Chapter 23: Neurocognitive Disorders – Dementia & Care

NCDs are manifested by alterations in cognitive functioning due to underlying physiological brain pathology, encompassing delirium, mild NCD, and major NCD (dementia). Delirium is presented as an acute, often reversible medical emergency characterized by an abrupt onset, fluctuating attention, disorientation, and disorganized thinking, typically affecting lower-level cognitive functions. Nursing interventions for delirium prioritize immediate patient safety and the identification and treatment of the multifactorial underlying causes, such as infection, dehydration, or psychoactive medications. In contrast, major neurocognitive disorders are characterized by a progressive and irreversible decline in higher-level cognitive function that significantly impairs independence in daily activities. The chapter focuses extensively on Alzheimer's disease (AD), the most frequent cause of dementia, detailing its progression through mild, moderate, and severe stages. Key behavioral and neurological deficits seen in AD progression include aphasia (loss of language ability), agnosia (inability to recognize objects or people), apraxia (loss of purposeful movement), confabulation (creating stories to maintain self-esteem), and sundowning. A critical nursing skill involves differentiating between the acute, fluctuating symptoms of delirium and the insidious, chronic nature of dementia, especially when symptoms overlap with depression. Pharmacological management for AD aims to slow symptom advancement using cholinesterase inhibitors (like donepezil) to increase acetylcholine and NMDA receptor antagonists (like memantine) to regulate glutamate activity. The core of care relies on implementing person-centered approaches, ensuring environmental safety to prevent injury, and providing extensive teaching and emotional support for families coping with significant caregiver stress.