Neurocognitive Disorders

Definition: Neurocognitive disorders are characterized by impairment in cognitive functions such as thinking, reasoning, memory, learning, and speaking.
- This impairment represents a significant change from a previous level of functioning, where clinically significant deficits in cognition or memory exist.
Types of Neurocognitive Disorders:
- Mild Neurocognitive Disorder: Often called mild cognitive impairment.
- Major Neurocognitive Disorder: Previously classified as dementia in the DSM.
Important Note: The distinctions of primary and secondary neurocognitive disorders are not necessary for understanding basic concepts.

Common Impairments:
- Impairment in abstract thinking, judgment, and impulse control.
- Symptoms may progress to include irritability, mood swings, and sudden outbursts over trivial issues.
- Patients may experience difficulties with personal care, wandering, and an overall disturbance in the level of awareness.
Delirium
- Definition: A disturbance in cognition that develops rapidly, characterized by symptoms such as:
- Difficulty sustaining or shifting attention.
- Extreme distractibility.
- Disorganized thinking, incoherent speech, impaired reasoning ability.
- Disorientation to time and place, misperceptions of the environment, including delusions and hallucinations (e.g., patients may think they see people that aren't there).
- Autonomic manifestations such as tachycardia, sweating, facial flushing, dilated pupils, and elevated blood pressure.

Significance: Alzheimer's disease accounts for 50% to 80% of all neurocognitive disorder cases.
Stages:
- Progression from Stage 1 (no apparent symptoms) to Stage 7 (very severe cognitive decline).
- Onset is typically slow and insidious; often not noticed until later stages.
Progression: Generally progressive and deteriorating, meaning it will worsen over time.
Etiological Factors:
- Neurotransmitter alterations.
- Presence of plaques and tangles in the brain that cut off oxygen and disrupt brain function.
Symptoms of Alzheimer's:
- Cognitive decline keeps advancing.
- Potential for violence, verbal aggression, and lack of impulse control.

Vascular Neurocognitive Disease:
- Caused by significant cerebral vascular disease (hypertension, strokes).
- More abrupt onset and variability compared to Alzheimer's.
Neurocognitive Disorder Due to Traumatic Brain Injury (TBI)
- Amnesia is the most common symptom following head trauma.
- Repeated trauma can lead to dementia with symptoms like emotional lability and impulsivity.
Lewy Body Disease:
- Alters cognition similarly to Alzheimer's but progresses more rapidly, affecting up to 25% of neurocognitive cases.
- Characterized by the presence of Lewy bodies in the cerebral cortex and brainstem.
Neurocognitive Disorder Due to Parkinson's Disease:
- Resulting from loss of nerve cells in the substantia nigra and decreased dopamine activity.
HIV-Related Neurocognitive Disorder:
- Caused by brain infections from either opportunistic organisms or HIV-1 virus directly.
- Symptoms can range vastly from slight cognitive changes to severe impairment.
Substance-Induced Neurocognitive Disorder:
- Caused by substances including alcohol, inhalants, and medications, that produce cognitive impairment through abuse or interactions.

Brain tumors, anemia, pernicious anemia: Related to cognitive impairments.
Nutritional deficiencies: Such as thiamine deficiency affect cognitive function.
Infections: General central nervous system and systemic infections can lead to neurocognitive disorders.

Assessment:
- Conduct comprehensive patient history focusing on mood swings, personality and behavioral changes, emotional reactions, cognitive changes, and social behavior implications.
- Physical assessment should include a neurological exam to assess mental status, alertness, language skills, and sensory perception.
- Laboratory evaluations: check blood and urine to evaluate for infections, renal dysfunction, diabetes, electrolyte imbalances, and other disorders such as exposure to toxins.
Nursing Diagnoses:
- Risk for trauma; disturbed thought processes; impaired memory; disturbed sensory perception; risk for violence; self-care deficits; low self-esteem; grieving.

The goal is that the patient does not experience harm to self or others and maintains reality orientation to the best of their capability.
Patients should participate in daily living activities with assistance and be able to discuss positive aspects about themselves.

Education topics include the nature of the illness, potential causes, and what to expect from the progression of neurocognitive disorders.
- Treatment discussions should include medications like Aricept, which does not cure but slows down Alzheimer's progression.
Managing meals should focus on nutritional value despite reduced appetite.

Ensuring Safety:
- Always prioritize safety in care settings, particularly with patients exhibiting wandering or aggressive behaviors.
Maintaining reality orientation includes gently correcting patients when they express false realities (i.e., saying it’s a holiday when it’s not) and redirecting their attention to more current activities.
Support with Daily Living:
- Assistance with activities such as nutrition, hygiene, and self-care is crucial, as many patients may refuse basic self-care or have difficulty performing these tasks independently.

Medication management often includes the careful administration of antipsychotics for agitation and aggression.
- Common medications such as Aricept, Risperdal, Seroquel, and others are administered based on patient needs and behaviors.
With Anxiety and Sleep Disturbances:
- Medications for anxiety should be used cautiously and not regularly for long periods. Sleeping pills should be used sparingly due to addiction risks, especially in children and those with a history of substance use.
Complications associated with medications include anticholinergic side effects from tricyclic antidepressants and close monitoring for addiction potential with sleep medications.