Notes on Neurocognitive Disorders

Neurocognitive Disorders

Definition of Key Terms

  • Cognition: The mental process of thinking.

  • Orientation: The awareness of the situation regarding:

    • Person: Awareness of one's identity.

    • Place: Awareness of one’s surroundings.

    • Time: Awareness of the current date and time.

    • Situation: Awareness of the current circumstances or context.

  • Degree of Wakefulness: Refers to states of consciousness including:

    • Consciousness: Fully awake and engaged.

    • Awake and Alert: Fully aware of surroundings and attentive.

    • Lethargic: A state of sluggishness or fatigue.

    • Comatose: Unresponsive and unable to awaken.

Delirium

  • Definition: A change in condition that occurs over a short period of time.

  • Key Characteristics:

    • The patient is easily distracted.

    • Disorientation is common.

    • Almost always results from an identifiable cause.

  • Identification of Delirium:

    • History Taking:

    • Obtain a detailed history from the patient or caregivers, including:

      • Medical conditions.

      • Medications currently used.

    • Lab and Diagnostic Tests:

    • Tests like White Blood Cell (WBC) count and urinalysis may be used to confirm diagnosis.

    • Priorities in Management:

    • Consider patient safety.

    • Focus on reversing the underlying cause of delirium.

Dementia

  • Definition: A progressive cognitive impairment that results in changes in various functions:

    • Changes in language abilities.

    • Deterioration in motor functions.

    • Impaired recognition capabilities.

  • Progression of Dementia:

    • Mild Stage: Forgetfulness, where memory lapses start to occur.

    • Moderate Stage: Increased confusion and difficulties in communication.

    • Severe Stage: Major personality shifts and emotional changes occur; patients will need assistance with daily activities.

  • Initial Treatment Considerations:

    • Rule out depression as it may present with similar symptoms.

Types of Dementia:

  • Alzheimer’s Disease:

    • Accounts for 50-75% of dementia cases.

  • Vascular Dementia:

    • Accounts for 20-30% of dementia cases.

  • Lewy Body Dementia:

    • Accounts for 10-25% of dementia cases.

  • Frontotemporal Dementia:

    • Accounts for 10-15% of dementia cases.

Cognitive Impairments Related to Dementia

  • Confabulation:

    • The act of making up answers to questions as a way to cover memory deficits.

  • Poor Judgement:

    • May cause patients to underestimate risks and inaccurately evaluate their abilities, leading to significant safety concerns.