NEUROLOGIC DISEASES: COGNITIVE DETERIORATION AND DEMENTIA.

Minor cognitive alteration: intellectual decrease of clinical appearance but there isn’t functional incapacity. If would be this last, it will denominate dementia.

DETERIORATION COGNITIVE EVALUATION

  

• Memory: it loss the work memory, episodic and free memory.
• Language: it loss the denomination and decreased the verbal fluency.
• Decreased the reasoning, capacity to resolve problems and the velocity to process the information.
• It preserves the attention.
• Neurologic evaluation: level of attention, orientation, collaboration, senses, muscle tone, trembling or other moves.
•  Delirium: significant fluctuations in mental status, and changes in the level of attention and level of consciousness.
• Risk factors:

•  Serious disease, depression, alcohol, dehydration, malnutrition.
•  Iatrogenic, physical restriction, use of urinary catheter.

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

RATING SACLES:

1. Mini Mental State Examination of Folstein (MMSE)
2. Memory Impairment Screen (MIS)
3. Test seven minutes

ALZHEIMER

It is a progressive brain disorder characterized by degenerative changes of cortical nerve cells and brain nerve endings. This process produces an irreversible impairment of memory and intellectual functions destruction.

The background cause is unknown.

It is characterized by loss of memory, deterioration of intellectual and personality change.

It is classified into three stages:

First state:

• Memory: loss of memory, difficulty to remember nouns or words, loss in family ways…
• Language: decrease of communication, reduction in vocabulary, without facial expression, to say impertinences…
• Behaviour and mood: change of mood, depression, facility to distraction, necessity to look for people or places families…
• Coordination: slowing – down of reaction time, incapacity to drive.

Second state:

• Memory: unknowing about all the recent events.
• Language: repeat the same words and phrases, to speak slowly, decrease demonstration of affection, shaking, hallucination, dream alteration.
• Coordination: loss of coordination and equilibrium, difficulty to walk and write.
• Own care: necessity of help to wash, choose the cloth, fecal and urinary incontinence.

Final state:

• Memory and language: incapacity to learn new concepts, loss of memory of recent and past events, reduction of vocabulary, incapacity to read and comprehension and repeat words or phrases.
• Behaviour and mood: frequently shaking, incapacity to remember the career, difficulty to walk, write, sit down, smile or swallow.
• Own care: necessity to most help to realize the daily activities life.

It is essential that nurses remain clam when confused individuals act out. It is not easy for nurses to deal with repeated irritating or hostile behaviours, but they must remember that anger, arguments, and explanations only confuse the person and make the situation worse. Even if nurses do not say anything negative to the person, body language may communicate a lack of acceptance.

1. Gloria Hoffmann Wold. Basic Geriatric Nursing. 5^th ed. Milwaukee, Wisconsin:Elsevier; 2012