted from animals (not clear if virus or bacteria)

S/S:

 Personality changes

 Memory loss

 Impaired thinking

 Blurred vision or blindness

 Insomnia

 Incoordination

 Difficulty speaking

 Difficulty swallowing

 Sudden, jerky movements