Podcast
Questions and Answers
Which of the following are potential symptoms observed in delirium? (Select all that apply)
Which of the following are potential symptoms observed in delirium? (Select all that apply)
- Enhanced reasoning and behavior
- Improved attention and focus
- Disorganized thinking and speech (correct)
- Sleep-wake cycle disruption (correct)
Which factors are known to affect the resolution of delirium? (Select all that apply)
Which factors are known to affect the resolution of delirium? (Select all that apply)
- The person's age (correct)
- Use of cholinesterase inhibitors
- The time of day the symptoms appear
- The duration of the delirium (correct)
Which of the following can act as predisposing factors for delirium? (Select all that apply)
Which of the following can act as predisposing factors for delirium? (Select all that apply)
- Substance use
- Serious medical, surgical, or neurological conditions (correct)
- Depression (correct)
- Advanced age (65 and older) (correct)
Which substances are examples of triggers for substance intoxication delirium? (Select all that apply)
Which substances are examples of triggers for substance intoxication delirium? (Select all that apply)
Which of the following medications are known to potentially cause delirium? (Select all that apply)
Which of the following medications are known to potentially cause delirium? (Select all that apply)
Which statements apply to delirium resulting from multiple combined factors? (Select all that apply)
Which statements apply to delirium resulting from multiple combined factors? (Select all that apply)
Classifying NCDs is based on what criteria? (Select all that apply)
Classifying NCDs is based on what criteria? (Select all that apply)
Which of the following is/are considered appropriate diagnostic criteria for NCD? (Select all that apply)
Which of the following is/are considered appropriate diagnostic criteria for NCD? (Select all that apply)
Which items describe cognitive and behavioral changes in NCD? (Select all that apply)
Which items describe cognitive and behavioral changes in NCD? (Select all that apply)
Which of the following accurately describes the characteristics of reversible NCD? (Select all that apply)
Which of the following accurately describes the characteristics of reversible NCD? (Select all that apply)
Which of the following symptoms may emerge in the later stages of NCD?
Which of the following symptoms may emerge in the later stages of NCD?
Which statements accurately describe Stage 2: MCI due to AD(Mild Cognitive Impairment)? (Select all that apply)
Which statements accurately describe Stage 2: MCI due to AD(Mild Cognitive Impairment)? (Select all that apply)
Which of the following are known to be categories of NCDs by Etiology? (Select all that apply)
Which of the following are known to be categories of NCDs by Etiology? (Select all that apply)
Which of the following statements are true regarding Microscopic Examination used as a tool to diagnose AD?
Which of the following statements are true regarding Microscopic Examination used as a tool to diagnose AD?
Which of the following statements accurately describe damage to the Frontal Lobe?
Which of the following statements accurately describe damage to the Frontal Lobe?
Which of the following describe Cholinesterase Inhibitors?
Which of the following describe Cholinesterase Inhibitors?
Which statements are true regarding the redefined criteria for Alzheimers Disease (AD) and related research?
Which statements are true regarding the redefined criteria for Alzheimers Disease (AD) and related research?
What is the effect of Late-Onset AD on neurotransmitters?
What is the effect of Late-Onset AD on neurotransmitters?
What is the importance of Interleukin-6 on AD?
What is the importance of Interleukin-6 on AD?
How can vascular NCD affect the blood flow?
How can vascular NCD affect the blood flow?
Which of the provided statements describe the DSM-5-TR diagnostic criteria for Neurocognitive Disorder Due to Traumatic Brain Injury:
Which of the provided statements describe the DSM-5-TR diagnostic criteria for Neurocognitive Disorder Due to Traumatic Brain Injury:
Which symptoms are common to Lewy body NCD?
Which symptoms are common to Lewy body NCD?
Which signs are symptomatic of Huntington's Disease (HD)?
Which signs are symptomatic of Huntington's Disease (HD)?
Which of the following are common diagnostic tests for prion disease? Select all that apply:
Which of the following are common diagnostic tests for prion disease? Select all that apply:
Which of the following medical conditions can lead to NCD? Select all that apply:
Which of the following medical conditions can lead to NCD? Select all that apply:
When assessing patients with delirium or NCD, which broad categories should the nurse focus on? Select all that apply:
When assessing patients with delirium or NCD, which broad categories should the nurse focus on? Select all that apply:
What are examples of biological factors that could lead to Delirium and/or Mild or Major Neurocognitive Disorder? Select all that apply:
What are examples of biological factors that could lead to Delirium and/or Mild or Major Neurocognitive Disorder? Select all that apply:
What is the purpose of lab tests when assessing for dementia? Pick all that apply:
What is the purpose of lab tests when assessing for dementia? Pick all that apply:
Which nursing diagnoses are key for patients with Neurocognitive Disorder? Select all that apply:
Which nursing diagnoses are key for patients with Neurocognitive Disorder? Select all that apply:
What reasons are known to cause wandering in wandering behavior? Select all that apply:
What reasons are known to cause wandering in wandering behavior? Select all that apply:
What interventions are appropriate for disoriented patients? Select all that apply:
What interventions are appropriate for disoriented patients? Select all that apply:
When working with a hallucinating person, which steps are key? Select all that apply:
When working with a hallucinating person, which steps are key? Select all that apply:
What steps can be taken to improve communication?
What steps can be taken to improve communication?
What can be done if a patient is experiencing a self-care deficit? Select all that apply:
What can be done if a patient is experiencing a self-care deficit? Select all that apply:
Which items are important to evaluate when assessing care of a patient? Select all that apply:
Which items are important to evaluate when assessing care of a patient? Select all that apply:
Which statements reflect facts about 'well-being and health for people with dementia' (WHELD)? Select all that apply:
Which statements reflect facts about 'well-being and health for people with dementia' (WHELD)? Select all that apply:
What should medical treament for Delirium focus on?
What should medical treament for Delirium focus on?
Which measures reflect Cognitive Imapirment in AD?
Which measures reflect Cognitive Imapirment in AD?
When anxiety occurs in the setting of NCDs, what should be considered? Select all that apply:
When anxiety occurs in the setting of NCDs, what should be considered? Select all that apply:
What treatments are appropriate for an NCD patient who is having sleep problems? Select all the apply:
What treatments are appropriate for an NCD patient who is having sleep problems? Select all the apply:
Which statements correctly emphasize the objectives of care pertaining to chronic, progressive disorders according to the text? Select all that apply.
Which statements correctly emphasize the objectives of care pertaining to chronic, progressive disorders according to the text? Select all that apply.
In Vascular Neurocognitive Disorder, emboli can obstruct blood vessels in the brain. Which of the following types of emboli are known to contribute to this condition? (Select all that apply)
In Vascular Neurocognitive Disorder, emboli can obstruct blood vessels in the brain. Which of the following types of emboli are known to contribute to this condition? (Select all that apply)
Damage to the parietal lobe due to Alzheimer's Disease can manifest in various impairments. Which of the following are recognized consequences of parietal lobe damage in this context? (Select all that apply)
Damage to the parietal lobe due to Alzheimer's Disease can manifest in various impairments. Which of the following are recognized consequences of parietal lobe damage in this context? (Select all that apply)
When diagnosing Vascular Neurocognitive Disorder (NCD), several diagnostic tests can be employed to identify contributing factors and brain changes. Which of the following tests are particularly useful in the diagnostic process for Vascular NCD? (Select all that apply)
When diagnosing Vascular Neurocognitive Disorder (NCD), several diagnostic tests can be employed to identify contributing factors and brain changes. Which of the following tests are particularly useful in the diagnostic process for Vascular NCD? (Select all that apply)
Nonpharmacologic treatments play a crucial role in managing cognitive impairment in Neurocognitive Disorder (NCD). Which of the following modalities are recognized as effective nonpharmacologic treatments for individuals with NCD? (Select all that apply)
Nonpharmacologic treatments play a crucial role in managing cognitive impairment in Neurocognitive Disorder (NCD). Which of the following modalities are recognized as effective nonpharmacologic treatments for individuals with NCD? (Select all that apply)
Care for patients with chronic, progressive neurocognitive disorders (NCDs) should be guided by specific objectives. Which of the following represent key objectives in the care of individuals with NCDs, focusing on maintaining their well-being and dignity? (Select all that apply)
Care for patients with chronic, progressive neurocognitive disorders (NCDs) should be guided by specific objectives. Which of the following represent key objectives in the care of individuals with NCDs, focusing on maintaining their well-being and dignity? (Select all that apply)
Flashcards
Select all that apply: What are Neurocognitive Disorders (NCDs)?
Select all that apply: What are Neurocognitive Disorders (NCDs)?
Conditions characterized by a significant decline in cognitive abilities like thinking, memory and reasoning, relative to a previous level of functioning.
Select all that apply: What is Delirium?
Select all that apply: What is Delirium?
A state of acute confusion and disorientation, characterized by a sudden disturbance in attention, awareness, and cognitive function.
Select all that apply: What is Major NCD?
Select all that apply: What is Major NCD?
Significant cognitive decline, previously referred to as dementia.
Select all that apply: What is Minor NCD?
Select all that apply: What is Minor NCD?
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Select all that apply: What are characteristics of Attention and Focus in delirium?
Select all that apply: What are characteristics of Attention and Focus in delirium?
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Select all that apply: What is Disorganized Thinking and Speech in delirium?
Select all that apply: What is Disorganized Thinking and Speech in delirium?
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Select all that apply: What is Impaired Reasoning and Behavior in delirium?
Select all that apply: What is Impaired Reasoning and Behavior in delirium?
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Select all that apply: What are characteristics of Disorientation and Memory in delirium?
Select all that apply: What are characteristics of Disorientation and Memory in delirium?
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Select all that apply: What are Perception Changes in delirium?
Select all that apply: What are Perception Changes in delirium?
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Select all that apply: What are Sleep Disturbances in delirium?
Select all that apply: What are Sleep Disturbances in delirium?
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Select all that apply: What are Psychomotor Changes in delirium?
Select all that apply: What are Psychomotor Changes in delirium?
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Select all that apply: What is Emotional Lability in delirium?
Select all that apply: What is Emotional Lability in delirium?
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Select all that apply: What are Autonomic Symptoms in delirium?
Select all that apply: What are Autonomic Symptoms in delirium?
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Select all that apply: What is Abrupt Onset in delirium?
Select all that apply: What is Abrupt Onset in delirium?
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Select all that apply: What is the Brief Duration of delirium?
Select all that apply: What is the Brief Duration of delirium?
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Select all that apply: What is Symptom Resolution in delirium?
Select all that apply: What is Symptom Resolution in delirium?
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Select all that apply: What is the High Mortality Rate associated with delirium?
Select all that apply: What is the High Mortality Rate associated with delirium?
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Select all that apply: What are Predisposing Factors for delirium?
Select all that apply: What are Predisposing Factors for delirium?
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Select all that apply: What are Precipitating Factors for delirium?
Select all that apply: What are Precipitating Factors for delirium?
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Select all that apply: What is Substance Intoxication Delirium?
Select all that apply: What is Substance Intoxication Delirium?
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Select all that apply: What is Substance Withdrawal Delirium?
Select all that apply: What is Substance Withdrawal Delirium?
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Select all that apply: What is Medication-Induced Delirium?
Select all that apply: What is Medication-Induced Delirium?
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Select all that apply: What is Polypharmacy related to delirium?
Select all that apply: What is Polypharmacy related to delirium?
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Select all that apply: What is an example of Delirium Due to Another Medical Condition or Multiple Etiologies?
Select all that apply: What is an example of Delirium Due to Another Medical Condition or Multiple Etiologies?
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Select all that apply: How are Neurocognitive Disorders (NCD) classified?
Select all that apply: How are Neurocognitive Disorders (NCD) classified?
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Select all that apply: What is Mild NCD?
Select all that apply: What is Mild NCD?
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Select all that apply: What is Major NCD?
Select all that apply: What is Major NCD?
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Select all that apply: Gradual Progression for dementia?
Select all that apply: Gradual Progression for dementia?
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Select all that apply: What is the Prevalence of Alzheimer's?
Select all that apply: What is the Prevalence of Alzheimer's?
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Select all that apply: What is Age-Related Increase in those with AD?
Select all that apply: What is Age-Related Increase in those with AD?
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Select all that apply: What is the General Explanation of Mild and Major Neurocognitive Disorders (NCDs)?
Select all that apply: What is the General Explanation of Mild and Major Neurocognitive Disorders (NCDs)?
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Select all that apply: What is Mild Neurocognitive Disorder?
Select all that apply: What is Mild Neurocognitive Disorder?
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Select all that apply: What does Without Behavioral Disturbance look like for Cognitive Decline?
Select all that apply: What does Without Behavioral Disturbance look like for Cognitive Decline?
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Select all that apply: What is Diagnostic Criteria for NCD?
Select all that apply: What is Diagnostic Criteria for NCD?
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Select all that apply: What is Impaired Thinking in Cognitive and Behavioral Changes in NCD?
Select all that apply: What is Impaired Thinking in Cognitive and Behavioral Changes in NCD?
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Select all that apply: What is Social Disregard in Cognitive and Behavioral Changes in NCD?
Select all that apply: What is Social Disregard in Cognitive and Behavioral Changes in NCD?
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Select all that apply: What is Language Difficulties in Cognitive and Behavioral Changes in NCD?
Select all that apply: What is Language Difficulties in Cognitive and Behavioral Changes in NCD?
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Select all that apply: What is Personality Changes in Cognitive and Behavioral Changes in NCD?
Select all that apply: What is Personality Changes in Cognitive and Behavioral Changes in NCD?
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Select all that apply: What is Reversible NCD?
Select all that apply: What is Reversible NCD?
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Select all that apply: What is Apraxia related to NCD?
Select all that apply: What is Apraxia related to NCD?
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Select all that apply: What are Emotional Changes in NCD?
Select all that apply: What are Emotional Changes in NCD?
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Select all that apply: What is Loss of Independence?
Select all that apply: What is Loss of Independence?
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Select all that apply: Characterization of Neurocognitive Disorder due to Alzheimer's Disease?
Select all that apply: Characterization of Neurocognitive Disorder due to Alzheimer's Disease?
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Select all that apply: What is the Gradual Onset and Progression in Alzheimer's?
Select all that apply: What is the Gradual Onset and Progression in Alzheimer's?
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Study Notes
Neurocognitive Disorders (NCDs)
- Conditions where individuals experience significant decline in cognitive abilities, such as thinking, memory, and reasoning
- Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) referred to them as "Dementia, Delirium, Amnestic, and Other Cognitive Disorders"
- The newer DSM-5-TR groups these conditions under "NCDs", which can be further classified
Types of NCDs
- Delirium: Acute confusion and disorientation
- Major NCD: Significant cognitive decline (previously referred to as dementia)
- Minor NCD: Mild cognitive decline, also called mild cognitive impairment (MCI)
- NCDs are specified further based on the underlying cause, like Alzheimer's disease or Parkinson's disease
Clinical Findings and Course of Delirium
- Characterized by a sudden disturbance in attention, awareness, and cognitive function
- Struggle to maintain and shift their focus, are easily distracted, and need constant reminders to pay attention
- Thinking becomes disorganized, leading to rambling, irrelevant, pressured, and incoherent speech
- Reasoning skills and goal-oriented behavior are diminished
- Disorientation to time and place is typical, and recent memory is often impaired
- Misperceptions of the environment include illusions (distorted perceptions) or hallucinations (false perceptions)
- The sleep-wake cycle is disrupted
- The level of awareness can vary from hypervigilance (excessive alertness) to stupor or semi-coma
- Sleep patterns fluctuate between excessive sleepiness (hypersomnolence) and insomnia including vivid dreams and nightmares
- Psychomotor changes fluctuate from agitation with purposeless movements (like restlessness or hyperactivity) to a vegetative state resembling catatonic stupor.
- Tremors are frequently observed
- Rapid shifts in emotions include fear, anxiety, depression, irritability, anger, euphoria, or apathy.
- Emotions manifest as crying, calls for help, cursing, moaning, self-destructive acts, attempts to flee, or aggression toward others who are perceived as threatening
- Autonomic nervous system changes occur, such as rapid heart rate (tachycardia), sweating, flushed face, dilated pupils, and elevated blood pressure
Onset, Duration, and Resolution of Delirium
- Abrupt Onset: Symptoms typically start suddenly, after a head injury or seizure
- Prodromal Symptoms: Delirium may be preceded by hours or days of prodromal symptoms like restlessness, difficulty thinking clearly, insomnia, excessive sleepiness, and nightmares
- Slower Onset: More likely when the underlying cause is a systemic illness or metabolic imbalance
- Brief Duration: Usually brief, lasting about a week and rarely more than a month
- Symptom Resolution: After addressing the underlying cause, symptoms typically subside within 3 to 7 days, and can take up to 2 weeks
- Resolution is affected by a person's age and the duration of the delirium
- Delirium is associated with a high mortality rate due to the severity of the underlying medical conditions that cause it.
- Delirium can transition into a more permanent neurocognitive disorder (NCD)
Predisposing and Precipitating Factors for Delirium
- Predisposing factors are conditions that make individuals susceptible to developing delirium like serious medical, surgical, or neurological conditions, older adults (age 65 and older), and depression, falls, and elder abuse
- Precipitating factors are triggers that directly lead to an episode of delirium in vulnerable individuals
- Systemic infections, febrile illness or hyperthermia (high fever), Metabolic disorders, hypoxia (low oxygen levels) and chronic obstructive pulmonary disease (COPD), hepatic (liver) failure or renal (kidney) failure, head trauma, seizures, migraine headaches, brain abscess or brain neoplasms (tumors), stroke, nutritional deficiency, uncontrolled pain, burns, heat stroke, orthopedic and cardiac surgeries, social isolation, emotional stress, physical restraints, and admission to an intensive care unit cause an episode
Substance-Related Delirium
- Substance Intoxication Delirium: Caused by the toxic effects of substances like alcohol, amphetamines, cannabis, cocaine, hallucinogens, inhalants, opioids, phencyclidine, and sedatives, hypnotics, or anxiolytics
- Substance Withdrawal Delirium: Occurs when someone abruptly stops using certain substances they have used for a prolonged period like alcohol, opioids, and sedatives, hypnotics, or anxiolytics
Medication-Induced Delirium
- Certain medications can trigger delirium as a side effect
- Common medications: anticholinergics, antihypertensives, corticosteroids, anticonvulsants, cardiac glycosides, analgesics, anesthetics, antineoplastic agents, and antiparkinson drugs H2-receptor antagonists (e.g., cimetidine)
Polypharmacy
- Taking multiple medications at the same time increases the risk of developing delirium
Delirium Due to Another Medical Condition or Multiple Etiologies
- Caused by an underlying medical condition or a combination of factors
- Urinary tract infections (UTIs) have a strong link to delirium, especially in older adults(65+)
- Increased levels of interleukin-6 (a marker of inflammation) might contribute to delirium
- Delirium can often result from multiple combined factors rather than a single cause.
Neurocognitive Disorder (NCD)
- Classified based on the DSM-5-TR, according to symptom severity
- Mild NCD: Referred to as mild cognitive impairment (MCI), with early intervention being key
- Major NCD: Encompasses what was previously known as dementia in the DSM-IV-TR
- Diagnoses (mild and major NCD) represent different stages of the same condition and can be reversible depending on symptom presentation
Dementia Defined
- Also known as major neurocognitive disorder
- A broad term describing a decline in cognitive functions like memory, thinking, and decision-making that is severe enough to interfere with social, behavioral, occupational, and emotional functioning
- Many different diseases can lead to dementia
Gradual Progression
- Unlike delirium, which has a rapid onset, dementia develops gradually over time
Reversibility
- In some instances, dementia can be reversible, depending on the underlying cause
Alzheimer's Disease (AD)
- Approximately 6.5 million people in the United States have AD
- AD is the most prevalent form of neurocognitive disorder (NCD)
- Incidence increases with age
- 5% of individuals between 65 and 74 years old
- 13.1% of individuals between 75 and 84 years old
- 33.2% of individuals 85 years and older
- The majority (80%) of those with AD are over 75,
- Growing older is the biggest risk factor for AD
- Almost two-thirds of Americans with AD are women
- There is a disproportionately higher prevalence in Black/African American and Hispanic/Latino people than among non-Hispanic White people
- The number of people aged 65 and older with Alzheimer's dementia is projected to reach 12.7 million by 2050
- The increase in AD incidence is due to the growing population of older adults rather than an epidemic
- After being diagnosed, people typically live for 4 to 8 years, spending most of that time in the most severe stage of the disease
- Some individuals may live as long as 20 years
- Recent studies suggest that dementia, including newly developing AD cases, has been declining in the United States due to improved treatment and awareness of risk factors for heart disease and stroke
Mild & Major Neurocognitive Disorders (NCDs)
- NCDs are characterized by a decline in cognitive functions
- They are classified based on the degree to which these deficits affect a person's ability to function in daily life
- The cognitive decline is determined from a prior level of cognitive ability in one or more cognitive areas Like complex attention, executive function, learning and memory, language, perceptual-motor, and social cognition
- Mild Neurocognitive Disorder shows a modest cognitive decline from a previous level of performance
- Cognitive deficits do not interfere with independence in everyday activities, although greater effort, compensatory strategies, or accommodation may be required
- Etiologies (possible causes) for both Mild and Major NCDs include substance/medication use, HIV infection, Prion disease, Parkinson's disease, Huntington's disease, another medical condition, multiple etiologies, and unknown etiology
Specifying Behavioral Disturbances in NCD
- Classify NCDs based on the presence or absence of accompanying behavioral disturbances:
- Without Behavioral Disturbance: The cognitive decline occurs without any significant behavioral or psychological symptoms
- With Behavioral Disturbance: The cognitive decline is accompanied by clinically significant behavioral or psychological symptoms (psychotic symptoms, mood disturbances, agitation, apathy, aggression, disinhibition, disruptive behaviors/vocalizations, and sleep or appetite/eating disturbance)
- Diagnostic Criteria, irrespective of behavioral disturbances, include key criterion for NCD diagnosis that is evidence of significant cognitive decline from a previous level of performance:
- Concern from the individual, a knowledgeable informant, or a clinician that there has been a significant decline in cognitive function.
Cognitive and Behavioral Changes in NCD
- Impaired Thinking: Abstract thinking, judgment, and impulse control are impaired
- Social Disregard: Individuals may disregard social norms, exhibiting uninhibited or inappropriate behavior
- Neglect of Hygiene: Personal appearance and hygiene are often neglected
- Language Difficulties: Language can be affected, with difficulty naming objects or vague/imprecise speech
- In severe cases, aphasia (inability to speak) may occur, and individuals struggle to communicate their needs to caregivers
- Personality Changes: Personality changes are common, either as an alteration or exaggeration of previous traits
Reversibility and Progression of NCD
- Reversible NCD: True reversibility is rare and may be more accurately described as temporary
- Reversible causes include brain tumors, subdural hematomas, medication reactions, normal pressure hydrocephalus, vitamin deficiencies (B1, B6, B12), poisoning, anoxia, CNS infections, immune disorders, thyroid disorders, sodium/calcium imbalances, and metabolic disorders (hypoglycemia)
- Irreversible NCD: In most cases, NCD is progressive and irreversible
Later-Stage Symptoms and Complications of NCD
- Apraxia: The inability to perform purposeful motor acts despite intact motor function
- Emotional Changes: Irritability, moodiness, and sudden outbursts can occur
- Loss of Independence: The ability to work or manage personal care independently diminishes (Supervision is required due to impaired judgment and increased risk of accidents)
- Wandering: Wandering away from home or care settings becomes a concern
- Advanced Dementia: Advanced stages include profound memory deficits, minimal verbal communication, loss of ambulatory ability, inability to perform activities of daily living (ADLs), and incontinence
- Common complications: Common clinical complications include eating problems and infections
Causes and Stages of Alzheimer's Disease (AD)
- Causes of NCD: While several factors can cause Neurocognitive Disorder (NCD), Alzheimer's Disease (AD) is the most common, accounting for 60-80% of all cases -Progresses via Five Stages:
- Preclinical AD
-
No noticeable symptoms or decline in memory -
Brain changes detectable through Positron Emission Tomography (PET) scans, showing abnormal levels of beta-amyloid and reduced glucose metabolism -
Cerebrospinal Fluid (CSF) analysis detects abnormal levels of beta-amyloid and changes in tau protein
- MCI due to AD (Mild Cognitive Impairment)
-
Subtle symptoms may be memory loss with language and thinking problems -
Symptoms may not interfere with everyday activities -
The brain can no longer compensate for neuron damage caused by AD -
Some may revert to normal cognition, while others progress to dementia -
Show progressive symptoms combined with biomarker evidence of Alzheimer's related brain changes,and multiple symptoms typically change over time
- Mild Dementia due to AD
-
Individuals can function independently in many areas, but need assistance with more complex tasks -
Individuals may deny problems and cover up memory loss by creating imaginary events to fill in memory gaps (confabulation) -
Depression and social withdrawal are common
- Moderate Dementia due to AD
-
This stage is often the longest -
Symptoms interfere with completing activities of daily living (ADLs), such as bathing and dressing -
Other symptoms include increasing confusion, personality and behavioral changes (agitation and suspiciousness), difficulty recognizing loved ones, and sometimes incontinence -
Symptoms often worsen in the late afternoon and evening, known as "sundowning"
- Severe Dementia due to AD
-
Symptoms interfere with most everyday activities -
Loss of interest in food, lack of awareness of mealtimes, and inability to remember having eaten, requiring assistance with adequate nutrition -
Inability to recognize family members and loved ones -
Likely to require 24-hour care -
Other symptoms include greatly diminished ability to communicate, difficulty moving (bed-bound), and difficulty swallowing -
Increased risk of bedsores (decubiti), contractures, blood clots, aspiration pneumonia, infections, sepsis, and death
Etiology of NCDs
- NCDs are categorized and distinguished based on their underlying cause, despite having some common symptoms
- AD (Alzheimer's Disease)
- Frontotemporal degeneration
- Lewy body disease
- Vascular disease
- Traumatic brain injury
- Substance/medication use
- HIV infection
- Prion disease
- PD (Parkinson's disease)
- Huntington's disease
- Another medical condition
- Multiple etiologies
- Unspecified (cause is unknown)
NCD due to Alzheimer's Disease
-
Characterized by NCD Symptoms of Alzheimer's Disease (AD)
-
Symptoms associated with either mild or major Neurocognitive Disorder (NCD), progressing through the five stages previously outlined
-
Gradual Onset and Progression with a gradual and subtle onset, and the disease typically progresses in a deteriorating manner, with memory impairment being a key characteristic
-
Diagnostic Tools that refine diagnostic criteria and tools to identify AD with greater accuracy
Scans
- CT and MRI Scans that reveal degenerative changes in the brain (atrophy or shrinkage), widened cortical sulci, and enlarged cerebral ventricles
- Microscopic Examination also reveals neurofibrillary tangles and senile plaques, which are dramatically more numerous and concentrated in the hippocampus/cerebral cortex in individuals with AD
Role of MARK4
- Recent research suggests that a mutation in microtubule affinity regulating kinase (MARK4), an enzyme involves cell functions and contributes to the accumulation and toxicity of tau proteins, which leads to neurodegeneration and the development of AD
- The development and progression of AD likely involve multiple contributing factors, as well as the role of neurotransmitters:
- Acetylcholine: A decrease in acetylcholine, a neurotransmitter, is linked to the development of Alzheimer's disease.
- Cholinergic neurons originate in the brainstem and basal forebrain and project to areas including the basal ganglia, thalamus, limbic structures, hippocampus, and cerebral cortex
- Serotonin: Cell bodies for serotonin pathways are in the raphe nuclei of the brainstem
- Norepinephrine: Norepinephrine pathways originate in the locus coeruleus project throughout the forebrain, prefrontal cortex, cerebellum, and limbic system
- Dopamine: Dopamine pathways originate in the midbrain and project to the frontal cortex, limbic system, basal ganglia, and thalamus. Dopamine neurons in the hypothalamus innervate the posterior pituitary
- Glutamate: Glutamate, an excitatory neurotransmitter, has descending pathways with high concentrations in the cerebral cortex.
- Damage to each area of the brain includes:
- Frontal Lobe: Impaired reasoning ability, inability to solve problems and perform familiar tasks, poor judgment, inability to evaluate appropriate behavior, and aggressiveness
- Parietal Lobe: Impaired orientation ability, and impaired visuospatial skills
- Occipital Lobe: Impaired language interpretation, and inability to recognize familiar objects
- Temporal Lobe: Inability to recall words, inability to use words correctly and delusions and hallucinations may occur in later stages
- Hippocampus: Impaired memory (with short-term memory affected first), with the individual unable to form new memories
- Amygdala: Impaired emotions, leading to depression, anxiety, fear, personality changes, apathy, and paranoia
- Neurotransmitters: Alterations in neurotransmitters (acetylcholine, dopamine, norepinephrine, and serotonin) can contribute to restlessness, sleep impairment, mood changes, and agitation. -Treatments used to Alzheimer's Disease and their effects on the brain includes:
Cholinesterase Inhibitors
- Donepezil, rivastigmine, and galantamine
- Mechanism: Inhibit the action of acetylcholinesterase, increasing acetylcholine levels in the brain
Common Side Effects
- Dizziness, gastrointestinal upset, fatigue, and headache
- NMDA Receptor Antagonists like memantine block NMDA receptors from excessive stimulation by glutamate, this helps prevent continuous influx of calcium into nerve cells, slowing down neuronal degradation and causing possible side effects like dizziness, headache, and constipation
Human Monoclonal Antibody Therapy
- Aducanumab Preferentially binds to aggregated amyloid-beta, reducing amyloid plaques in the brain and slowing the progression of Alzheimer's disease
- Redefinition of AD (2018) by shift the focus from cognitive symptoms to the presence of specific biomarkers, like Amyloid-beta plaques,Tau neurofibrillary tangles, Neuronal damage
Impacts of Redefinition
- Improve the clarity of research and clinical drug trials in the short term
- Change the overall way AD is understood and treated in the long term
- Factors that contribute to AD and can cause it include:Inflammation, Interleukin-6 and AD, Genetic and Current Research Focus such as the APOE gene
Blood Test for Early Detection
- Schindler et al.,(2019) suggest that a blood test measuring amyloid levels, when combined with age and APOE epsilon 4 gene variant. Can accurately identify individuals with early brain changes indicative of AD.
- Studies that there brain changes with the APOE4 gene and studies the ketones bodies for brain
- Vascular causes and Vascular Neurocognitive cause is significant damage to vascular problems in the brain with Location of Damage,Prevalence, Onset and Progression,Mechanism, Signs and Symptoms
Interrupted Blood Flow
- Vascular NCD is directly caused by an interruption of blood flow to the brain which leads to nerve cells death
Conditions that Effect Circulation
- High Blood Pressure, Emboli, Silent Strokes and Strategic Infract, Mixed Disorder;An individual can have both vascular NCD and Alzheimer's Disease (AD) simultaneously and Frontotemporal Neurocognitive disorder comes from shrinking (atrophy) of the frontal and temporal anterior lobes of the brain and is cause by: Genetic
- Two Main Symptom Patterns: Behavioual (impulsive) changes and Speech and language problems: , Spatial skills and memory typically remain intact or Preserved skills.
Neurocognitive Disorder Due to Traumatic Brain Injury
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DSM-5-TR Diagnostic Criterias: according to DSM-5-TR standards diagnosis requires the evidence of the following:
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Neurological signs (e.g., neuroimaging demonstrating injury; visual field cuts, anosmia, hemiparesis, hemisensory loss; cortical blindness; aphasia, apraxia; weakness; loss of balance; other sensory loss that cannot be accounted for by peripheral or other causes)|20]
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Amnesia is usually the first symptom
Neurocognitive Disorders due to Dementia of Lewy bodies
- Clinical Similarity to AD: Clinical shared but progress faster with halucinations and Parkinsons likle systems
Medications can not be used to treat Dementia:
- Neurocognitive Disorder Due to Parkinson's Disease (PD) which the damage can be from the lack of dopamine from the brain
- HIV-Associated NCD infection of HIV-1 can turn into a cognitive or motor complex and a Less Severe Forms of minor motors skills can occur
Substance/Medication-Induced Neurocognitive Disorder
- Can be caused by the reaction, abuse, ore the use of substances Symptoms: align by a major NCD but last during the acutal withdrawl It can be due to Huntington Diseaser (HD) where the is damage is usually thestriatum
Neurocognitive Disorder Due to Prion Diseases
- Caused by infectious agents called prions
- diagnostic tests should be performed the symtpoms usually starts at around age 40
- Medical issues can be the main contribution factor
Various Medical Condition and NCDs
- NCDs can be caused by various conditions such as the Endocrine disorders, Systemic lupus erythematosus, Multiple sclerosis, and assessment of the patient
Assess patients with Delirium or Neurocognitive Disorder (NCD)
- Nursing assessment is based on understanding the symptoms Patients History is taken and Physical assessments are the main tool for assess and physical and neurological exams used Tests given to assess the patient includes : Psychological exam and the purpose of the Lab test
Diagnostic Assessments
- Diagnostic tests are: RPR and HIV Testing, CT Scanningm MRI, CT and MRI Usefulness is also important
Diagnostic scans
- Lumbar Puncture, PET Scan, FDG-PET Scans, Blood Test for Ab Plaques, mRNA Analysis
Nursing Diagnosis for NCD
- Based on the data collected
- NANDA-I used often used for diagnosing Outcomes should assess if hte patient has not experiencd harmful events against themselves and other and be able to communicate with caregivers
Nursing Goals
- Safety and immediate needs
- Risk for Physical Trauma as it is essential to prevent bad environments from occurring
- Goals and interventions must be tailored and set
The goals for Nonpharmacoligc are
- Problems for caregivers
- Reasons for Wandering and Disrupting of the sleep cylce
Common NCD Interventions
- Disturbed Thought and Process from environmental misunderstandings
- Distrubed Sensory from mist understanding of actions Intervention-Maintain reality orientation within ability to ensure safety
General Reminders and Assessement
- Consistency with caregivers and patient is important
- Medication Assessment is extremely important
- Provide reassurance that the patient understands to promote safety
Goals for cognitive impairment
- Make sure patients are cared for
- Use short term and long terms interventions to improve communication
Use calm and soft approch and be direct in care
- Encourage independence as much as one can within reason and provide support
Implement caregiver education for the caregiver and ensure they have the resouces for education
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Understand quality and safety through QSEN and WHELD
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Treating Delirum can be done by assessing the causes Some doctors choose to avoid medications if can as medications side effects affects the brain a lot
Drugs/Treatments can consist of
- Benzodiazepines, Melatonin(over the counter)
How to Treat NCDs
- Focus of finding the reason for the disease
- General supportive care as well
Approved Medications:
Cholinesterase Inhibitors (donepezil, rivastigmine, galantamine which are helpful to low to moderate levels
- Memantine the receptor that aids to not allow glutamate to cause stress Anticholinergic: side effects include confusion , blurry vision , dry mouth and constipation
What else is FDA approved in NCD treatment
- Alzheimer's vaccine research and treatments for mental illnesses with NCDs
- Historical treatments versus the first treatment
- Treatment of Agitations :FDA BlackBox Warnings.
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WHELD programs -
Depression treatments:
Cognitive Therapy:
Help to help the brain with the illness
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