Neurocognitive Disorders & Geropsych Neurocognitive Disorders & Geropsych Chapters 22 & 34

Cognition What is cognition? Humans can:  Learn from experience  Remember what is learned  Modify behavior in response

Memory  a key cognitive ability  The ability to recall or reproduce what has been learned or experienced. To exercise judgment, make decisions, or be oriented to time and place, a person must remember past experiences.

Assessment—Delirium Sudden decline from a previous level of functioning. Medical emergency!!!!  Reversible if treated quickly  25% of patients do NOT survive Results in disturbances of:  Consciousness  Attention  Cognition  Perception  Motor Ability

Diagnostic Criteria—Delirium Key Diagnostic Criterion  Impaired Consciousness  Develops during a short period of time  Caused by general medical condition OR Substance-induced (intoxication or withdrawal) Associated Cognitive Changes  Problems in… Memory Orientation Language Attention Perception

Risk Factors of Delirium  Pre-existing cognitive impairment  Severe Illness  Advanced age—Elderly  Male gender  Alcohol Abuse  Lower levels of Education Attainment  Fracture  Depression  Impaired Vision

Etiology-Delirium  Postoperative states  Drug intoxications and withdrawals  Infections  Metabolic Disorders  Medications  Neurological Diseases  Tumors  Psychosocial stressors

Nursing Interventions-Delirium Elimination/Correction of Underlying Cause Symptomatic/Supportive Measures  Adequate rest  Comfort  Maintenance of fluid and electrolyte imbalance  Protection from injury Hallucinations/Disorientation  Promote relaxation  Gentle reorientation  Safety  Resolve underlying stressor  Reassurance

Nursing Diagnoses for Delirium

Evaluation & Treatment Outcomes-- Delirium Primary Goal  Prevention  Treatment of Cause Safety—prevent injury Family education  Understanding of diagnosis

Now classified in DSM-5 as Major Neurocognitive Disorder

Assessment-Dementia Gradual loss of intellectual abilities Continual, irreversible decline Types:  Alzheimer’s accounts for 50-60% of ALL dementias AKA Primary Dementia Vascular dementias, d/t Parkinson’s disease, d/t AIDS, Substance-Induced, etc.

Alzheimer Disease Type of Dementia Degenerative, Progressive Neuropsychiatric Disorder Primarily disorder of the older adult Two subtypes  Early onset 65 yrs and younger  Late-onset Older than 65 yrs old

Diagnostic Criteria—Alzheimers Signs & Symptoms  Cardinal symptoms: Amnesia/Memory Impairment Aphasia Apraxia Agnosia Disturbance of executive functioning Autopsy  Abnormal degenerative structures  Neuritic plaques  Neurofibrillary tangles

Epidemiology and Risk Factors--AD Epidemiology Estimated 5.1 million Americans had AD in 2007 In US, higher incidence in African Americans and Latinos 5 th leading cause of death among older adults in US Risk Factors First-degree biologic relatives of individuals with early onset AD Low educational level Prior head injury

Etiology—AD Genetic Factors Beta-amyloid Plaques/Senile plaques Neurofibrillary tangles Cell Death and Neurotransmitters  Deficits in Acetylcholine Granulovascular degeneration

Nursing Diagnoses associated with AD

Nursing Interventions-Dementia Help patient maintain optimum level of functioning Individualized nursing care is probably most important for those who will be institutionalized for a long time. Promote social interaction Promote independence and decision-making

Nursing Interventions-Dementia (cont’d) Disorientation  Clocks, calendars, familiar things, nightlights, labels and signs, newspapers (be careful w/TV)  Reality orientation – in group, gentle reminders Communication  Kindness, empathy  Yes/No questions, one-step sentences  Encourage reminiscence  Nonverbal communication

Nursing Interventions-Dementia (cont’d) Wandering-results in safety concerns, institutionalization  Locked units, “Alzheimer’s units”, “safe” gardens Decreasing agitation  Offer choices  Distraction  Eliminate power struggles, allow time to process requests

Nursing Interventions-Dementia (cont’d) Pharmacological  Cholinestrase inhibitors Glantamine (Razadyne) Rivastigmine (Exelon) Donepezil (Aricept)  N-methyl-D aspartate Memantine (Namenda)  Atypical antipsychotics *Start Low and GO Slow!!!

Nursing Interventions-Dementia (cont’d) Family/Caregiver Issues  Listen! Validate feelings  Support positive coping methods  Promote realistic expectations  Refer to support groups  Refer to adult daycare programs  Refer to the Alzheimer’s Association

Patient/Family/Caregiver Issues Coping  Remaining active, involved interpersonally, intellectually stimulated  Influenced by past experience and personality  Caregivers needs are tremendous  Grieving process for patient and caregiver

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