Introduction: Neurocognitive and Neurodegenerative Disorders (Nursing)

00:01 Now, let's talk about aging and neurocognitive disorders.

00:07 Let's start with a client case.

00:11 Jai, a 67-year-old man arrives in the emergency room along with a concerned partner, who tells the nurse, "Please help us. Jai's been acting very differently tonight, He doesn't seem to remember my name. He's talking like crazy.

00:29 And suddenly, he thinks that there are bugs in his bed.

00:34 He was fine when I left this morning, but when I called in the afternoon, he was stammering and he couldn't get a sentence out straight.

00:43 Maybe he's been getting worse in the last few months.

00:47 You know, I, maybe I just wasn't noticing the change.

00:52 We are all so worried." So when we think about Jai, and we watch that there is a change in the way Jai is thinking, and the way Jai is talking, and some of the other behaviors, we might start thinking about neurocognitive, or neurodegenerative disorders.

01:16 These are often used interchangeably these words neurocognitive or neurodegenerative.

01:24 And they describe the cognitive decline in certain disorders.

01:32 So a neurocognitive impairment is seen in the decline in one's or more of the following cognitive domains.

01:41 For example, a decline in memory, or perhaps in language.

01:48 We might see a decline in executive functioning, or maybe in visuospatial abilities.

01:58 We also categorize these neurocognitive disorders as mild or major.

02:04 And that is the degree which this disease is going to impact a person.

02:09 So if it is a mild or major disorder, that talks about the degree of that disorder, interfering with activities of normal daily living.

02:22 If the impact is very significant, for example, it now requires some assisted living, we're going to say that that is a major neurocognitive disorder.

02:35 But if the impact is not sufficient, or significant to make a big change in everyday living, for example, perhaps the person has a transient loss of word retrieval, we would say that that is a mild neurocognitive disorder.

02:56 So we want to be thinking about where these disorders are impacting the individual.

03:02 And how we can see this kind of decline.

03:06 Executive thinking capacity begins to decline, being able to organize the day, being able to organize what you're going to be doing over a week.

03:18 Also memory.

03:19 Being able to store recent memory becomes a real problem.

03:26 Language.

03:27 Being able to find the right words, when you want to say something, being able to retrieve or we call it, word retrieval when you're trying to speak.

03:38 We often see someone who is a bit older, sort of searching for their words.

03:45 "I'm, it's on the tip of my tongue," they will say.

03:49 Also, we see some socialization skills declining.

03:54 You may have visited with a grandparent who is getting older or perhaps a great grandparent.

04:01 And you find that when you walk in, they say "And what's that hairdo supposed to say about you?" And you think, "Boy, that's a little rude." That is a socialization skill that is kind of declining for them, being able to be socially competent.

04:22 Also perceptions.

04:24 Depth perception. Perception of their environment.

04:29 Being able to judge distances.

04:34 And their motor abilities. Walking.

04:37 Being able to grasp things, being able to bring cups from the table up easily to their mouth.

04:48 So what kind of symptoms are we looking at? We want to be thinking when there's a neurocognitive disorder, are we seeing confusion? Is the person now not quite sure? Are they a bit foggier than they have been? Are they now starting to be somewhat irritable? Normal questions now get a bit of a flare up.

05:13 And agitated.

05:14 This is small things really making them very agitated.

05:21 We also want to be thinking about recent memory loss.

05:28 So they might be able to tell you about a song that was played at their wedding 50 years ago.

05:34 But you say, "Grandpa, what did you have for breakfast?" And they can't remember.

05:38 Now, of course, if you are a nurse taking care of a patient, you would never call that person grandma or grandpa.

05:48 You would never use some sort of endearment term because that would only serve to confuse them even more.

05:58 The best bet is, when you're taking care of a person to ask them what they would like to be called.

06:05 Perhaps they want to be called Jai.

06:08 But perhaps they want to be called Mr. Jai.

06:12 And they have the right to have the respect even if they have declining cognitive abilities to be addressed in a manner that is respectful to them.

06:24 We also might see depression.

06:26 Because as a person is getting older, and as a neurocognitive disorder might be setting in the person is feeling the loss of the past self.

06:40 The stronger self, the more capable self.

06:44 So when we think about these characteristics of a neurocognitive disorder, we are thinking about somebody who he has or she has a neurocognitive difficulty.

06:58 They can't really process, or store, or retrieve information.

07:04 It is really hard to act on any information that is not being able to be retrieved, or stored, or processed.

07:14 This requires a lot of neurocognitive ability, that oftentimes as younger people we take for granted.

07:24 But as our neurotransmitters change, and as our brains begin to age, and as some of these disorders set in, this interference with our thinking, and our executive functioning, can be very disruptive and frightening.

07:42 The disease is also considered to be mild or major.

07:46 And that depends on the impact that that disease is having on the person's ability to function in the activities of daily living.

07:56 And so when we think about signs and symptoms, we need to understand that sometimes the onset of the signs and symptoms can be rapid, as we see in delirium, or they might be slow, as we see in Alzheimer's disease.

08:15 So what are the most common neurodegenerative disorders? Well, Alzheimer's disease is one of the more common disorders that we see in the elderly.

08:28 We also have Parkinson's disease that causes neurodegeneration.

08:34 And multiple sclerosis.

08:38 Other diseases can also cause neurocognitive decline.

08:43 For example, traumatic brain injury.

08:46 Anytime that you have an insult to the organ of the brain, there can be neurocognitive decline associated with it.

08:56 Epilepsy.

08:57 Epilepsy can cause a neurocognitive decline as well.

09:04 The more a person is having seizures and the more prolong the seizures, and the later that those seizures are being treated, the more serious that decline may be seen.

09:20 Schizophrenia is another diagnosis that can cause neurocognitive decline, because there is physiological changes in the brain as well as neurochemical changes.

09:37 And brain tumors.

09:38 Brain tumors or any other chronic brain injury is going to affect our ability to think, and our ability to retrieve information.