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Mental Health Disorders
Cognitive disorders
16
Nursing
Undergraduate 3
06/11/2013

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Cards

Term
Topic 1: Cognitive Disorders

Causes of Delirium?
Definition
- Central Nervous Disease (encephalitis, epilepsy, neoplasms)
- Drugs and poisons (intoxication or withdrawal)
- Neurological Disease
- Endocrine Dysfunction
- Metabolic Disorders
- Electrolyte Imbalance
- Infections
- Post op states
- Psychosocial stressors
Term
Topic 1: Cognitive Disorders

Assx of a pt with a cognitive disorder?
Definition
- The Folstein Mini-Mental Status Exam (MMSE)
- Psychogeriatric Assessment scales
- Mental Status Examination (MSE)
- Clifton Assessmen Procedures for the Elderly (CAPE)
- Suicide and Self-harm Risk Assessment
- Physical Assessment
Term
Topic 1: Cognitive Disorders

Diagnostic considerations used by doctors to rule out causes of DEMENTIA?
Definition
D - Drug Interaction?
E - Emotional disturbance/crises/loss?
M - Metabolic/Endocrine problems (diabetes/thyroid?)
E - Eyes and ears?
N - Nutritional Deficiencies (?Vit b12)
T - Tumor/Trauma?
I - Infection/brain abscess?
A - Arteriosclerosis?
Term
Topic 1: Cognitive Disorders

Cognitive Disorders involve impairment to...
Definition
- Reasoning
- Judgement
- Perception
- Attention
- Comprehension
- Memory
- *sometimes* Language
Term
Topic 1: Cognitive Disorders

What is delirium?
Definition
An acute and reversible condition secondary to an underlying disorder that causes temporary, diffuse disturbances of brain functions.
Term
Topic 1: Cognitive Disorders

What are the main features of Delirium?
Definition
- Sudden Onset
- Brief and fluctuation course
- Reversible when cause is eliminated
- Syndrome, not a disease
Term
Topic 1: Cognitive Disorders

Characteristic CMs of Delirium?
Definition
- Disturbance of consciousness (dec. awareness, shift in attention span, focus, confusion**)
- Cognitive Changes (memory deficit, disorientation, language distubance)
- Psychotic sympx (visual hallucinations and paranoid delusions)
- Abnormalities in motor activity
- Emotional changes (fear)
- Agnosia (naming objects), Dysgraphia (writing)
- Sundowning
Term
Topic 1: Cognitive Disorders

Treatment for Delirium?
Definition
*Treat underlying cause*
- If untreated - perm. brain injury may ensue
- Support and needs:
- physical, sensory and environmental
- reality orientation
- lower anxiety
- use of simple concrete phrases
Term
Topic 1: Cognitive Disorders

What is Dementia?
Definition
A progressive cognitive disorder associated with the deposition of beta-amyloid protein in and around nerve cells of the brain.
Term
Topic 1: Cognitive Disorders

Characteristic CMs of Dementia?
Definition
Alzheimer's Disease:
- Memory loss (ST)
- Language Imp (3 A's)
- Decline in fine motor skills
- Disorientation
- Loss of recognition skills
- Onset b/w 40-90yrs
- 10% experience epileptic seizures in later stages
Term
Topic 1: Cognitive Disorders

Comparison:
Delirium:
- Sudden onset, within days
- No sleep disturbance
- Cognitive awareness and alertness fluctuates, worse at night (sundowning)
- ACS
- Visual hallucinations
Definition
Topic 1: Cognitive Disorders

Comparison:
Dementia:
- Slow, insidious onset
- sleep disturbance present
- no changes to alertness
- no ACS
- Rarely hallucinations
Term
Topic 1: Cognitive Disorders

Distinguish between primary and secondary Dementia.
Definition
Primary: not reversible, is progressive and is not secondary to any other disorder.

Secondary: as a result of some other pathological process. Treatable if underlying cause is able to be eliminated.
Term
Topic 1: Cognitive Disorders

Name the reversible and potentially treatable dementia causes.
Definition
Reversible:
- Delirium
- Secondary dementia
Term
Topic 1: Cognitive Disorders

Irreversible cognitive disorders:
Definition
- Alzheimer's Disease
- Vascular Dementia (multi-infarct dementia -silent strokes)
- Mixed Alzheimer's and vascular
- Parkinson's disease
- Pick's disease
- Creutfeldt-Jakob disease
- AIDs, Down Syndrome
Term
Topic 1: Cognitive Disorders

Management of dementia pts:
Definition
- SAFETY: Maintain a safe, therapeutic environment.
- Identify Medical needs of the pt
- Provide supportive psychological care
- Maintain ADL's and status of functioning (independence)
- Educate the pt, family and carers on disease process
- Maintain consistency in daily care
Term
Topic 1: Cognitive Disorders

Pharmacotherpy for Dementia:
Definition
- Benzodiazepines: insomnia/anxiety
- Antidepressants: SSRIs b/c less EPSs
- Anti-psychotics: delusions/hallucinations
- Anti-Alzheimer's Agents:
-*Cholinesterase inhibitors decrease cognitive defects but have severe liver and GI side-effects
- Vitamin E: decreases functional decline
- MAOI (Selegiline): may delay cognitive deterioration
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