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Neurocognitive Disorders

Learning Competencies

  • Differentiate delirium from dementia.
  • Explain the biologic and functional changes associated with neurocognitive disorders.
  • Describe pharmaceutical interventions for patients with neurocognitive disorders.
  • Relate nursing interventions for the care of patients whose disturbed thoughts are expressed behaviorally.
  • Describe nursing interventions for the family of a patient experiencing disturbed thoughts.
  • Identify changes in neurological function associated with aging and their impact on neurological assessment findings.

Assessment of Cognitive Perceptual Pattern

  • The nurse must assess cognitive functional abilities:
    • Quality of Thought Process
    • Language: Content of speech
    • Present or Absence of Perceptual Disturbance: Assess for hallucinations, illusions, depersonalization, derealization.
    • Sensorium and Cognitive Ability
    • Impulse Control

Neurocognitive Disorders

  • Neurocognitive: A term used to describe cognitive functions closely linked to particular areas of the brain involved in thinking, reasoning, memory, learning, and speaking.
  • Neurocognitive Disorder (NCD): Impairment in cognitive functions of thinking, reasoning, memory, learning, and speaking.

Types of Neurocognitive Disorders

  • Mild NCD: Also known as mild cognitive impairment (MCI).
  • Major NCD: Constitutes what was previously known as dementia in the DSM.
  • Classification:
    • Primary/Secondary Neurocognitive Disorders.
    • Reversible NCDs.
    • Delirium.

Neurocognitive Disorders (formerly Dementia)

  • Dementia: A symptom of a cognitive disorder rather than a disorder itself.
  • Clinically significant deficits in cognition or memory with a loss of previous levels of cognitive, executive, and memory function, occurring in a state of full alertness.
  • Diagnostic Criteria:
    • Any syndrome manifesting in three main symptom sets:
    • Debilitating cognitive decline.
    • Decreased independence in activities of daily living (ADLs).
    • Behavioral changes.

Risk Factors for Neurocognitive Disorders

  • General Risk Factors:
    • Age.
    • Head trauma.
    • Cardiovascular disease.
    • Lifestyle factors.
    • Genetics.
  • Delirium-Specific Risk Factors:
    • Physiological changes associated with age.
    • Polypharmacy.
    • ICU admission/Change in environment.

Diagnostic Procedures

  • No specific lab or diagnostic testing exists for diagnosing NCD.
  • Tests are performed primarily to rule out other pathologies:
    • Mini-Mental Exam
    • Geriatric Depression Screening
    • Cognitive Performance Scale

Neuroanatomy Related to Neurocognitive Disorders

  • Dura Mater - Protective outer layer of the brain.
  • Cerebrospinal Fluid - Cushions the brain, removing waste and providing nutrients.
  • Brain regions:
    • Frontal Lobe: Movement, intelligence, reasoning, behavior, memory, personality.
    • Temporal Lobe: Speech, behavior, memory, hearing, emotions.
    • Parietal Lobe: Intelligence, reasoning, language, sensation, reading, telling right from left.
    • Occipital Lobe: Visual processing.
    • Cerebellum: Balance, coordination, fine muscle control.
    • Brain Stem: Controls breathing, blood pressure, heartbeat, and swallowing.

Types of Dementia

  • Neurocognitive Disorders resulting from various causes:
    • Alzheimer’s Disease.
    • Lewy Body Dementia.
    • Parkinson’s Disease.
    • Vascular dementia.
    • Substance or Medication-Induced NCD.
    • Frontotemporal NCD.
    • Post-Traumatic NCD (TBI/Prion/Huntington’s Disease/HIV).
    • NCD of Unknown Etiology.

Stages of Dementia (7 Stages)

  1. No Cognitive Decline: No noticeable symptoms.
  2. Very Mild Cognitive Decline: Subtle memory lapses, generally not detected.
  3. Mild Cognitive Decline: Increased forgetfulness, slight concentration issues.
  4. Moderate Cognitive Decline: Clear-cut memory loss, difficulty with complex tasks.
  5. Moderately Severe Cognitive Decline: Assistance with daily activities often needed.
  6. Severe Cognitive Decline: Significant memory issues, personality changes.
  7. Very Severe Cognitive Decline: Loss of verbal abilities, total dependence on caregivers.

Nursing Diagnoses for Patients with Neurocognitive Disorders

  • Caregiver role strain.
  • Chronic confusion.
  • Compromised family coping.
  • Disturbed sleep pattern.
  • Fear.
  • Grieving.
  • Impaired memory.
  • Impaired socialization.
  • Impaired verbal communication.
  • Ineffective role performance.
  • Risks:
    • Risk for caregiver role strain.
    • Risk for deficient fluid volume.
    • Risk for imbalanced nutrition.
    • Risk for trauma.
    • Self-care deficit (specific).
    • Sleep deprivation.

Pharmacologic Interventions for Neurocognitive Disorders

  • Acetylcholinesterase Enzyme Inhibitors: Slow degradation of acetylcholine, therefore enhancing availability (e.g., donepezil, rivastigmine, galantamine).
  • NMDA Receptor Antagonists: Blocks glutamate (e.g., memantine).
  • Antipsychotic Agents: Used to calm agitation (e.g., haloperidol, risperidone, olanzapine, brexpiprazole).
  • Anxiolytics: To ease anxiety (e.g., lorazepam, buspirone, alprazolam).
  • Antidepressants: For mood disturbances (e.g., citalopram, fluoxetine, sertraline; avoid tricyclic antidepressants).

Non-Pharmacologic Interventions

  • Nursing care to prevent wandering or dangerous behaviors.
  • Ensuring the patient consumes adequate food and fluids.
  • Monitoring restroom use to maintain cleanliness and hygiene.

Client/Family Education

  • Assist and educate prospective caregivers about appropriate client care:
    • Nature of the illness.
    • Possible causes.
    • What to expect (symptoms, management).
    • Support services and collaborative care