Neurocognitive Disorders PDF

Neurocognitive Disorders Conceptual Introduction What is a neurocognitive disorder  Cognitive Domains https://thekey.ca/learning-center/normal- aging-vs-possible-demen...

Neurocognitive Disorders Conceptual Introduction What is a neurocognitive disorder  Cognitive Domains https://thekey.ca/learning-center/normal- aging-vs-possible-dementia Inflexibilities or Deficits in above cognitive domains inhibit a person’s ability to adapt and interact rationally with the environment. Integrated cognitive function is no longer intact and https://psychiatryeducationforum.com/neuroc thus functioning is like cheese with holes in them. ognitive-domains/ Cognition may fluctuate from day to day but longitudinally deteriorates in Major Neurocognitive Cognitive Deficits may be acute, chronic or acute Disorders and are acutely severely deranged in on chronic delirium Examples of Functions in Specific Brain Regions: Networks Neurocognitive Disorders Represent a dysfunction in systemized brain networks that control the integrated function of cognition; aspects of which is assessed by evaluating the cognitive domains. https://www.researchgate.net/profile/Emilia- Tarland/publication/330485391/figure/fig1/AS: 716495076208641@1547837146942/Brain- region-key-functions-and-their-implications-for- schizophrenia-adapted-from-Stahl.jpg At the synaptic level Delirium Part I Delirium (The Acute Syndrome) Risk factors for Delirium Predisposing factors Precipitating factors  Clouding of Consciousness represented by criterion A. The DSM V Criteria For Delirium Specifiers for Delirium Specifiers for Delirium Describing Activity Level Specify if: The activity level of the patient is not part Acute: Lasting a few hours or days. of the diagnostic criteria of delirium: the Persistent: lasting weeks or months key is the presence of criteria A firstly and then C in the setting of whatever activity level So which domains are problematic in delirium? The definitive treatment for delirium is treating the underlying cause and recognizing it as an encephalopathic syndrome secondary to a serious biological/medical/physiological insult to the homeostatic equilibrium of the patient Delirium is: 1. Acute in onset 2. Fluctuating in course (the patient will have times of clarity and relapse as part of the presentation) Parting Comments on Delirium: Principles of Treatment D Drugs I Infections M Metabolic T Trauma O Oxygen /Hypoxia P Psychological/Percept ual  Benzodiazepines Symptomatic Management preferable in withdrawal delirium by OH or benzo abusers Ictal and Post ictal delirium with concomitant antiepileptics  IV Other Management Guidelines 1. Nurse in a quiet, well-lit room if possible. 2. Ensure that the patient is safe and cannot wander or injure him- or herself. 3. Ensure constant nursing observation and frequent monitoring of vital functions. Avoid frequent changes of staff 4. Prominently display reminders of family, place, date and time. 5. Medication for behaviour control: only use medication if essential avoid combinations of drugs. Benzodiazepines: use short-acting (lorazepam or oxazepam), beware of over sedation and respiratory depression. Antipsychotics: use where psychotic symptoms are prominent or where benzodiazepines have failed to control symptoms (haloperidol, clothiapine, risperidone, olanzepine) Ensure that all medication is carefully charted 6. Delirium is a medical and, psychiatric emergency. The patient is entitled to frequent and regular monitoring by the doctor. Neurocognitive Disorders Part II Diagnostic Criteria Major NCD  Alzheimer’s Disease Frontotemporal Degeneration Lewy Body Dementia Vascular Disease Conceptual Explanation Traumatic Brain Injury Substance/medication use (esp inhalant users) HIV (HIV Associated NCD) Prion disease Parkinsons Huntington’s AMC Multiple Etiologies Specifiers: Unspecified With behavioral disturbance e.g. psychotic symptoms, mood symptoms, agitation, apathy others SEVERITY Without behavioral disturbance MILD: Difficulties with instrumental activities of daily living e.g. managing money housework MODERATE: Basic activities of daily living, dressing eating SEVERE : Fully dependent  Manifestations of NCD Behavior Thought content Emotions or Mood Aggression 20% Delusions 16-30% Depressive Symptoms Mania very Rare Wandering 19% Form of Thought Perceptions Over eating 10% Directly related to degree of Hallucinations illusions and atrophy and severity. perceptual disturbances are Perseveration stereotype common thoughts Mutism Cumbersome Thoughts Hyper orality 6% Orientation Sleep Urinary Incontinence 48% Disorientation due to memory Intermittent Insomnia impairment Sexual disinhibition 7% Libido Appetite 7% become disinhibited Changes  https://www.google.com/imgres?q=major%20neurocognitive%20disorder%20imaging&imgurl=https%3A%2F%2Fradiologyassi stant.nl%2Fimg%2Fcontainers%2Fmain%2Fdementia-role-of-mri%2Fa509797720938b_FDG- pet.jpg%2Ff4c8518ef9ff8dbe403e8c9b0b929cb7.jpg&imgrefurl=https%3A%2F%2Fradiologyassistant.nl%2Fneuroradiology%2 Fdementia%2Frole-of- mri&docid=luwSIUvfoflv6M&tbnid=u1yc3B47NygPkM&vet=12ahUKEwii08_jnOmKAxWtWEEAHeTnMNgQM3oECHkQAA..i&w= 640&h=541&hcb=2&ved=2ahUKEwii08_jnOmKAxWtWEEAHeTnMNgQM3oECHkQAA https://www.google.com/imgres?q=major%20neurocognitive%20disorder&imgurl=https%3A%2F%2F s3-us-west-2.amazonaws.com%2Fcourses-images%2Fwp- https://www.google.com/imgres?q=major%20neurocognitive%20disorder%20imaging&imgurl=https%3A%2F%2Fprod- content%2Fuploads%2Fsites%2F3707%2F2019%2F01%2F27012757%2F800px- images- Alzheimers_disease_brain_comparison.jpg&imgrefurl=https%3A%2F%2Fcourses.lumenlearning.com static.radiopaedia.org%2Fimages%2F4975521%2Fe7a536c7d9b07142bc48237931b1e2114441a81cbf400459fa9fb5968c29f5 %2Fwm-abnormalpsych%2Fchapter%2Fneurocognitive-disorder-due-to-alzheimers- 5c_big_gallery.jpeg&imgrefurl=https%3A%2F%2Fradiopaedia.org%2Farticles%2Fdementia&docid=Aygq0AwmV21zsM&tbnid disease%2F&docid=K_rArhy97F8atM&tbnid=j0RVOmSfF- =yxOnZe4D_5J85M&vet=12ahUKEwii08_jnOmKAxWtWEEAHeTnMNgQM3oECGwQAA..i&w=630&h=630&hcb=2&ved=2ahUK SoBM&vet=12ahUKEwjqxdGknOmKAxWtVUEAHXsmHcAQM3oECEoQAA..i&w=799&h=361&hcb=2 Ewii08_jnOmKAxWtWEEAHeTnMNgQM3oECGwQAA &ved=2ahUKEwjqxdGknOmKAxWtVUEAHXsmHcAQM3oECEoQAA Treatment Symptomatic Treatment Psychoeducation of Caregivers Bad Cop Decisions: Time to admit to care facility, revoke gun access and lisences, driving and access to vehicles Medical Treatment: