Neurocognitive Disorders Assessment and Diagnosis

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Questions and Answers

What is a key feature of neurocognitive disorders (NCD)?

A significant improvement in cognitive function from a previous level

A permanent loss of cognitive function

A clinically significant deficit in cognition or memory (correct)

A sudden onset of cognitive decline

Which of the following is NOT a component of the 'MAPPT' assessment?

Memory

Problem solving

Activity of daily living

Emotional regulation (correct)

What is the purpose of a lumbar puncture in diagnosing NCD?

To examine CSF for infection or hemorrhage (correct)

To identify atrophy seen in AD

To reveal metabolic activity

To test for syphilis and HIV

What does a PET scan reveal in diagnosing NCD?

All of the above Signup and view all the answers

What is the recommended starting dose for Donepezil?

5 mg a day Signup and view all the answers

What is the mechanism of action of Cholinesterase Inhibitors?

Blocking the enzyme that degrades acetylcholine Signup and view all the answers

Why is Donepezil the treatment of choice for NCD?

It slows the progression of symptoms Signup and view all the answers

What is the purpose of a CT Scan or MRI in diagnosing NCD?

To identify atrophy seen in AD Signup and view all the answers

What is the purpose of increasing acetylcholine in the synaptic cleft?

To enhance cholinergic transmission Signup and view all the answers

What is the role of the NMDA receptor in learning and memory?

It is stimulated by glutamic acid Signup and view all the answers

Which medication is used to treat hallucinations and delusions in Parkinson's disease psychosis?

Pimavanserin Signup and view all the answers

What is the characteristic of delirium in terms of its development?

It develops rapidly over a short period of time Signup and view all the answers

What is the prevalence of delirium in the community?

1-2% Signup and view all the answers

What is the primary mechanism of action of memantine?

It blocks the excitotoxic effects of glutamate Signup and view all the answers

What is the Black Box warning associated with atypical antipsychotics in elderly patients with dementia?

Increased risk of death Signup and view all the answers

Which medication is an acetylcholinesterase inhibitor used to treat cognitive impairment?

All of the above Signup and view all the answers

Study Notes

Neurocognitive Disorders (NCD)

Clinically significant deficit in cognition or memory exists, representing a significant change from a previous level of functioning.
Involves "MAPPT": Memory, Activity of daily living, Problem solving, Processing, and Thinking.

Assessment and Diagnosis

Nursing Process Application (variable to help diagnose NCD-AD)
Blood/urine test, various infections, hepatic/renal dysfunctions, diabetes or hypoglycemia, electrolyte imbalances, metabolic and endocrine disorders, nutritional deficiencies, and presence of toxic substances.
RPR - Rapid plasma reagin to test for syphilis and HIV.
CT Scan/MRI to identify atrophy seen in AD.
Lumbar Puncture to examine CSF for infection or hemorrhage.
PET - Positron emission tomography to reveal metabolic activity and identify Amyloid-beta plaques, tau neurofibrillary tangles, and neuronal damage for AD.
Fluorodeoxyglucose (FDG) PET scans to show areas of brain where nutrients are poorly metabolized, indicating areas of degeneration.

Stages of Impairment

Documentation
Safety
Medications

Medical Treatment Modalities

Donepezil, Galantamine ER, Rivastigmine patch = First-line Therapy
Allow once a day dosing
Start with 5 mg a day → if tolerated after 4 weeks, increase to 10 mg or 23 mg/day
Donepezil may be better tolerated than other cholinesterase inhibitors
Donepezil is the treatment of choice to slow symptoms/progression
Cholinesterase inhibitors act by blocking the enzyme that degrades acetylcholine in the brain
Intended to diminish symptoms of dementia by improving function and slowing the progression of the disease

NMDA Receptor Antagonists

The NMDA receptor is linked to learning and memory and is stimulated by glutamic acid
Excessive stimulation of the NMDA receptor leads to excitotoxicity
Blocking of this receptor is thought to prevent cognitive damage in patients with VASCULAR DEMENTIA
Memantine blocks the excitotoxic effects associated with abnormal transmission of glutamate

Pharmaceutical Agents

Cognitive impairment: Physostigmine (Antilirium), Tacrine (Cogex), Donepezil (Aricept), Rivastigmine (Exelon), Galantamine (Razadyne), Memantine (Namenda)
Agitation, aggression, hallucinations, thought disturbances, and wandering: Risperidone (Risperdal), Olanzapine (Zyprexa), Quetiapine (Seroquel), Ziprasidone (Geodon), Pimavanserin (Nuplazid) for hallucinations and Delusions in Parkinson’s Disease Psychosis

Specific Disorders

Delirium

Change in mental status/cognition
Develops rapidly over a short period of time
Reversible when underlying cause is treated
Etiology: Intoxication/withdrawal, drugs inducing delirium, CNS Depressants, Stress, Sleep deprivation, Emotional disturbances, Medical
Prevalence: 1-2% prevalent in the community, increases by 14% among clients older than 85 years of age, 15-53% in post-op older adults, 60% in nursing home/post-acute settings, 83% in end of life setting

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Description

This quiz covers the assessment and diagnosis of neurocognitive disorders, including the signs and symptoms, and the various tests and examinations used to diagnose these conditions. It also explores the role of the nursing process in diagnosing neurocognitive disorders.