Unit 7 : Neurocognitive disorders

3 types of Neurocognitive disorders

• delirium

• mild NCD

• major NCD

Delirium

• ALWAYS secondary to another condition/ medication

• acute onset

• resolves after primary cause

• syndrome not a disorder

• may have change in consciousness

Etiology/ common causes of delirium (10)

• common in older frail adults

• untreated pain

• ploypharmacy

• dehydration

• sleep deprivation

• immobility

• infections

• restraint use

• post op

• ICUs

S/S of delirium (6)

• attention deficit (lethargic)

• rapid fluctuation of lucidity to confusion

• disorientation of time and place

• anxiety and agitation

• delusions and visual hallucinations

• hypervigilance

Interventions to delerious pt

• safety / risk for injury

• keep them oriented

• use visual cues to redirect

• quiet and calm

• short simple statements

• NEVER leave them alone

• do not assume delirium is dementia in an older pt

Mild NCD

• noticeable decline from previous functioning

• does not interfere with ADLs

• Does not necessarily progress

Major NCD

• significant decline

• interferes with daily functioning and independence

Dementia

• progressive decline of cognitive function, language, personality and memory

• no change in consciousness

• irreversible

Alzhiemrs’s

• 60-80% of all dementia

• inability to perform routine tasks of daily living

• impaired thinking

• memory loss

Neurobiological cause of alzheimer's

• deterioration if neurons

• acetylcholine low

• beta-amyloid and neurotic plaque

• nuerofibirillary tangkes and tau

• apolipoprotien E4 gene

Risk factors for Alzheimers

• cardiovascular disease (hypertension, sedentary lifestyle)

• TBI/ head injury

• lack of sleep

• lack of social engagement

• lack of education/ mental stimulation

Mild Alzheimers (6)

• trouble retrieving names and words

• trouble remembering names of new people

• forgetting material one has just read

• losing items of value

• trouble with planning and organizing

• may be in denial

Moderate/ middle stage of AZ (8)

• forgets personal history

• becomes moody and withdrawn

• confused about where they are or what day it is

• unable to recall old addresses or where they went to school

• wandering

• sleep disturbances

• forgetting if they ate

• suspiciousness

severe/ late stage of AZ(5)

• loss of ability to urinate/ defecate

• loss of physical abilities (sit/walk/swallow)

• vulnerable to infections, especially pneumonia

• cant respond to environment

• around the clock care at the end

aphasia

• s/s of AZ

• loss of language ability

• mutism in late stages

agnosia

• loss of sensory ability to recognize previously familiar objects/ people/ sounds.

confabulation

making up Stories in place of missing memories to maintain self esteem

agraphia

lost ability to read or write

hyperorality

putting everything in their mouth

preservation

repetition of a word phrase or gesture long after the stimulus is gone

sundowning

tendency for mood to drop/ become agitated as day light diminishes

Intevrentions for AZ

• locks on top of doors

• good lighting

• fall precautions

• med alert bracelets

• tracking devices

• physical activity during day to avoid restlessness at ight

• coping for caregiver stress