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.