neuro-cognitive disorders.pptx
- 1. NEUROCOGNITIV E DISORDERS Presented by: Rabia Javed Iqbal
- 2. NEURO-COGNITIVE DISORDERS • Delirium • Neuro cognitive disorder due to Lewy bodies • Neurocognitive disorder due to Alzheimer disease. • Frontotemporal neurocognitive disorder • Vascular neurocognitive disorder • Neurocognitive disorder due to traumatic brain injury
- 3. DELIRIU M • Clouding state of consciousness in which a person has great difficulty in concentrating, focusing, keeping attention and a straightforward stream of thought. • Delirium can often be traced to one or more contributing factors, such as a • severe or chronic medical illness, • changes in your metabolic balance (such as low sodium), • medication, infection, surgery, or alcohol or drug withdrawal.
- 4. SIGNS AND SYMPTOMS • Disturbance of attention often manifested by reduced ability to focus, direct, sustain and shift attention. • Repetition of questions. • Easily distracted by irrelevant stimuli. • Disturbance of awareness manifested by reduced orientation to environment and time.
- 5. • Signs and symptoms of delirium usually begin over a few hours or a few days. • They often fluctuate throughout the day, and there may be periods of no symptoms. • Symptoms tend to be worse during the night when it's dark and things look less familiar.
- 6. • Reduced awareness of environment; • Cognitive Impairment (Poor Thinking Skills) • Emotional Disturbances • Behavioral Changes
- 7. TYPES OF DELIRIUM • Hyperactive Or Hyper Alert Delirium • The patient is hyperactive, aggressive, argumentative and uncooperative. • May appear to be responding to internal stimuli • Frequently the people suffering come to our attention because they are difficult to care for.
- 8. TYPES OF DELIRIUM Hypoactive or hypo-alert • Person appears to be napping on and off throughout the day • Unable to sustain attention when awakened, quickly fallingback asleep • Misses meals, medications, appointments • Does not ask for care or attention • This type is easy to miss because caring for these patients is not problematic to staff
- 9. TYPES OF DELIRIUM Mixed Delirium • This includes both hyperactive and hypoactive symptoms. • The person may quickly switch back and forth from hyperactive to hypoactive states. • The most common types are hypoactive and mixed accounting for approximately 80% of delirium cases
- 10. CAUSES OF DELIRIUM • Delirium occurs when the normal sending and receiving of signals in the brain become impaired. • This impairment is most likely caused by a combination of factors that make the brain vulnerable and trigger a malfunction in brain activity. • Delirium may have a single cause or more than one cause, such as a medical condition and medication toxicity. Sometimes no cause can be identified.
- 11. CAUSES OF DELIRIUM • In a study of delirium in elderly patients, Francis and colleagues • identified five leading causes of delirium. 1. Fluid/electrolyte disturbance 2. Infection 3. Medication toxicity 4. Metabolic derangement
- 12. DEMENTIA VS. DELIRIUM • Dementia has an deceptive onset, chronic memory and executive function disturbance, tends not to fluctuate. • In delirium cognitive changes develop acutely and fluctuate. • Dementia has intact alertness and attention but broken speech and thinking. • In delirium speech can be confused or disorganized. • Alertness and attention wax and wane.
- 13. TREATMENTS • First and foremost treat the underlying cause. • Environmental interventions • cues for orientation must be used e.g. (calendar, clock, family pictures, windows), • frequently reorient the patient, • have family or friends visit frequently making sure they introduce themselves, • minimize staff switching.
- 14. NEUROCOGNITIVE DISORDER DUE TO LEWY BODIES • Lewy bodies = microscopic protein deposits that damage brain over time • NCDLB is the newest dementia diagnosis with an incidence of 7 per 1,000 individuals among those aged 65 and older. • Individuals with NCDLB are often misdiagnosed with NCD due to Parkinson’s Disease. • Both show similar motor and cognitive clinical symptoms.
- 15. • There are intense neurotransmitter deficits along the dopaminergic and cholinergic pathways. • In The cholinergic deficit, acetylcholine is responsible for cognitive dysfunction • whereas the dopamine deficit is responsible for motor dysfunction.
- 16. CONTINUE.. • NCDLB can be differentiated from NCD due to Parkinson’s Disease based on the chronological onset of symptoms. • Individuals with NCDLB will exhibit cognitive symptoms before the onset of motor symptoms
- 17. CAUSE S • NCDLB results in a collection of proteins, called Lewy bodies, that progress through the neuronal synapses. • The functional deficits seen with NCDLB are greater than NCD with Alzheimer Disease as a result of the effects on motor and involuntary nervous systems.
- 18. TREATMEN T • When developing a plan for individuals with NCDLB, it is important to modify care by having the patient or caregiver rank the cognitive, emotional, and motor difficulties by level of subjective distress. effective with many symptoms cognition, hallucinations, and • The medications are including fluctuating mood disorders.
- 19. NEUROCOGNITIVE DISORDER CAUSED BY ALZHEIMER DISEASE • Neurocognitive disorder caused by Alzheimer Disease (NCD due to AD) is a slow developing non-reversible brain disorder that results in a permanent loss of neurons and neuronal synapses. • The loss of neurons is prevalent in the areas of the brain responsible for memory, function, and cognition. • Neuronal destruction comes from extracellular neurotic plaque and neurofibrillary tangles inside neurons. • Acetylcholine, which enables learning and memory, is also decreased.
- 20. RISK FACTORS • NCD due to AD is gender neutral i.e. occurrence rate is equal both in males and females. • Family history and age increase the risk of developing NCD due to AD. • The risk for an individual with a parent or sibling with NCD due to AD increases as much as 30% with each afflicted family member
- 21. TREATMEN T • Pharmacologic treatment of NCD due to AD includes 2 classes of pharmacologic treatment: • cholinesterase inhibitors (CEIs) • N-methyl-D-aspartic acid receptor antagonists. • Although CEIs do not stop the disease trajectory, they may slow the decline.
- 22. FRONTOTEMPORAL NEUROCOGNITIVE DISORDER • It is a mental health condition characterized by abnormal shrinkage in two parts of the brain, called the frontal and temporal anterior lobes. • This condition replaces an essentially equivalent illness, known as Frontotemporal dementia, in DSM 5.
- 23. • The brain’s frontal and temporal lobes play a primary role in maintaining brain function such as the ability to use language, the ability to regulate behavior. • The specific manifestation of the disorder depends upon the particular portions of the frontal and temporal lobes that undergo shrinkage, as well as the degree of shrinkage that occurs at any given point in time.
- 24. SYMPTOM S • Loss of the normal ability to make appropriate decisions or control impulsive urges. • loss of the ability to show empathy with others or develop personal motivation • changes in self grooming or eating habits.
- 25. SYMPTOM S • Language- or speaking-related difficulties associated with the disorder include: • aphasia (loss of the ability to use or understand words). • difficulties with normal body movement such as rigid or trembling muscles, loss of the ability to coordinate the activity of different muscles, unusually weak muscles, or swallowing problems (rare occurrence of these symptoms)
- 26. TREATMEN T • Frontotemporal neurocognitive disorder is both incurable and progressive. • Gets worse over time. • Doctors can potentially manage the effects of Frontotemporal dysfunction through the use of medications i.e. types of antidepressants.
- 27. VASCULAR NEUROCOGNITIV E DISORDER • vascular neurocognitive disorder is a condition characterized by disruptions in the brain’s blood supply that lead to impairment of one or more aspects of a person’s conscious brain functions. • The DSM includes this as a replacement for a condition previously identified as vascular dementia.
- 28. • The term “vascular” in vascular neurocognitive disorder refers to the body’s system of blood vessels, known medically as the vascular system or circulatory system. • The disorder is named so because the impairments it produces originate from some sort of reduction or blockage in the supply of blood that normally passes through the blood vessels called arteries and into the brain’s tissues.
- 29. CAUSE S Stroke – a condition that occurs when a brain artery either gets blocked or springs a leak of blood Ongoing health problems that either decrease a blood vessel’s general health or produce abnormal narrowing in a blood vessel’s interior diameter. Conditions that can trigger these damaging blood vessel changes include atherosclerosis (hardened arteries), hypertension (high blood pressure) diabetes effects of the normal aging process.
- 30. TREATMEN T • Vascular dementia is incurable and inevitably shortens the lives of affected individuals. the disorder’s from growing • However, doctors can potentially slow progression or even stop its effects substantially worse over time • treated with the help of certain medications originally developed to treat Alzheimer’s disease. Examples of these medications include a group of drugs known collectively as cholinesterase inhibitors and a single drug called memantine.
- 31. NEUROCOGNITIVE DISORDER DUE TO TRAUMATIC BRAIN INJURY • It is a mental health condition that sometimes arises in the long-term outcome of a physical injury that results in brain damage. • Some people affected by neurocognitive disorder due to traumatic brain injury experience symptoms that are severe enough to degrade their ability to lead independent lives • Others experience milder symptoms and retain most of their day-to-day mental function.
- 32. • Neurocognitive disorder due to a traumatic brain injury comes in both major and mild forms. • People with the major form of the disorder have symptoms that the general public commonly refers to as dementia (including such things as memory problems, a declining ability to think logically, and a declining ability to make decisions or control one’s behavior). • People with mild neurocognitive disorder due to a traumatic brain injury don’t have dementia-like symptoms; instead, they have less dramatic changes in their mental function that can worsen over time.
- 33. DIFFERENCE BETWEEN MILD AND MAJOR NEUROCOGNITIVE DIORDER • People with mild neurocognitive disorder have impairments in their conscious brain functions • Prominent enough to produce testing results lower than those found in people unaffected by a disorder • But not prominent enough to produce serious life disruption.
- 34. CONTINUED …. • individuals with major vascular neurocognitive disorder produce test results that are considerably lower than those produced by individuals with the mild form of the disorder • Have impairments that at least partially eliminate their ability to live successfully without some form of outside care.