Cognitive Disorders Chapter 15

Defined as when a human being can no longer understand facts or connect the appropriate feelings to events, they have trouble responding to complexity of life challenges 3 main types: delirium, dementia and amnesia  Delirium and dementia most frequently seen by health care workers Cognitive disorders

Delirium  A disturbance of consciousness and change in cognition such as impaired attention span and disturbances of consciousness over short period of time that fluctuate by minute, hour or time of day  Always secondary to another condition (med, drugs, toxic)  If not treated can induce permanent damage to neurons Types of cognitive disorders

Dementia  Usually more insidious onset than delirium  Global deterioration of cognitive functioning (memory, judgment, ability to perform abstract thinking, and orientation)  Is often progressive and irreversible, depending on underlying cause  May be primary (Alzheimer Disease, vascular dementia, Pick’s Disease, Lewy body disease). These are irreversible Types of cognitive disorders

Disorders of memory

Amnesic Disorder  Loss of both short term memory (including the ability to learn info) and long term memory, sufficient to cause some impairment in the persons functioning  Always secondary to underlying cause Types of cognitive disorders

Alzheimer Disease  No single cause identified, most likely genetic and nongenetic factors  Age: doubles every 5 yrs >65 yrs  Genetic: early onset familial: inherited ages  Accounts for 70%-80% of all cases of dementia Theory

Stage 1: Mild  Loss of intellectual ability is insidious  Loss of energy, drive, initiative & has difficulty learning new things  Personality & social behavior intact  Depression may be present Stages of Alzheimer disease

Stage 2: Moderate  Deterioration becomes evident  Cannot remember address or date  Memory gaps in patient history  Hygiene & dress inappropriate  Mood labile with bursts of paranoia, anger, jealousy & apathy Stages of Alzheimer disease

Moderate to Severe  Unable to identify familiar objects or people  Needs repeated instructions to perform simple tasks  May wander  May pose danger to self and others  Incontinent  Sleep and is dependent on others for care  Institutionalization may be necessary Stages of Alzheimer disease

Late  Agraphia: inability to read or write  Hyperorality (the need to taste or chew)  Hypermetamorphosis: must touch everything  Ability to talk and walk is lost  Stupor, coma and death Stages of Alzheimer disease

Cholinesterase inhibitors  Approved by FDA & have positive effects on cognition, behavior and function Razadyne Exelon Aricept Antagonist NMDA-glutamatergic ion channel making acetylcholine more readily available  Namenda Medications

Goals  Increase communication, safety and self-care  Minimize confusion  Family teaching and support is crucial Nursing intervention

Assessment Diagnosis Outcomes Identification Planning Implementation Evaluation Application of nursing process