Neurocognitive Disorders

Unit Overview

  • This unit covers the following topics related to various disorders affecting cognitive and functional abilities:

    • Description and definition of different disorders

    • Etiology, incidence, and prevalence

    • Signs and symptoms

    • Diagnosis, course, and prognosis

    • Medical and surgical management

    • Impact on occupational performance

  • Focus areas include:

    • Progressive neurodegenerative disorders

    • Acquired brain injury

    • Spinal cord injury

    • Spina bifida

    • Major neurocognitive disorders, including dementia

Major Neurocognitive Disorders

  • Neurocognitive disorders are characterized by a decline in cognitive functioning.

  • Types of disorders can include:

    • Delirium

    • Alzheimer’s Dementia

    • Other forms of dementia

  • Importance of occupational therapy (OT) in enhancing the quality of life for patients and supporting their families.

Delirium

Definition

  • Delirium is defined as a disturbance in attention and awareness, accompanied by a fluctuating course of cognitive function.

Symptoms

  • Decreased ability to focus, sustain, or shift attention.

  • Development of perceptual disturbances.

  • Severity of symptoms fluctuates throughout the episode.

Etiology

  • Caused by various medical conditions (e.g., infections, metabolic imbalance) or substance intoxication/withdrawal.

Interventions

Medical

  • Treat underlying causes (e.g., infection).

Environmental

  • Create a safe and quiet environment.

  • Ensure frequent contact with family and loved ones.

Pharmacological

  • Adjust contributing medications; avoid sedatives when possible.

    • Use neuroleptic Haloperidol as required.

    • Prescribe antipsychotics carefully.

Health Management

  • Avoid restraints unless absolutely necessary.

  • Use simple and clear communication, with attempts to reorient patients.

  • Minimize extraneous stimulation to reduce confusion.

Precautions

  • Patients with hyperactive delirium presenting danger may not be suitable for active therapeutic interventions.

  • Increased risk of falls for those experiencing delirium.

Impact on Occupational Performance

  • Consider the challenges faced by individuals with neurocognitive disorders impacting their daily routines and skills.

Case Study: V.T.

Background

  • V.T. lives with her husband and their adult children nearby.

  • Household responsibilities managed, but familial support acknowledged.

Health Issues

  • After a hospitalization for pneumonia, V.T. exhibited delayed recovery characterized by confusion.

  • Evaluated for delirium and transitioned to specialized rehabilitation.

Symptoms Observed

  • Confusion and hallucinations regarding events and people.

  • Reports of seeing her deceased pet and misidentifying hospital staff.

  • Progress towards recovery observed, but initial impact on mental state was profound.

Rehabilitation Process

  • Includes occupational therapy, nursing support, and environmental modifications (e.g., removal of sliding shower doors, installation of safety equipment).

  • Gradual improvement in cognitive function observed over time.

Diagnosis, Signs, and Symptoms of Delirium (V.T. Example)

  • Initial confusion, hallucinations of non-present pets, recognized as symptoms of delirium.

  • Family dynamics adjusted to support communication during rehabilitation.

Major Neurocognitive Disorders

Types

  • Common types of major neurocognitive disorder include:

    • Alzheimer’s type dementia

    • Vascular dementia

    • Frontotemporal dementia

    • Lewy body dementia

    • Reversible neurocognitive disorders

Pathophysiology

  • Poorly understood etiology thought to be associated with neurotransmitter abnormalities, along with neurofibrillary tangles and beta-amyloid plaques.

  • These changes lead to brain structural shrinkage but do not directly cause cognitive disorders.

Early vs Late Onset

  • Early onset is defined as diagnosed before age 65; late onset is after age 65.

Course and Prognosis of Major Neurocognitive Disorders

Staging of Disease

  • Mild Stage (Lasts 2-3 years):

    • Increased time to perform familiar tasks; mistakes are common.

    • Difficulty following written directions; short-term memory impairment.

    • Procedural memory remains intact.

    • Signs of depression and delusions may appear.

  • Moderate Stage (Can last 2 to 10 years):

    • Severe impact on daily function, inability to problem-solve.

    • Increased disorientation and memory loss.

    • Loss of fluent language and awareness of social norms.

  • Severe Stage (Lasts 8 or more years):

    • Fully dependent; serious impairment in problem-solving.

    • Little recognition of family members; lack of affect in communication.

    • Increased risk of falls, and may become bedbound.

    • Hallucinations persist for varying durations.

Interventions for Major Neurocognitive Disorders

Medical Management

  • Address comorbidities like diabetes, depression, cardiovascular concerns.

Therapy & Support

  • Cognitive stimulation and the use of compensatory strategies like memory aids.

  • Education and support for caregivers to enhance home care.

Pharmacological Interventions

  • Cholinesterase inhibitors for memory improvements.

  • NMDA receptor antagonists for moderate to severe Alzheimer’s cases.

Health Management Strategies

  • Supervised medication management.

  • Consistent care routines to minimize patient confusion and anxiety.

  • Precautions to reduce fall risks, and ensure communication strategies are non-confrontational.

Prevalence of Major Neurocognitive Disorders

  • Approximately 2 million adults currently affected, with forecasts of increase in coming years.

  • Alzheimer’s disease remains the most common, impacting about 5 million people.