NUR-3412 Mental Health Nursing: Neurocognitive Disorders

Major Domains of Cognitive Function

• Complex attention: difficulty in environments with multiple stimuli
• Executive function: inability to perform complex projects
• Learning and memory: repeats conversation, often within the same conversation
• Language: significant difficulties with expressive or receptive language
• Perceptual – Motor: significant difficulties with previously familiar activities
• Social cognition: changes in behavior, showing insensitivity to social standards

Delirium

• Acute cognitive disturbance, often reversible condition
• Characterized by a disturbance in attention and awareness and a change in cognition
• Develops rapidly over a short period
• Epidemiology: most common complication of hospitalization, especially in older patients
• Comorbidity: always due to underlying physiological causes
• Etiology: multifactorial, including systemic infections, metabolic disorders, comorbid medical conditions, and more

Delirium - DSM 5 Diagnostic Criteria

• Rapid and abrupt onset of impaired attention and lack of awareness of environment
• Change in at least one cognitive domain, including impairment in recent memory, disorientation to time and place, language, and perceptual disturbance
• Associated features: change in sleep-wake cycle, change in emotional states

Delirium - Management

• Treat underlying causes
• Provide a consistent physical environment, daily routine, and caregivers
• Use environmental cues to stimulate memory, reorient, and promote appropriate behavior
• Communicate with simple, direct, descriptive statements
• Use physical restraints, as needed

Neurocognitive Disorders (NCDs)

• Include both delirium and major and mild neurocognitive disorders
• Characterized by a clinically significant deficit in cognition or memory, representing a significant change from a previous level of functioning

Alzheimer's Disease

• Characterized by memory loss that disrupts daily life
• Signs and symptoms include:
  • Misplacing things and losing the ability to retrace steps
  • Challenges in planning or solving problems
  • Difficulty completing familiar tasks
  • Confusion with time or place
  • Trouble understanding visual images and spatial relationships
  • New problems with words in speaking or writing
  • Decreased or poor judgment
  • Withdrawal from work or social activities
• Etiology: unknown, but several hypotheses have been supported, including genetics, biological, brain changes, head injury, and Down's syndrome
• Pharmacological interventions: symptomatic treatments, including acetylcholinesterase inhibitors (e.g., Aricept, Cognex, Exelon, Razadyne)