Chapter 28: Cognitive Disorders in Psychiatric Nursing

Cognitive Disorders in Psychiatric Nursing defines mild cognitive impairment as a decline beyond normal aging that often serves as a precursor to more severe neurocognitive conditions. Delirium is presented as a medical emergency characterized by rapid onset and fluctuating consciousness, frequently caused by physical illness, electrolyte imbalances, or medication toxicity. In contrast, the text details irreversible dementias, with an extensive focus on Alzheimer’s disease. It explores the biologic hallmarks of Alzheimer’s, including the formation of beta-amyloid plaques and neurofibrillary tangles, as well as the genetic influence of the Apo E4 allele and mutations on specific chromosomes. Clinical manifestations such as agnosia, aphasia, amnesia, and apraxia are highlighted along with behavioral challenges like sundowning and misidentification. The discussion extends to vascular dementia’s stepwise decline resulting from small strokes, the personality shifts seen in frontotemporal lobe dementia, and the motor-cognitive overlap in Parkinson’s and Lewy body diseases. Additionally, it addresses reversible conditions like normal-pressure hydrocephalus and vitamin B12 deficiency, as well as substance-related damage like Wernicke-Korsakoff syndrome and the rapid progression of prion-based Creutzfeldt-Jakob disease. Nursing management is central to the chapter, offering strategies for therapeutic communication, nutritional maintenance, and environmental modification to ensure safety and dignity for patients who wander or struggle with activities of daily living. The pharmacological section reviews the use of acetylcholinesterase inhibitors and NMDA receptor antagonists, noting the importance of monitoring for anticholinergic effects and the complexities of off-label drug use in elderly populations with multiple comorbidities.