neurocognitive disorders (329 E2)

Question 1

cognition

Answer 1

System of interrelated abilities such as perception, reasoning, judgment, intuition and memory. Allows one to be aware of oneself in relation to others

Question 2

memory

Answer 2

facet of cognition, retaining and recalling past experiences

Question 3

delirium

Answer 3

acute cognitive impairment with rapid onset caused by medical condition

Question 4

dementia

Answer 4

chronic cognitive impairment; differentiated by cause not symptoms

Question 5

sundowning

Answer 5

the tendency for an individual’s mood to deteriorate and agitation increase in the later part of the day, with the fading of light, or at night

Question 6

aphasia

Answer 6

loss of language ability

• expressive: cannot find the words to express ideas (broca’s area)
• receptive: cannot interpret what is said (wernicke’s)

Question 7

apraxia

Answer 7

loss of purposeful movement

Question 8

agnosia

Answer 8

loss of ability to recognize objects

Question 9

confabulation

Answer 9

unconscious creation of stories or answers in place of actual memories (maintains self esteem)

Question 10

preservation

Answer 10

persistent repetition of a work, phrase or gesture

Question 11

hyperorality

Answer 11

tendency to put everything in the mouth and to taste and chew

Question 12

clinical picture of delirium

Answer 12

• disturbance in attention and awareness
• acute onset, change from baseline, fluctuates with periods of lucidity over over of 24hrs a day
• there is a direct physiological cause

Question 13

w/ delirium, may experience

Answer 13

• memory deficit
• disorientation (usually still oriented to self)
• language changes (ex: pressured or mute)
• visuospatial ability
• delusions and hallucinations
• disturbances in sleep wake pattern

Question 14

delirium is considered

Answer 14

a medical emergency

Question 15

commonly identified causes of delirium

Answer 15

• meds
• infections
• fluid & electrolyte imbalances
• hypoxia/ischemia
• brain alterations: reduction in cerebral functioning or brain metabolism, increased plasma cortisol level, neurotransmitter imbalance, damage to enzyme systems, blood brain barrier or cell membranes, uti’s in elderly

Question 16

four cardinal features of delirium

Answer 16

1. acute onset and fluctuating course
2. reduced ability to direct, focus, shift and sustain attention
3. disorganized thinking
4. disturbance of consciousness

Question 17

illusions vs hallucinations in delirium

Answer 17

illusions can be explained and clarified to the individual, hallucinations cannot be

Question 18

physical needs of a pt w/ delirium

Answer 18

• trying to get out of bed
• fall risk
• thinks bugs and rats are in there bed
• pulling out IVs and catheters
• help w/ ADLs

Question 19

medication interventions for delirium

Answer 19

• very small doses of antipsychotics or benzos (lorazepam, watch for opposite action of agitation & use if their is hepatic dysfunction)
• mirtazapine for sleep
• pain control

Question 20

dementia diagnostic definition

Answer 20

degenerative, progressive neuropsychiatric disorder that results in cognitive impairment, emotional and behavioral changes, physical and functional decline and ultimately death

Question 21

neurocognitive disorders

Answer 21

• progressive deterioration of cognitive functioning and global impairment of intellect
• no change in consciousness
• the condition is acquired, not developmental
• difficulty w/ memory, problem solving and complex attention
• affects orientation, attention, memory, vocabulary, calculation ability, & abstract thinking

Question 22

neurocognitive disorders: mild

Answer 22

does not interfere w/ ADLs, does not necessarily progress

Question 23

neurocognitive disorders: major

Answer 23

interferes w/ daily functioning and independence

Question 24

Alzheimer’s Disease

Answer 24

• 60 to 80% of all dementias
• disturbances in executive functioning
• aphasia
• apraxia
• agnosia (loss of sensory ability to recognize objects or people)
• sundowning
• memory impairment (confabulation)
• perservation
• hyperorality

Question 25

Alzheimer's risk factors

Answer 25

- age and family hx - cardiovascular disease - social engagement and diet - head injury and traumatic brain injury - HTN and dyslipidemia

Question 26

Alzheimer's biological factors

Answer 26

- oxidative stress and free radicals - inflammation

Question 27

Alzheimer's hallmarks of dx

Answer 27

**tau proteins and beta amyloid plaques create neurofibrillary tangles** - amyloid plaques: sticky clumps between nerve cells - neurofibrillary tangles: abnormal collections of protein threads inside nerve cells - brain atrophy

Question 28

neurotransmitters implicated in Alzheimer's

Answer 28

- acetylcholine: involved w/ learning, memory and mood. As AD progresses the brain **produces less acetylcholine** (cholinesterase inhibitors keep the acetylcholinesterase enzyme from breaking down acetylcholine) - glutamate: involved w/ cell signaling, learning and memory **(in AD there is excess)**. NMDA antagonists help reduce excess calcium by blocking some NMDA receptors

Question 29

stages of Alzheimer's: mild

Answer 29

forgetfulness, misplace articles, decreased recall, social withdrawal, frustrated w/ self, changes may not be apparent to others

Question 30

stages of Alzheimer's: moderate

Answer 30

decreased for self care, disoriented to time & place, wandering, pacing, delusions or hallucinations, decreased visual perception, leading to accidents (needs supervision), emotional lability - big swings, sx noticeable

Question 31

stages of Alzheimer's: severe

Answer 31

cannot care for self, loss use of language; minimal long term memory, constant complete care

Question 32

dx test for Alzheimer's

Answer 32

- CT - PET - mental status questionnaires - complete physical & neurological exam - med & psych hx - review of sx

Question 33

Alzheimer's medication: acetylcholinesterase inhibitors

Answer 33

**first line** - galatamine (mild to mod AD) - donepezil and rivastigmine PO or transdermal (mild to mod)

Question 34

acetylcholinesterase inhibitors

Answer 34

- used to delay not decrease cognitive decline - stabilize memory, language and orientation - SE: N/v - peaks in 3 months but continues to delay decline

Question 35

Alzheimer's medication: NMDA antagonists

Answer 35

- memantine - modulation of NMDA receptor activity - restore the function of damaged nerve cells and reduce abnormal excitatory signals of the NT glutamate - mild side effects of dizziness, confusion, headaches and constipation

Question 36

medications for behavioral sx of Alzheimer's

Answer 36

**off label, not FDA approved for AD** - antipsychotics (may inc risk of mortality, use w/ extreme caution) - antidepressants - anti anxiety - anticonvulsants