SPECIFIC GERIATRIC SYNDROME. NEUROLOGICAL DISEASES: COGNITIVE IMPAIRMENT AND DEMENTIA

Introduction:

Cognitive impairment and dementia are among the issues most important public health in developed countries.

Etiology:

■ Extrinsic factors: age-dependent diseases à psychiatric pathology, sociocultural isolation, sensory disturbances and the aging.

■ Intrinsic factors: Brain structural and functional reserve, genetic endowment…

MCI: mild cognitive impairment.

Intellectual decreased clinical appearance, although no apparent functional disability entails. In this present case this functional disability associated with cognitive impairment, dementia will denominate.

Nursing role:

-        Memory: working memory and free recall.

-        Language: decreased verbal fluency

-        Reasoning: reducing speed of information processing

-        Attention is preserved

Able to identify…

1)     Delirium: means fluctuations in mental status, and changes in the level of attention and level of consciousness.

2)     Depression: adversely affects cognitive functions, and can be confused with dementia. Patients with depression tend to have more subjective complaints of memory loss, often have psychomotor retardation and poor motivation in conducting the test.

3)     Dementia: is a syndrome that has to be understood as a decline of cognitive function.

DEMENTIA:

■ Primary degenerative dementia:

               ▪ Predominantly cortical:

○ ALZHEIMER:  it’s a progressive brain disorder characterized by degenerative changes of cortical nerve cells and brain nerve ending. This process produces an irreversible impairment of memory and intellectual functions destruction. The background cause is UNKNOWN. It’s characterized by loss of memory, deterioration of intellectual and personality change. It is classified into 3 stages:

§        initial loss of short term memory

§        medium: trouble recognizing objects and things, for activities or communicate

§        End: the patient is in a vegetative state. Loss of memory and intellectual capacity.

The definitive diagnosis is histopathological. The rating scale for Alzheimer’s disease: Reisberg Global Deterioration Scale

               ▪ Predominance corticobasal

■ Vascular dementia:

               ▪ multi-infarct dementia

               ▪ hemorrhagic dementia

■ Secondary dementias:

            ▪ metabolic

            ▪ deficiency

            ▪ endocrine

▪ infectious

▪ brain expansion mechanism

▪ drugs

▪ posttraumatic

▪ psychiatric

▪ collagen diseases

▪ deposit diseases

▪ miscellany

▪ toxic

DELIRIUM:

alteration of the level of attention, this reduced ability to focus, sustain, or shift attention.

Predisposing factors:

-        Prior cognitive impairment

-        Serious illness

-        Dehydration

-        Metabolic alterations

-        Elderly

-        Depression

-        Toxic habits

Precipitating factors:

-        Polypharmacy

-        Urinary catheter use

-        Iatrogenic

-        Physical restraint

-        Malnutrition

Valuation functional patterns by Maryory Gordon: Perform valuation obtaining a comprehensive view of patient identifying health problems to establish appropriate care plan.

Personal reflection:

This is an important issue in our country.

As nurses we must be able to detect memory lapses, cognitive performance, failure in language, reasoning, etc.

For this value the patient's medical history and carry out a valuation of nursing including rating scales.

With these patients always look carefully to make an accurate diagnosis and more specific treatment.

BIBLIOGRAPHY:

Liaño V.M. El profesional de Enfermeria y el alzheimer. Nurse investigation. 2005.
Esandi Larramendi N, Canga-Armayor A. familia cuidadora y enfermedad de alzheimer. Madrid. 2011