Neurocognitive Disorders Overview

Neurocognitive Disorders

• Delirium is a disturbance in attention with abrupt onset, characterized by disorganized thinking, disorientation, anxiety and agitation, poor recall, delusions and hallucinations.
• Delirium is multifactorial with physiological causes like cognitive impairment, immobilization, psychoactive medications, dehydration, infection, sleep deprivation, and visual and perceptual disturbances
• Assessment should include Cognitive assessment sheet, identification of illusions (errors in perception) and hallucinations (false sensory stimuli)
• Do not assume confusion is dementia in the older patient.
• Major Neurocognitive disorders involve a progressive deterioration of cognitive function and global impairment of intellect (dementia) with no change in consciousness.
• Difficulties involve memory, problem solving, complex attention
• Mild does not interfere with ADLs and does not necessarily progress, while Major interferes with daily functioning and independence
• Major Neurocognitive Disorders include Alzheimer's disease, Frontotemporal lobar degeneration, Lewy body disease, Parkinson's disease, Traumatic brain injury, and Cerebrovascular disease.

Alzheimer's Disease

• It is important to distinguish normal forgetfulness from memory deficits in dementia.
• Memory loss in dementia interferes with ADLs.
• Alzheimer's disease progression is categorized as mild, moderate, and severe.
• Symptoms include memory impairment, disturbances in executive functioning, aphasia, apraxia, agnosia, and amnesia.
• It is the most common type of dementia; with late onset and females are affected more.
• Modifiable risk factors include diet, cardiovascular health, head injury, social engagement, and exercise.

Nursing Process: Alzheimer's Disease

• Confabulation or the creation of stories in place of missing memories.
• Perseveration or the repetition of phrases or gestures long after the stimulus is gone.
• Agraphia or diminished ability to read or write.
• Hyperorality or the tendency to put everything in the mouth.
• Sundowning or sundown syndrome; the tendency of mood to drop and agitation to rise as the light of day leaves.
• Assess memory impairment.
• Assess disturbances in executive functioning: problem solving, planning, abstract thinking.
• Assess diminished emotional affect.
• Agnostic testing includes MSE, neuro exam, medication review, and nutrition assessment.

Treatment Modalities: Alzheimer's Disease

• Pharmacotherapy: Medications for cognitive symptoms include cholinesterase inhibitors (Donepezil, Rivastigmine, Galantamine) and NMDA receptor antagonist (Memantine).
• Pharmacotherapy: Medications for behavioral symptoms; none are approved, antipsychotics are used off-label with extreme caution.
• Integrative Therapy: Omega-3 fatty acids and diet.

Chapter 30: Dying, Death and Grieving

• Kubler-Ross Stages of Grieving: Denial and isolation, Anger, Bargaining, Depression, and Acceptance.
• Practice the art of presence with open-ended questions.
• Anticipatory Grief: Future loss is mourned in advance, adjusting life to accommodate the time left and forseeing how the future will be.
• Anger is a common component of anticipatory grief.

Palliative Care for Patients with Dementia

• Anticipate needs.
• Encourage meaningful connections between the patient and loved ones.
• Identify patient goals for care.
• Educate family to minimize aggression during care.
• Manage pain and depression.
• Developmental tasks of dying help people identify what they want to accomplish before death.

Grief

• Grief is the reaction to loss.
• Bereavement is the period after grieving a death.
• Mourning are the things people do to cope with grief.
• Grief vs. Major Depressive Disorder:
  • Grief: feelings of emptiness and loss, intense sadness and anger that occurs in waves and gradually subsides, self-esteem intact, reorganization tasks may impact sense of self but thoughts of death may focus on someday reuniting with the deceased.
  • Major Depressive Disorder: Feelings of depressed mood, self-esteem involves worthlessness and self-loathing, thoughts of death are focused on ending the pain, may develop a plan for death.

Types of Grieving and Associated Nursing Care

• Complicated Grief: Painful experience after loss that can lead to impairment of relationships and occupational performance.
  • Nursing Care: Nursing diagnosis of risk for dysfunctional grieving, respond to grieving, assist with daily functioning.
• Disenfranchised Grief: Grief experience not congruent with socially recognized relationship.
  • Nursing Care: Combine support and guidance with individual consideration, virtual support, and psychotherapy.
• Grief Caused by Public Tragedy
  • Nursing Care: Acknowledge and validate the grief experienced, encourage self-care activities.

Chapter 31: Older Adults: Mental Health and Aging

• Late-life mental disorders: Major depressive disorder and anxiety disorder.
• Suicide: Suicide is a concern with those experiencing mental illness and older adults.

This quiz covers key concepts related to neurocognitive disorders, including delirium and major neurocognitive disorders like dementia. It highlights symptoms, assessments, and the importance of distinguishing between confusion and dementia in older patients. Test your understanding of these critical cognitive health issues.