Neurocognitive disorders

delirium

acute, sudden change

what patients are at an increased risk for delirium?

• older adults

• seriously medically ill

• surgical patients

• neurological illness

what is important for patients who have delirium?

• safety because they are at an increased risk for falls

how do we treat delirium?

we treat whatever is causing the delirium

DELIRIUM FINDINGS

cognitive:

disoriented

disorganized

distractable

perceptual changes:

illusion

hallucinations

mood/behavior:

agitation

restlessness

anger

fear

anxiety/depression

physical changes:

increased HR, BP,

sweats

dilated pupils

flushed face

delirum treatment

• decrease stimuli

• fall precautions

• low dose antipsychotics

• benzos when it is substance induced

• melatonin or ramelteon for insomnia

delirum versus dementia

delirum:

• acute

• treat cause

• safety

dementia

• progressive

• chronic

• safety+ function and quality of life

dementia:

progressive cognitive decline affecting social/occupational functioning

what are possible findings of dementia:

• poor abstract thinking

• poor judgement

• poor impulse

• personality changes

alzheimer’s disease:

slow insidious and progressive deterioration

associated with changes/theories

what are some characteristics of alzheimers

• decreased ACH

• plaques and tangles

• head/trauma risk

vascular dementia:

related to cerebral vascular disease

what are some characteristics of vascular dementia:

• abrupt onset

• periods of improvement followed by decline

• small stepped gait

• limb weakness

• speech difficulties

frontotemporal dementia signs/symptoms:

• frontal lobe shrinkage

• rapid steady progression

• personality changes

• impulsivity

• inappropriate social behavior

• difficulty with spoken/written language

• loss of speech or speech problems

neurocognitive disorder related to TBI

• associated with head trauma

• implement seizure precautions

Lewy body dementia:

• rapid progression

• visual hallucinations occur earlier

• Parkinson like symptoms occur earlier

• lewy bodies in cortex

“they are highly sensitive to EPS for antipsychotics”

parkinsons disease

decreased dopamine

caused by loss of nerve cells in the substantia nigra

s/s of parkinsons disease:

• rigidity

• slowness

• tremors

• abnormal involuntary movements

huntington’s disease:

damage to the basal ganglia or cerebral cortex

10-20 year progression

progression:

1. mild cognitive changes

2. involuntary movements

3. depression

4. profound cognitive impairment

5. ataxia

6. weakness

prion disease

very rapid neurocognitive decline

s/s of prion disease:

• ataxia

• dementia

• death within 2 years

misfolded proteins

contaminated materials

MEDICATIONS FOR NCD

cognitive impairment:

• cholinesterase inhibitor → donepezil

• NMDA receptor agonist → memantine

behavior/psychiatric problems:

agitation/wandering → antipsychotic

depression→ SSRI’s, trazadone

anxiety→ benzos

sleep disturbance → benzos, sedatives, hypnotics

assessment and nursing care for NCD:

• get the hx from the caregivers

• do a focused assessment on safety, mental, and check for abuse/neglect

nursing priorities:

• prevent falls

• safe environment

• assist with ADL’s