Chapter 17: Neurocognitive Disorders Disorders characterized by the disruption of thinking, memory, processing and problem-solving Types of Cognitive Disorders Delirium Mild Neurocognitive disorder (NCD) and Major NCD o NCD due to Alzheimer’s Alzheimer’s is neurodegenerative; results in the gradual impairment of cognitive function; most common type of major NCD o NCD due to Parkinson’s o NCD due to Huntington’s Learn to distinguish between a cognitive disorder and other mental health disorders (depression can mimic early alzheimer’s) Assessment Risk Factors: o For delirium: neurological (Parkinson’s, Huntington’s), Metabolic (hepatic/renal failure, F&E imbalances, nutritional deficiency), Cardiovascular and respiratory disease, infections (HIV/AIDS), surgery and substance use/withdrawal Prevent/ manage delirium by: minimize risk factors and promote early detection o For NCD and Alzheimer’s: advanced age, prior head trauma, lifestyle factors, and family hx Expected Findings: Delirium NCD Onset Rapid over a short period of time (hours to days) Gradual deterioration (months to years) Manifestations Impairment in memory, judgement, ability to focus, and ability to calculate that can fluctuate throughout the day (disorientation/ confusion often worse at night and early morning) LOC usually altered and can rapidly fluctuate 4 Types: Hyperactive w/ agitation & restlessness Hypoactive w/ apathy & quietness Mixed, having a combo of hyper and hypo manifestations Unclassified Impairment in memory, judgement, speech , ability to recognize familiar objects , executive functioning (managing daily tasks), and movement. DOES NOT fluctuate throughout the day LOC usually unchanged Restlessness and agitation are common (may have sundowning) Gradual personality change v/s stable (unless another illness is present)
Restlessness, anxiety, motor agitation, and fluctuating moods; rapid personality changes Perceptual disturbances can be present (hallucinations and illusions) Change in reality causes: fear, panic and anger May cause unstable v/s Medical emergency Cause Common in hospitalized older adults Secondary to another condition (infection, malnutrition, depression, electrolyte imbalance, substance use Not r/t another mental health disorder Advanced age biggest risk factor (other causes: genetics, lifestyle, metabolic syndrome, DM) Subtypes: Alzheimer’s Traumatic brain injury Parkinson’s Disorders affecting neurological system Outcome Reversible with prompt dx and tx Irreversible/ progressive STAGES OF ALZHEIMER’S Mild (stage 1): memory lapse, misplacing items, trouble concentrating/organizing, unable to remember material just read, CAN STILL PREFORM ADLS**, short term memory loss usually only noticed by close relations Moderate (stage 2): forgets one’s own hx, trouble with planning and organizing (forgets to pay bills, cannot manage money), trouble with mental math, personality/behavioral changes (withdrawn, subdued, compulsive, repetitive actions), changes in sleep,
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- Selective serotonin reuptake inhibitor, Major depressive disorder, Antidepressant, Tricyclic antidepressant, W/, Caution w/