Overview
This lecture covers cognitive alterations, focusing on dementia, Alzheimer's disease, and delirium, including their pathophysiology, risk factors, clinical presentation, nursing care, and interventions.
Cognition & Pathophysiology
- Cognition is controlled by the brain and neurons, requiring adequate blood flow for function.
- Cognitive processes include memory, problem solving, language, and comprehension.
- Disruption of brain signaling leads to various cognitive alterations.
Dementia: Types, Causes, & Risk Factors
- Dementia results from brain injury or physiological changes causing impaired signaling.
- Types include vascular, Lewy body, frontotemporal, and mixed dementia.
- Common causes: Alzheimer's disease (most common), vascular changes, protein deposits, and multiple combined factors.
- Risk factors: advanced age, unhealthy diet, physical inactivity, brain injury, cardiovascular disease, neurodegenerative disease, and social isolation.
- Comorbidities: hypertension, diabetes, high cholesterol, depression, and anxiety.
Dementia: Clinical Manifestations & Diagnosis
- Key symptoms: memory loss, impaired judgment, confusion, wandering, and language difficulties.
- Progressive and worsens over time; activities of daily living become difficult.
- Diagnosis involves labs (electrolytes, liver, hormone levels), imaging (CT, MRI), cognitive assessments, and mental status exams.
Dementia: Nursing Role & Interventions
- Nursing care focuses on safety, maintaining independence, and reducing caregiver strain.
- Assess home environment for hazards; promote routines, familiar surroundings, and social interaction.
- Educate clients and caregivers; manage nutrition and pharmacologic treatments appropriately.
- Monitor physical and cognitive status regularly.
Alzheimer's Disease: Pathophysiology, Risk Factors & Manifestations
- Alzheimer's involves abnormal protein buildup (beta-amyloid plaques, neurofibrillary tangles) causing neuron death and brain shrinkage.
- Risk factors: advanced age, genetics (e.g., Down syndrome), cardiovascular disease, low education, and unhealthy lifestyle.
- Stages: mild (memory issues), moderate (confusion, impaired reasoning), severe (loss of communication, mobility, and self-care).
- Diagnosis: cognitive testing, labs, and neuroimaging.
Alzheimer's Disease: Nursing Care
- Prioritize safety (risk of wandering, falls, fire hazards).
- Educate families using simple language; involve caregivers in planning and care transitions.
- No specific curative diet or medication; focus on symptom management and quality of life.
- Maintain routines and basic physiological needs; evaluate and adjust care as disease progresses.
Delirium: Overview, Risk Factors & Causes
- Delirium is acute confusion developing over hours to days, often with sudden changes in cognition and behavior.
- Causes: oxygen deprivation, fluid/electrolyte imbalances, medications, infection, drug/alcohol use, surgery, or trauma.
- Advanced age and underlying diseases increase risk.
Delirium: Clinical Features & Nursing Interventions
- Symptoms: abrupt changes in consciousness, cognition, mood, perception, hallucinations, and sleep patterns.
- Diagnosis focuses on identifying and treating underlying causes; assessment tools include the Confusion Assessment Method.
- Nursing priorities: ensure safety, decrease environmental stimuli, and address reversible causes swiftly.
Key Terms & Definitions
- Cognition — mental processes for memory, thinking, language, and comprehension.
- Dementia — progressive impairment of cognitive functions interfering with daily activities.
- Alzheimer’s Disease — neurodegenerative disorder marked by plaques and tangles causing dementia.
- Delirium — acute, fluctuating disturbance in attention and cognition, often reversible.
- Lewy Bodies — protein deposits impairing neuron communication in Lewy body dementia.
- Frontal Temporal Dementia — dementia due to protein buildup in frontal and temporal brain lobes.
Action Items / Next Steps
- Review assigned textbook chapters on dementia, delirium, and Alzheimer’s disease.
- Prepare for clinical assessment practice using cognitive testing tools (e.g., MMSE).
- Complete any posted worksheet or case studies related to cognitive alterations.