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10 Cards in this Set

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Brain Impairment in Adults
In the DSM-5 the disorders that used to be known as as “Delirium, Dementia, and Amnestic and Other Cognitive Disorders” are now grouped into a new diagnostic category called “Neurocognitive Disorders.”

Disorders in this category are those that involve a loss of cognitive ability that is presumed to be caused by brain damage or disease.

Subsections of this diagnostic category include delirium, major neurocognitive disorder, and mild neurocognitive disorder. The distinction between major and mild neurocognitive disorder is based on severity.

Premise:
Most develop it late on in life. It affects learning, memory, and awareness.

There are two classes of cognitive disorders: Delirium and Major/Mild neurocognitive disorder (delirium)
Delirium
A state of acute brain failure that lies between normal wakefulness, stupor or coma.

Clinical Picture:
Confusion, disturbed concentration, and cognitive dysfunction. The essence is the idea of a disturbance in awareness. A condition with a sudden onset of fluctuating state of reduced awareness. Involves with impairments of memory, attention, and disorganized thinking. It can occur in a person of any age; however the elderly and children are at high risk because of a reduced brain or developing brain.
It can result from head injury or infection. The most common cause is drug intoxication or withdrawal. Toxicity from medications can also be a cause. Elderly having surgery after the age of 80.

Treatment:
It is a true emergency and its underlying cause should be identified and managed.
Medications that are used are mostly neuroleptics. For delirium that is caused from alcohol or drug withdrawal, Benzodiazepines are used. Environmental manipulations that help patients stay oriented in place, time, and those around them. It is also important that staff members introduce themselves when they work with patients, explain their duty, and keep the patient oriented.
Major Neurocognitive Disorder (Dementia)
Marked deficits in cognitive abilities such as attention, memory, language, learning, judgement, and advanced cognitive processes. There is a decline from a previous attained level of functioning. In older people this decline is quite gradual.
It is reversible if it has a underlying cause, but usually its not. At least 50 different disorders are known to cause the types of cognitive deficits, such as: Parkinson's Disease, Strokes, Head Injury, Multiple Causes, Other causes, but Alzheimer's is the most common cause (almost half).
Alzheimers
A progressive and fatal neurodenerative disorder. Onset usually occurs in the 60-70s. It is a slow and deteriorating course terminating into delirium and death. The average survival time is 8 years.

Clinical Picture:
Characterized by multiple cognitive deficits. Memory, orientation, judgment, and reasoning deficits. Difficulty with language,  impaired motor functioning, failure to recognizeobjects, failure to recognize people.
Additional symptoms of wandering off, depression/anxiety, agitation, confusion, or
 combativeness.

Causes:
Cases of early onset appear to be caused by rare genetic mutations. 1) APP gene on the chromosome 21. 2) Preselnilin 1 on chromosome 14 and Presenilin 2 on chromosome 1.
Cases of late onset appear to be APOE gene on chromosome 19 which codes for blood protein that helped carry cholesterol through the bloodstream. Differing forms of this gene predict the risk for late onset. Having more as well. Gene and environment play a role by being overweight, type 2 diabetes, not being active, exposure to metals, depression, and head trauma.
Alzheimers Neuropathology
Brain abnormalities that are the characteristics of the disease.
1) In the neurons a sticky substance called Beta Amyloid is being produced at a much faster rate, it then accumulates and turns into plague. This leads to the death of brain cells. It also triggers local chronic inflammation in the brain and releases cytokines that further enhances the process.

2) Having the APOE-4 form of the APOE gene is associated with the more rapid buildup of amyloid in the brain. Stress makes it much worse. Insulin plays a role in regulating amyloid.

3) Neurofibrillary tangles are webs of abnormal filaments within a nerve cell. These filaments are made up of another protein called tau. The tau is mishapen and tangled. This causes the neuron tube to collapse. The buildup of tau protein is accelerated by an increasing burden of amyloid in the brain. They also block communication of cells.

4) ACh neurotransmitter is known to be important for memory. Cluster of cell bodies located in the basal forebrain are involved in the release of ACh. Since there is a reduction of ACh activity the cluster of cell bodies are also damaged.

Overtime the brain cells and tissue shrink and the brain decreases in volume, thus, cognitive deficits are formed. The cortex shrivels up harming memory, thinking, and planning. Hippocampus is severely shrunk in the area of the campus thus causes a hard time to form new memories. Ventricles of fluid filled sacs grow larger. Less healthy synapses and nerve cells. Plagues build within the nerve cells. Dead and dying nerve cells contain tangles which are made up of twisted strands of another protein. Plagues and Tangles are prime suspects for cell deaths and tissue loss.
Parkinson's Disease
The second most common neurodegenerative disorder.
It is characterized by resting tremors or rigid movements.
The underlying cause of this is loss of dopamine neurons in an area of the brain called the substantia nigra. Dopamine is in charged of motor controls.
The disease usually can involve psychological symptoms such as depression, anxiety, apathy, cognitive problems, hallucinations, and delusions.

About 75% show signs of Dementia.
Huntington's Disease
A rare degenerative disorder of the central nervous system that afflicts about 1 in every 10,000 people. The illness begins in midlife (40 yrs) and it affects men and women equally.
It is characterized by a chronic and progressive chorea (involuntary and irregular movements that flow randomly from one area of the body to another.
Patients eventually develop dementia, and death usually occurs within 10-20 years of first developing the illness.
It is caused by a single dominant gene on chromosome 4.

Other Causes:

The HIV virus can also cause it by damaging the brain and cells. 30% showed mild cognitive impairment (memory, attention, forgetfulness.)

Vascular Disease having a interruption of blood supply to minute areas of the brain because of small strokes causing a destruction of neurons. The progressive loss of cells leads to brain atrophy and behavioral impairments.
Alzheimer's Medications
The Works: remember there is no cure

AD causes destruction of cells that make neurotransmitter important for memory

Drug treatments include cholinesterase inhibitors such as donepezil (Aricept), and non- cholinesterase inhibitor memantine.

Which help stop Ach (neurotransmitter that is important for memory) from being broken down; increase availability to the brain.


Having Small effects but can slow progression
Psychosocial Treatments of Dementia
Try to manage memory deficits (routines, lists, diaries, clocks,calendars, labeling doors and cupboards, music, photos.) —

Exercise associated with mild improvements by being in a more stimulating environment.

Interventions tend to focus on caregivers and teaching them on how to treat the patient the most sufficiently.

Coping tips:
Avoid being confrontational, —Redirect the person's attention, Create a calm environment, Allow adequate rest, Provide a security object. — Acknowledge requests-respond to them, and Don't take the behavior personally- share your experiences with others.
Video of Treatment
Male patient who always loved music. He is given an ipod containing his favorite song. He starts to sing and being animated by the music.