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A comprehensive review of key concepts related to neurocognitive disorders, particularly focusing on delirium and dementia. It includes detailed explanations of different types of dementia, such as alzheimer's disease, vascular dementia, lewy body dementia, and frontotemporal dementia. The document also covers the diagnosis, treatment, and management of these conditions, highlighting the role of medications like cholinesterase inhibitors and memantine. It is a valuable resource for students and professionals seeking to understand the complexities of neurocognitive disorders.
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Neurocognitive disorders - Answer>> delirium and dementia Dementia - Answer>> -a group of symptoms that mainly affects memory, cognition and social interactions, and the ability to do everyday tasks. -Symptoms start gradually often with no clear beginning, and are usually permanent. -Most dementias are caused by neurodegenerative diseases, most commonly Alzheimer's disease, Lewy body dementia and frontotemporal dementia
-lewy bodies found in ppl with parkinsons disease, leads to dementia Frontotemporal dementia - Answer>> -Frontal lobe damage
-stage 5: early dementis to moderate alzheimer's diease, cognitive decline more drastic, lasts 1.5 years -stage 6: moderatly severe alzheimer's disease, help with basic daily tasks, lasts 2.5 years -stage 7: final stage, speech severely limited, decline in basic abilities, movement abilities affected Diagnosis of dementia and Alzheimer's disease - Answer>> - Patient History -Physical Exam -neurological eval -neuropsychological test
Galantamine (Razadyne, Razadyne ER) - Answer>> -elevating acetylcholine (Ach) in the cerebral cortex, modulating the nicotinic Ach receptors to increase Ach release from existing presynaptic nerve terminals, increases glutamate and serotonin levels -Side effects: GI symptoms, headache, dizziness, fatigue -Precautions:
the corner of his room were people standing over him, watching him breathe. He was unable to be reoriented, became agitated, and required soft wrist restraints for safety. In the morning interview, Pete is alert, oriented, pleasant, and cooperative. He complains that he has not had a good night's sleep since before his surgery, and states that last night he asked for and was given a "sleeping pill." Review of his electronic medical record (EMR) confirms a as needed (PRN) dose of zolpide - Answer>> F13.221- moderate delirium due to sedative Rationale: Pete meets diagnostic criteria for medication-induced acute hyperactive delirium due to the administration of zolpidem. Clinical Presentation: Mild and Major NCDs - Answer>> NCD, or dementia, are chronic and progressive processes characterized by cognitive deficits in language, speech, memory, and a decline in motor skills -often accompanied by a decline in emotional control, social behavior, or motivation -Differentiation between mild and major disorders is a continuum
managing the household finances, as Lisheng missed several payments on the mortgage and utilities. Her medical history includes hypertension. She does not have a psychiatric history. Based on the DSM-5-TR (APA, 2022) criteria, which of the following is the most appropriate criteria for Lisheng? major neurocognitive disorder mild neurocognitive disorder - Answer>> major neurocognitive disorder Rationale: Lisheng meets the criteria for major neurocognitive disorder. Both mild and major neurocognitive disorders involve a significant decline in cognitive function; however, cognitive deficits that interfere with independence, such as difficulty paying bills or managing medications, meet the criteria for major neurocognitive disorder. Based on DSM-5-TR (APA, 2022) criteria and the information provided, which of the following is the most appropriate classification for Lisheng's behavioral symptoms and severity? mild - with behavioral disturbance mild - without behavioral disturbance moderate - with behavioral disturbance moderate - without behavioral disturbance severe - with behavioral disturbance severe - without behavioral disturbance - Answer>> mild - without behavioral disturbance Rationale: The classification of severity and behavioral symptoms for Lisheng is mild without behavioral disturbance. Lisheng presents with difficulties with instrumental ADLs, such as managing money and driving, consistent with mild severity of NCD. Neither she nor her daughter indicates any behavioral disturbance, such as apathy, depression, or agitation.
(developmental age 1). Can no longer walk (developmental age 1). Can no longer sit up without assistance (developmental age 6- 10 months). Can no longer smile (developmental age 2- months). Can no longer hold head up by self (developmental age 1-3 months) Clinical Presentation: Other Mild and Major NCDs - Answer>> Additional diagnoses may be considered as differentials for a client with cognitive impairment -delirium -depression -schizophrenia -head trauma
Rationale: Tonia is most likely experiencing major depressive disorder (MDD). The hallmark features that indicate MDD are depressed mood or loss of interest in usual activities. Although memory difficulties and loss of concentration are common with MDD, they are not predominant features. Daron is a 72-year-old who presents with complaints of memory changes. He states he often walks into a store and forgets why he is there. He reports that he frequently struggles to find the right word to complete a sentence. He endorses difficulty in organizing his monthly finances, although he has not missed any bill payments. He states that he has also been feeling "down" lately. His past history includes hypertension and carotid endarterectomy. Which of the following diagnoses is most appropriate for Daron? Major depressive disorder Vascular neurocognitive disorder NCD with Lewy bodies Frontotemporal neurocognitive disorder Neurocognitive disorder due to Parkinson's disease Mild neurocognitive disorder due to traumatic brain injury - Answer>> Vascular neurocognitive disorder Rationale: Daron's symptoms indicate a possible diagnosis of mild vascular neurocognitive disorder. He presents with memory loss, difficulty in executive function, and feelings of depressed mood, which are frequently associated with vascular NCD. He has cardiovascular risk factors, including hypertension and a past vascular intervention. The PMHNP should ask about symptoms of TIA or CVA, and imaging studies should be conducted to confirm the diagnosis. Trent is a 75-year-old who presents with changes in cognition. He states that there are times that he cannot follow a TV show or
Vascular neurocognitive disorder NCD with Lewy bodies Frontotemporal neurocognitive disorder Neurocognitive disorder due to Parkinson's disease Mild neurocognitive disorder due to traumatic brain injury - Answer>> Frontotemporal neurocognitive disorder Rationale: Cassie's symptoms are consistent with frontotemporal NCD. Hallmark features include behavioral disturbances such as impulsivity, socially inappropriate behavior, hoarding, or apathy; personality changes; and decline in language abilities. Memory is typically intact. Frontotemporal NCD presents at an earlier age than many other forms of NCD. Imaging studies should be conducted to rule out other forms of NCD; frontal lobe atrophy is commonly seen on the CT scan. Dae is a 72-year-old who presents with complaints of increasing memory loss; he is having difficulty remembering things that happened recently. He states that his wife has started preparing his medications after he missed a few doses. He also complains of apathy and daytime sleepiness. Walter was diagnosed with Parkinson's disease three years ago; he has experienced motor symptoms, but the cognitive symptoms are new to him. Which of the following diagnoses is most appropriate for Dae? Major depressive disorder Vascular neurocognitive disorder NCD with Lewy bodies Frontotemporal neurocognitive disorder Neurocognitive disorder due to Parkinson's disease Mild neurocognitive disorder due to traumatic brain injury - Answer>> Neurocognitive disorder due to Parkinson's disease Rationale: Since Dae has an existing diagnosis of Parkinson's disease, he may meet the criteria for NCD due to Parkinson's
disease. In addition to memory loss and decreased executive functioning, symptoms often include apathy, depressed mood, visual hallucinations, and daytime sleepiness. Isaiah is a 28-year-old who presents with difficulty concentrating. He states that he cannot follow conversations when more than one person is talking, and he is having problems at work completing multi-step tasks. He endorses feelings of irritability. He was involved in a motor vehicle crash two days ago; he hit his head on the windshield and briefly lost consciousness. He was treated and released from the emergency department after the crash. Which of the following diagnoses is most appropriate for Isaiah? Major depressive disorder Vascular neurocognitive disorder NCD with Lewy bodies Frontotemporal neurocognitive disorder Neurocognitive disorder due to Parkinson's disease Mild neurocognitive disorder due to traumatic brain injury - Answer>> Mild neurocognitive disorder due to traumatic brain injury Rationale: Isaiah meets diagnostic criteria for mild NCD due to traumatic brain injury; he sustained a head injury with loss of consciousness and his symptoms of difficulty with complex and sustained attention began shortly after the injury. Emotional disturbances, such as irritability, frustration, or anxiety are common. Mild NCD due to traumatic brain injury typically resolves within a few weeks to months after the injury. causes of neurocognitive disorders include: - Answer>> Alzheimer's disease frontotemporal lobar degeneration Lewy body disease