EXAM 3 - Neurocognitive Disorders Flashcards
Neurocognitive Disorders
Affect learning, memory, and consciousness
Most develop later in life
Types of neurocognitive disorders
Delirium
Major or mild neurocognitive disorder
Amnestic
Delirium
– temporary confusion and disorientation
Major or mild neurocognitive disorder
– broad cognitive deterioration affecting multiple domains
Amnestic
Amnestic – refers to problems with memory that may occur in neurocognitive disorders
delirium
Central features – impaired consciousness and cognition
Develops rapidly over several hours or days
Appear confused, disoriented, and inattentive
Marked memory and language deficits
DSM5 criteria for Delirium
A. Disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment).
Patient will be able to see and acknowledge you however they will not be able to sustain the attention
B. The disturbance develops over a short period of time (usually hours to a few days), represents an acute change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day.
Patient will have an abrupt change in cognition from baseline and symptoms will be fluctuating. Patient will go in and out of a state of confusion. Sundowning.
C. An additional disturbance in cognition (e.g. memory deficit, disorientation, language, visuospatial ability, or perception).
Patient has difficulty with attention and is accompanied by an additional disturbance in cognition.
Very Low Mini Mental Score
D. The disturbances in Criteria A and C are not better explained by a pre-existing, established or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal such as coma.
Not a progression of a pre-existing dementia (dementia predisposes) , remember acute.
Patient has to be able to respond to verbal stimulation.
E. There is evidence from the history, physical examination or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal (i.e. due to a drug of abuse or to a medication), or exposure to a toxin, or is due to multiple etiologies.
There is always a medical reason for delirium, trick is to find it.
Delirium Facts and statistics
Affects up 20% of adults in acute care facilities (e.g., ER)
More prevalent in certain populations, including:
Older adults
Those undergoing medical procedures
AIDS patients and cancer patients
Full recovery often occurs within several weeks
Medical Conditions Related to Delirium
Medical conditions
Dementia (50% of cases involve temporary delirium)
Drug intoxication, poisons, withdrawal from drugs
Infections
Head injury and several forms of brain trauma
Sleep deprivation, immobility, and excessive stress
Delirium Treatment
Attention to precipitating medical problems
Psychosocial interventions
Reassurance/comfort, coping strategies, inclusion of patients in treatment decisions
Delirium Prevention
Address proper medical care for illnesses, proper use and adherence to therapeutic drugs
Nature of dementia
Gradual deterioration of brain functioning
Deterioration in judgment and memory
Deterioration in language / advanced cognitive processes
Has many causes and may be irreversible
Individual is able to function independently with some accommodations (e.g., reminders/lists)
DSM5 criteria for MAJOR dementia
pic - NOT POSSIBLE TO LIVE INDEPENDENTLY
DSM5 criteria for MILD dementia
pic - POSSIBLE TO LIVE INDEPENDENTLY
DSM-5 Types of Major and Mild Neurocognitive Disorder
Due to Alzheimers Disease Frontotemporal Vascular With Lewy bodies Due to traumatic brain injury Substance/medication induced Due to HIV infection Due to prion disease Due to Parkinson’s Disease Due to Huntington’s disease Due to another medical condition Due to multiple etiologies Unspecified
