2. NEUROCOGNITIVE DISORDERS DEFINED
deficits in a person’s thought processes or
memory that are due to brain dysfunction
represent a significant decline from the previous
level of functioning

3. TYPES OF NEUROCOGNITIVE DISORDERS
Dementia (discussed in detail later)
Delirium
 is the most common cognitive disorder, and also the least debilitating
 Unlike dementia, originates outside the central nervous system and symptoms
fluctuate and are short-term
Amnestic disorders
 feature impairments of memory that do not include any other type of cognitive
impairment
 relatively uncommon
 associated with the effects of substance abuse and medical conditions.
 Transient forms from epilepsy, side effects of electro-convulsive therapy and
some medications, thiamin deficiency, and hypoxia (temporary oxygen loss)
Permanent amnesia
 may result from head trauma, carbon monoxide poisoning, cerebral infarction,
hemorrhage and brain swelling related to herpes simplex

4. SYMPTOMS OF DEMENTIA
Memory impairment is always required to
make a diagnosis of dementia.
Aphasia - loss of the ability to use words
Apraxia - loss of the ability to use common
objects correctly
Agnosia - loss of the ability to understand
sound and visual input
Loss of executive functioning - an inability to
plan, organize, follow sequences, and think
abstractly.
http://www.youtube.com/watch?v=imQvmxx_
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5. PREVALENCE
rare among children and adolescents but can occur at any age as the result
of certain medical conditions
1.4% to 1.6% for persons aged 65-69 years, rising to 16% to 25% for
persons over 85
Average age of diagnosis – 80

6. VASCULAR DEMENTIA
a progressive, irreversible cognitive
disorder caused by blocked blood
vessels to the brain due to cerebral
infarction or hemorrhage
accounts for 10 to 15% of all types of
dementia
Depression is a relatively frequent
complication of VaD, more so than with
Alzheimer’s disease (27% of people
with VaD experience major depression)

7. Alzheimer’s disease
50-60% of those with dementia
Autopsies show that brain cells in the cortex and
hippocampus, areas that are responsible for learning,
reasoning, and memory, have become clogged with two
abnormal structures:
 Neurofibrillary tangles - twisted masses of protein fibers inside cells or
neurons
 plaques - deposits of a sticky protein called amyloid that is surrounded
by debris from deteriorating neurons
duration of its course is unpredictable, although 5-10 years
most common
Unknown cause and no cure, although meds may slow
course

8. Behavioral problems – reason
people seek tx
Perceptual disturbances including delusions,
hallucinations, and the misidentification of people
Mood disturbances
Wandering and other dangerous or careless behavior
Agitation or rage
Sleep disturbances
Distressing repetitive behavior
Inappropriate sexual behavior
Incontinence
Refusal to eat

9. COMORBIDITY
40–50% of persons with dementia experience symptoms of anxiety and
depression
10–20% have a major depressive disorder
30–40% have delusions (often persecutory)
20–30% experience hallucinations (primarily with Alzheimer’s)

10. DIAGNOSIS
Medical diagnosis
Not positively identified by medical examination and tests, ruled “in” if
other possible conditions can’t account for the symptoms

11. quality of person’s life
determined by:
quality of health care
family support provided him or her

12. CHALLENGES TO FAMILIES
1/3 live in nursing homes
monitor the client’s changing levels of dependence
and independence as the disease progresses.
He or she must care for the loved one, preserve the
client’s dignity, and balance his or her own limits
on time, energy, and patience.
The stress to family member caretakers may be
heightened by their fears of loss, guilt over not
being an adequate caregiver, ambivalence about the
caregiver role, and fears about their own mortality.

13. MEDICATION
cholinesterase inhibitors, which work by inhibiting the
breakdown of a key brain chemical, acetylcholine
Tacrine (Cognex), 1st drug approved by the FDA, but
intolerable side effects
The FDA has approved three other drugs since 1994
that are intended to have a mild to moderate effect
on its presentation
donepezil, rivastigmine (Exelon), and galantamine
(Reminyl)
may improve cognitive function and global level of
functioning in mild to moderate Alzheimer’s disease

14. OTHER MEDICATIONS
may be effective for treating the symptoms of psychosis, agitation, and
depression
Lower doses for the elderly because of slower metabolism and rates of
clearance through the kidneys

15. PRACTICE GUIDELINES
Establish and maintain an alliance with the client and family
Arrange and participate in a diagnostic evaluation, and link the client with
resources for any needed medical care.
Assess and monitor the client’s noncognitive (emotional and behavioral) mental
status.
Monitor provisions for the client’s safety and intervene when appropriate
Intervene to decrease the hazards of the client’s wandering behavior (if
applicable).
Advise the client and family concerning driving and other client activities that
put people at risk.
Educate the client and family about the illness and available interventions
Advise the family regarding sources of care and support
 Psychoeducation
 Respite care
Assess and refer the family for assistance with any related financial and legal
issues.

16. PSYCHOSOCIAL INTERVENTIONS
behavioral management
staff training on behavioral management
cognitive stimulation
reminiscence therapy
Creative arts therapies
Recreational therapies