Cognitive Impairment

NUR 484: Mental Health Nursing; MCSON; Ms. Bryant

_____ is the mind’s process of awareness, including perceiving, thinking, and remembering

cognition

_____ _____ _____ refers to physical disorders that impair mental function

organic brain syndrome

_____ refers to a decline in cognitive abilities that interferes with everyday activities

dementia

_____ often leads to difficulties with memory, reasoning, and organizing thoughts

dementia

dementia typically progresses _____, worsening as time goes on

gradually

how many stages of dementia are there

3

what are the 3 stages of dementia

1. mild

2. moderate

3. severe

_____ _____ _____ is general forgetfulness common with aging; only some cases progress to dementia

mild cognitive impairment

_____ dementia is cognitive impairments that occasionally affect daily life, including memory loss, confusion, personality changes, getting loss, and difficulty planning or completing tasks

mild

_____ dementia makes daily tasks harder, needing more help. symptoms worsen from mild dementia. help with dressing an grooming is often needed, personality may change, causing suspicion or agitation. sleep problems are common.

moderate

_____ dementia worsens symptoms greatly. communication may stop, and full-time care is needed. basic actions like sitting or holding up the head become impossible. bladder control is often lost.

severe

_____ _____ causes 60-80% of dementia cases

Alzheimer’s disease

_____ _____ happens when brain blood flow is blocked by artery clogs or strokes

vascular dementia

_____ _____ _____ happens when protein clumps block nerve cells, causing missed signals, slow reactions, and memory loss

lewy body dementia

_____ _____ _____ his advanced Parkinson’s that can lead to dementia, causing poor thinking, bad decisions, and mood changes

Parkinson’s disease dementia

_____ _____ affects the front and side brain areas, causing speech and behavior problems and loss of social control

frontotemporal dementia

_____ _____ causes involuntary movements and dementia-related thinking problems

Huntington’s disease

_____ is a specific type of dementia - a progressive, degenerative brain disorder that gradually destroys memory and thinking skills

Alzheimer’s

what is the most common cause of dementia

Alzheimer’s disease

_____ _____ is caused by abnormal protein buildup in the brain (amyloid plaques and tau tangles)

Alzheimer’s disease

***Alzheimer’s disease progresses in stages: mild —→ moderate —→ severe

what are the four A’s of Alzheimer’s disease

1. agnosia

2. amnesia

3. aphasia

4. apraxia

_____ is the inability ti recognize or identify objects, people, sounds, or smells

agnosia

agnosia is when the brain can no longer correctly interpret _____ information

sensory

***example of agnosia: not recognizing a loved one’s face or mistaking a toothbrush for a comb

_____ is memory loss

amnesia

amnesia is difficulty remembering _____ events and is usually the first sign. long-term memories may remain intact in early stages

recent

***example of amnesia: forgetting conversations, appointments, or where items were placed

_____ is loss of ability to communicate effectively

aphasia

***aphasia is difficulty with speaking, understanding speech, reading, or writing

***example of aphasia: calling objects by the wrong name or being unable to follow a conversation

_____ is the inability to carry out purposeful, learned motor activities despite having the physical ability and desire to perform them

apraxia

***apraxia is the person can’t do familiar movements like dressing or using tools, even though their muscles work and they want to do it. The brain has trouble sending the right signals to the body to complete the task

***example of apraxia: A person may not remember how to button a shirt or use a spoon, even though they’ve done it many times before.

mild Alzheimer’s disease: memory lapses, word-finding issues, mostly _____

independent

moderate Alzheimer’s disease: confusion, behavioral changes, daily care needed, needs _____

assistance

severe Alzheimer’s disease: loss of communication, full physical decline, fully _____

dependent

list some symptoms for mild (early stage) Alzheimer’s stage

uForgetfulness, especially recent events or conversations

uTrouble finding words or names

uMisplacing objects (e.g., keys, phone)

uGetting lost in familiar places

uDifficulty with planning or organizing (e.g., managing finances)

uSubtle changes in personality or mood (e.g., anxiety, apathy)

uStill able to function independently with minimal help

uRepeating questions

uStruggling to follow a recipe

uBecoming withdrawn in social situations

list some symptoms for moderate (middle stage) Alzheimer’s disease

uIncreased memory loss and confusion

uTrouble recognizing family and friends

uDifficulty with language, reading, and writing

uInability to perform complex tasks (e.g., cooking, driving)

uSleep disturbances

uWandering and getting lost

uBehavior changes (e.g., suspicion, agitation, aggression)

uNeeds help with daily activities like dressing and hygiene

uBelieving others are stealing from them

uGetting dressed in the wrong order

uRepeating the same stories or phrases

list some symptoms for severe (late stage) Alzheimer’s disease

uLoss of ability to communicate clearly (may only say a few words)

uInability to recognize close loved ones

uComplete dependence on others for care

uLoss of physical abilities (walking, sitting up, swallowing)

uIncontinence

uRisk of infections (especially pneumonia)

uNeeding to be fed or turned in bed

uNot responding to surroundings

uSleeping more often or being nonverbal

list some nursing considerations for Alzheimer’s disease that can maintain dignity

*Always identify yourself and call the patient by name – a form of orientation
*Communication – speak slowly, simple sentences, face to face
*Talk about meaningful things to them
*Be sure glasses and hearing aids are available
*Identify doors with pictures or identifiable objects
*Monitor fluid intake – they forget to eat and drink
weigh weekly
*Group activities  - individualize to patient
*Dress in their own clothes
*Calm atmosphere
*Let the patient do as much as they can on their own to help them feel confident.

list some nursing considerations for safety with a patient with Alzheimer’s disease

uPrevent wandering – use door alarms, ID bracelets.

uFall prevention – clear walkways, non-slip shoes, bed alarms.

uMonitor for swallowing difficulty – risk of choking and aspiration.

uRemove hazards – lock up medications, cleaning supplies, sharp objects.

list some nursing considerations for communication with an Alzheimer’s disease

uUse simple, short sentences.

uSpeak slowly and clearly; allow extra time for response.

uUse calm, reassuring tone – avoid arguing or correcting.

uUse nonverbal cues (gestures, pictures) when words are difficult.

list some nursing considerations to promote routine and structure for an Alzheimer’s disease patient

uKeep daily routines consistent – same time for meals, hygiene, activities.

uUse familiar objects to reduce confusion.

uDisplay calendars and clocks to help with orientation.

list some nursing considerations to support independence for an Alzheimer’s disease patient

uEncourage patients to do as much as they can safely.

uOffer step-by-step instructions for tasks.

uUse adaptive devices as needed (e.g., easy-grip utensils).

list some nursing considerations to provide emotional support for an Alzheimer’s disease patient

uAcknowledge their feelings – use empathy and validation.

uAvoid confrontation – redirect rather than challenge hallucinations or confusion.

uMaintain a calm and supportive environment to reduce agitation.

list some nursing considerations for nutrition and hydration for an Alzheimer’s disease patient

uOffer small, frequent meals with finger foods if needed.

uMonitor for weight loss or signs of dehydration.

uLimit distractions at mealtime to help focus on eating.

list some nursing considerations to manage behavioral symptoms for an Alzheimer’s disease patient

uIdentify triggers for agitation or aggression (pain, fear, noise).

uUse non-pharmacologic interventions first (music, redirection).

uKeep the environment low-stimulation and quiet.

list some nursing considerations for family and caregiver education of an Alzheimer’s disease patient

uTeach about the progressive nature of Alzheimer’s.

uProvide resources for respite care, support groups, and advance directives.

uEncourage realistic expectations and self-care for caregivers.

***medication treatment for dementia manage symptoms but do not cure or stop disease progression. medications can only slow progression

what medication is used for mild to moderate Alzheimer’s disease

cholinesterase inhibitors

cholinesterase inhibitors work by increasing levels of _____, a chemical involved in memory and learning

acetylcholine

_____ (Aricept) is approved for all stages of dementia

Donepezil

_____ (Exelon) is available in pill and patch form

Rivastigmine

_____ (Razadyne) is for mild to moderate stages of dementia

Galantamine

list some common side effects cholinesterase inhibitors

• nausea

• vomiting

• diarrhea

• loss of appetite

• bradycardia

_____ _____ _____ is used for moderate to severe Alzheimer’s disease

NMDA receptor antagonist

_____ (Namenda) works by regulating glutamate, a brain chemical involved in learning and memory

Memantine

list some common side effects of a NMDA receptor antagonist

• dizziness

• headache

• confusion

• constipation

list some medications for symptom management of dementia. these do not treat dementia directly but help manage behavioral or psychological symptoms

uAntidepressants (e.g., Sertraline, Citalopram) – for depression, anxiety

uAntipsychotics (e.g., Risperidone, Quetiapine) – used cautiously for aggression or severe agitation

uMood stabilizers – sometimes used off-label (e.g., Valproate)

INFO DUMP!!!

⚠ Note: Antipsychotics carry a black box warning for increased risk of death in elderly patients with dementia-related psychosis.
How do they increase the risk of death?

u1. Heart Problems: They can cause irregular heart rhythms (arrhythmias) or heart attacks, which are more dangerous in older adults.

u2. Stroke: Some studies have shown a higher risk of stroke and mini-strokes (TIAs) in dementia patients taking antipsychotics.

u3. Infections: They can increase the risk of pneumonia, especially if the medication makes the person very sleepy or causes difficulty swallowing.

u4. Sedation and Falls: These drugs often cause drowsiness or confusion, which can lead to falls, head injuries, or broken bones.

u⚠ Summary:

uBecause of these risks, the FDA issued a black box warning to alert doctors and nurses that using antipsychotics in dementia patients with psychosis can lead to early death, and should be done only when absolutely necessary, with close monitoring.

_____ is a sudden, acute, and reversible change in mental status

delirium

delirium involves confusion, disorientation, and impaired attention, often developing within _____ to _____

hours to days

delirium is not a _____, but a syndrome that signals an underlying problem (e.g., infection, medication, dehydration)

disease

***_____ adults are at high risk to delirium due to age-related brain changes and chronic illnesses

older

delirium is often misdiagnosed as _____- but unlike _____, delirium has a sudden onset and fluctuates

dementia

_____ is a medical emergency that requires quick identification and treatment

delirium

list some cognitive key symptoms of delirium in the elderly

• sudden confusion

• disorientation to time/place/person

list some attention key symptoms of delirium in the elderly

• trouble focusing

• distractibility

• inability to follow conversations

list some perception key symptoms of delirium in the elderly

• hallucinations (seeing/hearing things that aren’t there)

• delusions

list some behavioral key symptoms of delirium in the elderly

• restlessness

• agitation

• sleep disturbances

• mood swings

list some speech key symptoms of delirium in the elderly

• rambling

• incoherent

• slurred speech

list some consciousness key symptoms of delirium in the elderly

• fluctuates - may be alert one moment, drowsy the next

list some psychomotor key symptoms of delirium in the elderly

• may be hyperactive (pacing) or hypoactive (quiet, withdrawn, slow to respond)

list some sleep-wake cycle of key symptoms of delirium in the elderly

• disturbed (awake at night, sleepy during day)

list some cause of delirium (especially in elderly)

uInfections (e.g., UTI, pneumonia)

uMedications (polypharmacy, opioids, anticholinergics)

uDehydration or malnutrition

uElectrolyte imbalances

uHospitalization or surgery

uPain or sensory deprivation (poor vision/hearing)

delirium is _____, _____, and usually _____ once the cause is treated

sudden, temporary, reversible

dementia is _____, _____-_____, and _____

chronic, slow-progressing, irreversible