UNIVERSITY OF EASTERN AFRICA, BARATON

SCHOOL OF NURSING

DEPARTMENT OF NURSING

PRESENTATION NOTES DONE IN THE PARTIAL FULFILMENT OF THE REQUIREMENTS OF THE

COURSE NRSG 318: MENTAL HEALTH NURSING

TOPIC; NEUROCOGNITIVE DISORDERS

PRESENTED BY;

Sheila emmy nyaboke

Thomas makori

Job mogendi

Gideon nyanchabera

INSTRUCTOR:

DR. LORRAINE LYNNE C. VILLAGOMEZ

DATE DUE; 28th october 2022.

NEUROCOGNITIVE DISORDERS
Neurons - are fundamental units of the brain and nervous system.Are cells
responsible for receiving sensory input from the external world for sending motor
motor commands to our muscles, and for transforming and relaying the electrical
signals.

Cognition - cognition revolves around learning and memory. Loss of this

fundamental abilities is a common threat in all cognitive disorders.

Cognitive disorders comprise of a variety of assaults on the human brain.

Neurocognitive disorders are a group of conditions that frequently lead to

impaired mental function.

Neurocognitive disorders occur due to a wide variety of medical conditions or

injury to the brain.

There are three main categories of neurocognitive disorders;

1.Delirium

2.Dementia i). Alzheimer's disease

ii). Vascular dementia

iii). Huntington's

iv). Lewy body disease

v). Parkinson's disease

3. Mild cognitive disorder

Other neurocognitive disorders include; HIV infection, traumatic Brain Injury,

multiple sclerosis and prion disease.

1.DELIRIUM

(1) Definition of DELIRIUM

✓ Delirium is a serious disturbance in mental abilities that results in confused thinking and reduced
awareness of surroundings.

✓ It is characterized by a notable disturbance in attention or awareness and cognitive performance that

is significantly altered from one’s usual behavior .

✓ The onset of delirium is abrupt, occurring for several hours.

(2) Pathophysiology OF DELIRIUM

✓The pathophysiology is not fully understood, but delirium may be due to inflammatory mechanisms
and a cholinergic neurotransmitter deficiency in the brain. During acute illness, older patients are at risk
of delirium due to a decreased cognitive reserve.

Types of delirium

i. Hyperactive delirium.

✓ It's the most easily recognized type

✓ This may include restlessness, agitation, rapid mood changes or hallucinations, and refusal to
cooperate with care.

ii. Hypoactive delirium.

✓ This may include inactivity or reduced motor activity, sluggishness and abnormal drowsiness

iii. Mixed delirium.

✓ This includes both hyperactive and hypoactive signs and symptoms.

✓ The person may quickly switch back and forth from hyperactive to hypoactive states.

(3) Risk factors OF DELIRIUM

✓ Brain disorders such as dementia, stroke or Parkinson's disease

✓ Previous delirium episodes

✓ Visual or hearing impairment

✓ The presence of multiple medical problems

Causes

Certain medications or drug toxicity

• Alcohol or drug intoxication or withdrawal

• A medical condition, such as a stroke, heart attack, worsening lung or liver disease, or an injury from a
fall

• Metabolic imbalances, such as low sodium or low calcium

• Severe, chronic or terminal illness

• Fever and acute infection, particularly in children

• Urinary tract infection, pneumonia or the flu, especially in older adults

• Exposure to a toxin, such as carbon monoxide, cyanide or other poisons

• Malnutrition or dehydration

• Sleep deprivation or severe emotional distress

• Pain

• Surgery or other medical procedures that include anesthesia

(4)Clinical presentation OF DELIRIUM

✓Symptoms can range from mild to severe and can last from days to several months.

✓ The symptoms 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.

1. Reduced awareness of the environment

✓ This may result in:

• An inability to stay focused on a topic or to switch topics

• Getting stuck on an idea rather than responding to questions or conversation

• Being easily distracted by unimportant things

• Being withdrawn, with little or no activity or little response to the environment

2. Poor thinking skills (cognitive impairment)

✓ This is manifested through:

• Poor memory, particularly of recent events

• Disorientation — for example, not knowing where you are or who you are

• Difficulty speaking or recalling words

• Trouble understanding speech

• Difficulty reading or writing

3. Behavior changes

✓These may include:

• Seeing things that don't exist (hallucinations)

• Restlessness, agitation or combative behavior

• Being quiet and withdrawn — especially in older adults

• Slowed movement or lethargy

• Disturbed sleep habits

4. Emotional disturbances

✓ Which may appear as:

• Anxiety, fear or paranoia

• Depression

• Irritability or anger

• A sense of feeling elated (euphoria)

• Apathy

• Rapid and unpredictable mood shifts

Personality changes

(5) Treatment OF DELIRIUM

✓ Treatment for delirium depends on the cause. Treatments may include:

 i. Antibiotics for infections.

ii. Fluids and electrolytes for dehydration.

iii. Benzodiazepines for problems due to drug and alcohol withdrawal.

2. DEMENTIA

Dementia is not a specific disease but rather a general term for the impaired ability to remember, think
or make decisions that interfere with activities of daily living. It comprises of the 5 diseases below;

I) ALZHEIMER'S DISEASE
This is a degenerative brain disorder of unknown etiology which is the most common form of dementia,
that usually start in the late middle age or in old age. It results in progressive memory loss, impaired
thinking, disorientation and changes in mood and personality.

There is the degeneration of brain neurons especially in the cerebral cortex and presence of
neurofibrillary tangles and plaques containing beta amyloid cells.

PATHOPHYSIOLOGY
The disease affect both the nerves, brain cells and the neurotransmitters.

Destruction of the nerves, brain cells and neurotransmitters cause the accumulation of plaques and
bundles around the brain cells. Plaques are amyloid proteins.

The presence of plaques begin to destroy more connections between the brain cells, thus the disease,
Alzheimer's disease.

Stages of Alzheimer's disease

Stage 1; Mild, or early stage: presence of mild symptoms, general forgetfulness. In the early stage of
Alzheimer's, a person may function independently. He or she may still drive, work and be part of social
activities. Despite this, the person may feel as if he or she is having memory lapses, such as forgetting
familiar words or the location of everyday objects. Symptoms may not be widely apparent at this stage.
Common difficulties include:Coming up with the right word or name, Remembering names when
introduced to new people, Having difficulty performing tasks in social or work settings. Forgetting
material that was just read, Losing or misplacing a valuable object, Experiencing increased trouble with
planning or organizing.

Stage 2; Moderate, or middle stage. ; Presence of disabling symptoms, more care is needed. During the
middle stage of Alzheimer’s, the dementia symptoms are more pronounced. the person may confuse
words, get frustrated or angry, and act in unexpected ways, such as refusing to bathe. Damage to nerve
cells in the brain can also make it difficult for the person to express thoughts and perform routine tasks
without assistance.

Stage 3; Severe, or late stage. Presence of significant changes in personality and behavior and lack of
awareness. In the final stage of the disease, dementia symptoms are severe. Individuals lose the ability
to respond to their environment, to carry on a conversation and, eventually, to control movement. They
may still say words or phrases, but communicating pain becomes difficult. As memory and cognitive
skills continue to worsen, significant personality changes may take place and individuals need extensive
care.

Causes of Alzheimer's disease

The disease is of unknown cause but the possible causes can be;

1. Neurochemical factors such as acetylcholine, somatostatin, norepinephrine

2. Environmental factors such as cigarette smoking, certain infections, metals, industrial or other
toxins, use of cholesterol lowering drugs(statin)
3. Genetic
4. Immunological factors. Oxidized LDL receptor 1 and angiotensin 1 converting enzyme, are tied to
the way the brain cells bind to apolipoprotein 4(APOE4) and reduce build up of harmful
proteins, known as plaque in the brain respectively.

10 warning signs of Alzheimer's disease

1. Memory loss
2. Difficulty to perform familiar tasks
3. Problems with language
4. Disorientation to time and place
5. Poor or decreased judgement
 6. Problems with abstract thinking
7. Misplacing things
8. Changes in mood and behavior
9. Changes in personality
10. Loss of initiative

Symptoms of Alzheimer's disease

1. Confusion
2. Disturbances in short term memory
3. Problems with attention and spatial orientation
4. Personality changes
5. Language difficulties 6. Unexplained mood swings

Diagnostic tests for Alzheimer's disease

Mental status examination and neuropsychological assessment

Brain imaging such as CT scan, MRI

Electroencephalogram

Treatment of Alzheimer's disease

1. Administration of acetylcholinesterase inhibitors. These prevent the breakdown of acetylcholine
which is a chemical messenger responsible for learning and memory. Examples include;
Donepezil, Rivastigmine, Galantamine
2. Antidepressants
3. Anxiolytic drugs
4. Antipsychotics
5. Anticonvulsants

ii) VASCULAR DEMENTIA

Vascular dementia is a type of dementia that can cause a decline in cognitive skills, including memory,
reasoning, judgment, and speech.

Vascular dementia is caused by different conditions that interrupt the flow of blood and oxygen supply
to the brain and damage blood vessels in the brain.
symptoms of vascular dementia

The most common symptoms of vascular dementia include:

 Confusion and memory problems

 Difficulty paying attention and focusing
 Trouble doing tasks that used to be easy
 Weakness in your hands, feet, arms, and legs
 Being easily agitated or upset
 Changes in personality or behavior
 Depression
 Misplacing items
 Frequently getting lost
 Unsteady gait or balance issues
 Difficulty controlling urination or needing to urinate frequently
 Trouble finding or using the right word
 Trouble reading or writing
 Hallucinations
 Trouble with judgment

Stages of vascular dementia

Unlike other types of dementia, vascular dementia doesn’t always have a typical progression. It can
occur suddenly or start slowly. Generally, though, it tends to progress in a step-like manner, where there
are periods of decline, followed by stability, then decline again.

Still, it can roughly be classified into:

1. Early stages. Making the diagnosis may be difficult because symptoms are mild. However, you’re
usually aware that your memory and mental capabilities are not the same as they once were.
2. Middle stages. This is when the symptoms listed above become more noticeable.

3. Late stages. This is where there are dramatic changes in cognitive and physical symptoms. Often,
this stage occurs after a severe event, such as a large stroke.

Causes of vascular dementia

Vascular dementia results from conditions that damage your brain's blood vessels, reducing their ability
to supply your brain with the amounts of nutrition and oxygen it needs to perform thought processes
effectively.
Common conditions that may lead to vascular dementia include:

1. Stroke (infarction) blocking a brain artery. Strokes that block a brain artery usually cause a range
of symptoms that may include vascular dementia. But some strokes don't cause any noticeable
symptoms. These silent strokes still increase dementia risk. With both silent and apparent
strokes, the risk of vascular dementia increases with the number of strokes that occur over time.
One type of vascular dementia involving many strokes is called multi-infarct dementia.
2. Brain hemorrhage. Often caused by high blood pressure weakening a blood vessel leading to
bleeding into the brain causing damage or from buildup of protein in small blood vessels
occurring with aging weakening them over time (cerebral amyloid angiopathy)
3. Narrowed or chronically damaged brain blood vessels. Conditions that narrow or inflict long-
term damage on your brain blood vessels also can lead to vascular dementia. These conditions
include the wear and tear associated with aging, high blood pressure, abnormal aging of blood
vessels (atherosclerosis), diabetes

Risk factors of vascular dementia

There are several risk factors for vascular dementia, including:

1.Age

2.Hstory of stroke

3.History of heart attacks

4.High cholesterol

5.Diabetes

6.Lupus

7.High blood pressure

8.Typical heart rhythms

Treatment of vascular dementia

Treatment often focuses on managing the health conditions and risk factors that contribute to vascular
dementia.

1. Lower your blood pressure

2. Reduce your cholesterol level

3.Prevent your blood from clotting and keep your arteries clear

4. Help control your blood sugar if you have diabetes

iii?HUNTINGTON’S DISEASE
Huntington's disease is a rare, inherited disease that causes the progressive breakdown (degeneration)
of nerve cells in the brain. Huntington's disease has a wide impact on a person's functional abilities and
usually results in movement, thinking (cognitive) and psychiatric disorders.

Signs and symptoms of Huntington's disease

Personality and mood changes

Depression

Problems with memory, thinking, and judgment

Loss of coordination and control of movements

Difficulty swallowing and speaking

Early signs and symptoms

Initial signs and symptoms may include:

Slight uncontrollable movements

Small changes in coordination and clumsiness

Stumbling

Slight mood and emotional changes

Difficulty focusing and functioning at school or work

Lapses in short-term memory

Depression and irritability

Causes of Huntington's disease

Huntington’s disease results  from the mutation of a gene on chromosome number 4.

A typical copy of the gene produces huntingtin (HTT), a protein. The gene with the mutation is larger
than it should be. This leads to excessive production of cytosine, adenine, and guanine (CAG), the
building blocks of DNA. Normally, CAG repeats 36 times or less , but in Huntington’s disease, it repeats
36 times or more.

This change results in a larger form of the HTT protein, which is toxic. As the toxic protein accumulates
in the brain, it begins to damage certain brain cells.

If the repetition is 36–39, the person could develop Huntington’s disease but may not. If it repeats 40
times or more, a person will almost certainly develop the condition.

Juvenile Huntington’s disease

If symptoms start before a person is 20, this is termed as juvenile Huntington’s disease.

The physical symptoms of the juvenile version of the disease tend to be different and can include leg
stiffness, tremors, and regression in learning.

This version of the disease usually progresses more rapidly. It may be fatal within 10 years of a
diagnosis. The cause of death is often a complication, such as pneumonia or choking.

iv) LEWY BODY DISEASE

Also known as dementia with lewy bodies. Its defined as irregular brain cells that results from the build
up of abnormal proteins in the nuclei of neurons. These brain cells deplete the cortex of acetylcholine,
which causes behavioral and cognitive symptoms.

Symptoms

 Recurrent visual hallucinations

 Impaired mobility
 Fluctuations in attention and alertness
 Sleep disturbances or difficulties
 Poor regulation of body functions

Risk factors

 Age; people older than 60 years are at a greater risk of being affected with the disease
 Sex; tends to affect more men than women
 Family history; those who have a family member suffering from the disease are at a greater risk
of contracting the disease.
Treatment

There’s no cure but symptoms can be managed.

Pharmacologic; cholinesterase inhibitors and levodopa

Non- pharmacologic; physical therapy, occupational therapy and speech therapy

V) PARKINSON’S DISEASE
This is a brain disorder that causes unintended or uncontrollable movements such as shaking, stiffness
and difficulty with balance and coordination.

Cause

Caused by a loss of nerve cells in the part of brain called substantial nigra. Nerve cells in this part of the
brain are responsible for producing dopamine which acts as a messenger between the parts of the brain
and nervous system, which help control and co-ordinate movement. If the nerve cells die or become
damaged, the amount of dopamine is reduced. This results in movements becoming slow and abnormal.

Risk factors

 Age; young adults rarely experience. Mostly begins in middle or late life and the risk increases
with age affecting mostly those 60 years and above.
 Hereditary; having a close relative who has suffered from the disease increases chances of one
developing the disease.
 Sex; men are more likely to develop the disease than women
 Exposure to toxins such as herbicides and pesticides
 Symptoms

Usually begins gradually and worsens as the condition progresses overtime.

 Tremor or shaking
 Slowed movement
 Rigid muscles, muscles become stiff
 Impaired posture and balance
 Loss of automatic movements; one may have a decrease ability to perform movements such as
blinking, smiling or swinging your arms when walking
 Speech changes
 Writing changes

Treatment

Physiotherapy, speech and language therapy, occupational therapy Medications such as levodopa,
dopamine agonists and monoamine oxidase beta inhibitors.
3.MILD COGNITIVE DISORDER
Is the stage between the expected cognitive decline of normal aging and the more serious decline of
dementia. It's characterized by problems with memory, language, thinking or judgment.Mild cognitive
impairment may increase your risk of later developing dementia caused by Alzheimer's disease or other
neurological conditions. But some people with mild cognitive impairment never get worse, and a few
eventually get better.

Symptoms

Forgetting things more often.

Forgetting important events such as appointments or social engagements.

Losing train of thought or the thread of conversations, books or movies.

Feeling increasingly overwhelmed by making decisions, planning steps to accomplish a task or

understanding instructions.

Having trouble finding familiar environments.

Becoming more impulsive or showing increasingly poor judgment.

Causes

There's no single cause of mild cognitive impairment. Symptoms may remain stable for years, progress
to Alzheimer's disease or another type of dementia, or improve over time.

 lesser degree of the same types of brain changes seen in Alzheimer's disease or other forms of
dementia. Some of these changes have been identified in autopsy studies of people with MCI.
These changes include: Abnormal clumps of beta-amyloid protein (plaques) and microscopic
protein clumps of tau characteristic of Alzheimer's disease (tangles) and Lewy bodies, which are
microscopic clumps of another protein associated with Parkinson's disease, dementia with Lewy
bodies and some cases of Alzheimer's disease

Risk factors

Increasing age.

Other medical conditions and lifestyle factors have been linked to an increased risk of cognitive change,
including:Diabetes, Smoking, High blood pressure, Elevated cholesterol and obesity.

Treatment
There currently is no standard treatment or approved medication for mild cognitive disorder but there
are things a person can do that may help them stay healthy and deal with changes in their thinking.
Majorly, practice living a healthy lifestyle.

REFERENCE

Varcarolis M.Elizabeth, Essentials of psychiatric Mental Health Nursing. 9th edition. Evolve. Elsevier.
London.

Keltner L. Norman et Al, Psychiatric Nursing. 6th edition. Evolve. Elsevier. London