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Chapter 27Cognitive Disorders
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In older people, the development of delirium or
acute confusion…has been associated with increased lengths of hospital stay, the need for chemical and physical restraints, readmission, and increased mortality. Wakefield, 2002 2
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Learning Objectives After studying this chapter, you should be able to
Discuss the changes that occur in the aging brain Describe the four distinct, yet mutually interacting, memory systems identified by Heindel and Salloway Explain the latest research findings related to the etiology of dementia of the Alzheimer’s type Compare and contrast the etiology of vascular dementia and dementia with Lewy bodies Distinguish the clinical symptoms of delirium, dementia, and amnestic disorders Describe the onset and course of dementia from early to terminal stages 3
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Learning Objectives (cont.)
Explain the rationale for use of the Wong-Baker Faces Rating Scale, NEECHAM Confusion Scale, and Agitated Behavior in Dementia Scale when assessing clients with cognitive disorders Articulate the importance of identifying a client’s cultural and educational background during the assessment process Identify the elements of a comprehensive history and physical examination for a client who exhibits clinical symptoms of dementia of the Alzheimer’s type Formulate nursing interventions for a client with the diagnosis of delirium who exhibits agitated and aggressive behavior Develop an educational program to use with family members of clients with the diagnosis of dementia 4
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Areas of the Brain Involved in Cognitive Function
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Memory Systems and Their Locations
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Etiology of Cognitive Disorders
Etiology of delirium Etiology of dementia Etiology of dementia of the Alzheimer’s type (DAT) Etiology of dementia with Lewy bodies (DLB) Etiology of vascular dementia Etiology of diseases associated with dementia Etiology of amnestic disorders 7
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Clinical Symptoms and Diagnostic Characteristics of Cognitive Disorders
Delirium Delirium due to a general medical condition Substance-induced delirium Delirium due to multiple etiologies Delirium, not otherwise specified 8
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Clinical Symptoms and Diagnostic Characteristics of Cognitive Disorders (cont.)
Dementia Dementia of the Alzheimer’s type Stages of dementia of the Alzheimer’s type Dementia with Lewy bodies Vascular dementia Dementia due to other general medical conditions 9
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Clinical Symptoms and Diagnostic Characteristics of Cognitive Disorders (cont.)
Amnestic disorders Anterograde amnesia Retrograde amnesia Cognitive disorder, not otherwise specified 10
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The Nursing Process Assessment Nursing diagnoses
Outcome identification Planning interventions Implementation Evaluation 11
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Assessment Ability to meet basic needs Appearance, mood, and affect
Cognitive abilities Behavioral manifestations Assessment tools Transcultural considerations 12
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Nursing Diagnoses Interrupted family processes Ineffective coping
Ineffective role performance Disturbed thought processes Hopelessness Impaired social interaction Ineffective coping Risk for injury Situational low self-esteem Social isolation 13
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Outcome Identification
Outcomes for clients with cognitive disorders include the following: Elimination of organic etiology, if possible Prevention of acceleration of symptoms Preservation of the client’s dignity 14
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Planning Interventions
Interventions are planned that focus on the following: Maintaining the client’s contact with reality Reducing agitation Preventing injury Promoting adequate nutritional and fluid intake Promoting adequate sleep and rest Treating any underlying causes Encouraging expression of feelings Stimulating the memory through various activities Decreasing socially inappropriate behavior Encouraging satisfactory social relationships Assisting to live in as nonrestrictive an environment as possible 15
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Implementation Establishment of a safe environment
Assistance in meeting basic needs Stabilization of behavior Behavioral intervention techniques and programs Outreach programs Medication management Client and family education Continuum of care 16
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Future Research The short-term and long-term efficacy of donepezil and cognitive training to improve memory in elderly adults not affected by dementia The effects of NSAIDs in the delay of cognitive decline in older adults with age-associated memory impairment Alzhemed, an investigational drug that appears to prevent formation of amyloid fibrils in the brain Use of a low-flow cerebrospinal fluid shunt to increase the clearance of beta amyloid deposition from the brain to improve cognitive stability Passive immunization by vaccine to develop antibodies that target the beta amyloid peptide in the brain to prevent DAT 17
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Evaluation Successful interventions for a client with dementia are measured in terms of quality of life. It is achieved by slowing down the disease process. 18
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Key Terms Delirium Dementia Agnosia Amnestic disorders
Dementia with Lewy bodies Disturbances in executive functioning Dysgraphia Dysnomia Perseveration Retrograde amnesia Sundown syndrome Agnosia Amnestic disorders Anterograde amnesia Aphasia Apraxia Asterixis Binswanger’s disease Cognition Cognitive disorder Confabulation 19
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Reflection Reflect on the chapter-opening quote, “In older people, the development of delirium or acute confusion…has been associated with increased lengths of hospital stay, the need for chemical and physical restraints, readmission, and increased mortality.” Articulate the rationale for increased length of hospital stay, the need for chemical and physical restraints, readmission, and increased mortality in older clients who exhibit clinical symptoms of delirium or acute confusion. What nursing interventions could you provide to older clients who exhibit clinical symptoms of delirium or acute confusion following relocation to a rehabilitation unit? ? 20
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