1reversible / urgent to treat / variable course
delirium
2non-reversible decline; can be optimized or slowed
Mild Neurocognitive Disorders/Major Neurocognitive Disorders
3what is the etiology of delirium
- Fever
- Infection (UTI)
- Toxin exposure
- Substance intoxication
- Substance withdrawal
- Hospitalization
- Acute medical condition
4what is the course and prognosis of delirium
- Typically reversible, improves once main cause treated
5what are the interventions for delirium
o Treating the primary cause
o Medications
o Mobility
o Orientation
o Connection to familiar people and activities
o Mental engagement/encouragement
6compare and contrast mild and major NCD
Mild NCD Major NCD
Does not interfere with independence Does interfere with independence
May require additional supports or modifications Significant cognitive decline
Modest cognitive decline Includes dementia
May or may not develop into Major NCD Updated language in DSM-5
7what are the risk factors for NCDs
- Advanced age
- Black and Hispanic ethnicities
- Family history
- Poor cardiovascular health
- TBI
8- 40% family Hx
- Patterns of atrophy; use of CT or MRI
- Behavioral disinhibition; apathy
- Compulsive / ritualistic behavior
- Dietary changes
- Decline in word finding, grammar, speech production
- Dx late 60s
- Problems in workplace and other social settings
NCD due to Frontotemporal Disease
9- Abnormal deposits of protein (Lewy) in brain
- More than a million people in U.S. affected
- More men affected
- Onset ~50 years old or older
- Lewy clumps impair neuron transmission / brain chemistry
- Severe neuroleptic sensitivity; visual hallucinations; fluctuating cognition
NCD due to Lewy Body Disease
10- Cerebrovascular disease
- Vascular depression; executive dysfunction
- Can occur any age; 0.2% aged 65-70 years; 16% aged 80 years or older
Vascular NCD