Treatment of Neurocognitive Disorder.

Treatment of Neurocognitive Disorder.

 

Neurocognitive disorders (NCD) such as delirium, dementia, and amnestic disorders are more prevalent in older adults. As the population ages and as life expectancy in the United States continues to increase, the incidence of these disorders will continue to increase. Cognitive functioning such as memory, language, orientation, judgment, and problem solving are affected in clients with NCDs.

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Caring for someone with a neurocognitive disorder is not only challenging for the clinician, but also stressful for the family. The PMHNP needs to consider not only the client but also the “family as client.” Collaboration with primary care providers and specialty providers is essential. Anticipatory guidance also becomes extremely important. In this Discussion, you will integrate several sources of knowledge specific to NCDs as you discuss evidenced-based therapies used to treat these disorders. Learning Objectives Students will: Analyze diagnostic criteria for neurocognitive disorders Analyze evidence-based psychotherapy and psychopharmacologic treatment for neurocognitive disorders Evaluate benefits and risks of neurocognitive therapies Compare differential diagnostic features of neurocognitive disorders To prepare for this Discussion: By Day 5 of Week 7, your Instructor will have assigned you a neurocognitive disorder, which will be the focus for your initial post for this Discussion.. NOTE: ( MY ASSIGNED NEUROCOGNITIVE DISORDER IS VASCULAR NEUROCOGNITIVE DISORDER ) QUESTION: Explain the diagnostic criteria for your assigned neurocognitive disorder. ( MY ASSIGNED NEUROCOGNITIVE DISORDER IS VASCULAR NEUROCOGNITIVE DISORDER ) Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned neurocognitive disorder. Identify the risks of different types of therapy and explain how the benefits of the therapy that might be achieved might outweigh the risks. Support your rationale with references to the Learning Resources or other academic resource.

Diagnostic Criteria for Vascular Neurocognitive Disorder (VaD)

Dichgans & Leys (2017) define vascular neurocognitive disorder as a condition which occurs due to blood supply disruption to the brain leading to cognitive impairment. It is also called vascular neurocognitive impairment or vascular dementia. The diagnostic criterion for VaD is specific to meeting the criteria of either major or mild vascular neurocognitive impairment (Dichgans & Leys, 2017). In the former, a client must present with all the following symptoms:  a decline in the levels of performance of major cognitive domains, the clients independence and the performance of daily life activities are due to cognitive deficits, cognitive deficits do not occur exclusively in the context of a delirium and neither are they due to other mental health disorders (Sachdev, et al., 2014).

According to Sachdev, et al., (2014), a diagnosis of mild vascular neurocognitive disorder, a client should meet the following criterion: a moderate decline in  levels of performance  of cognitive domains, cognitive deficits do not prevent independence and capability to perform activities of daily life, deficits cannot be explained by other  mental health conditions,  clinical symptoms are consistent with a vascular etiology, there is evidence of cerebrovascular disease from historical and physical assessment or neuroimaging studies, the cognitive deficits are not linked to a brain or systemic illness.

Evidence-based Psychopharmacologic Treatment and Psychotherapy for Vascular Neurocognitive Disorder

Vascular neurocognitive disorder has no cure. Therefore, psychopharmacologic treatment and psychotherapy are indicated to improve a client’s physical functioning capacity, independence and to alleviate symptoms that cause distress (Perneczky, et al., 2016). Pharmacological agents that are widely used are cholinesterase inhibitors and a drug by the name Memantine.  Memantine is indicated to regulate the activity levels of glutamate, which is a transmitter that boosts both memory and learning.  According to Sachdev, et al. (2014), atypical antipsychotics are only prescribed when a client is in severe distress, proves to be aggressive and is at risk of harming those who work or live with them.

CBT is a widely embraced psychotherapy that is used to stimulate the feelings, thoughts and emotions of these clients to influence behavior and how to engage with people. With CBT, clients can also discuss about diet modification, lifestyle modification and exercise programs.

Risks of Various Therapies and How Benefits Outweigh the Risks

Physiotherapy, occupational therapy and cognitive behavioral therapy are all recommended for patients with vascular neurocognitive disorder. The risk of occupational therapy and physiotherapy is associated with high chances of back pain and muscular pain due to physical activity (Perneczky, et al., 2016). However, since a patient is able to improve his/her physical movements and to identify areas which are impaired, it is worthy that the benefits outweigh the risks. Similarly, the major risk of emotional pain in CBT where clients remember painful past experiences cannot outweigh the benefit of being able to identify and link negative thoughts, feelings and emotions to prevent a relapse of symptoms (Perneczky, et al., 2016).

QUESTION:

Explain the diagnostic criteria for your assigned neurocognitive disorder. ( MY ASSIGNED NEUROCOGNITIVE DISORDER IS VASCULAR NEUROCOGNITIVE DISORDER )
Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned neurocognitive disorder.
Identify the risks of different types of therapy and explain how the benefits of the therapy that might be achieved might outweigh the risks.
Support your rationale with references to the Learning Resources or other academic resource.

 

 

 

PLEASE NOTE THAT THE QUESTION ASKED TO EXPLAINED DIAGNOSTIC CRITERIA FOR ASSIGNED NEUROCOGNETIVE DISORDER  AND I PUT IN PERENTESES THAT MY ASSINGED DISORDER IS ( VASCULAR NEUROCOGNITIVE DISORDER, PSYCHOTHERAPY AND PSYCHOPHARMACOLOGGIC TREATMENT.  ( IT IS MISSING CRITERIA FOR VASCULAR NEURO COGNITIVE DISORDER)

Iaboni & Rapoport (2017) define neurocognitive disorders refer to a state where mental function is decreased to due to an underlying disease as compared to a psychiatric illness and the most common type is Alzheimer’s disease. Neurocognitive disorders pose huge social, financial and physical burdens to individual patients, families and friends. In most patients, neurocognitive disorders increase severity of independence and activities of daily life. Treatment modalities include both pharmacological and non-pharmacological approaches which ensure that mental and health status are maintained (Piersol, et al., 2017). Despite the fact that drugs prescribed are highly dependent on the duration and severity of symptoms, it also depends on the symptoms that a client presents with.

Generally, the most prescribed pharmacological drugs include: antipsychotics, antidepressants, mood stabilizers, beta blockers, benzodiazepines and NMDA receptor antagonists. For instance, pharmacological drugs such as exelon, aricept and razadyne are prescribed to boost the neurotransmitter levels (Nathan & Gorman, 2015).  Memantine is prescribed to regulate the activity levels of glutamate which is a neurotransmitter that boosts learning and memory.

With reference to non-pharmacological agents, occupational therapy is the most preferred approach to management. It lays emphasis on teaching patients some of the strategies that are highly effective in minimizing the effect of brain impairment on daily life. Therefore, rather than focusing on disabilities, occupational therapy tends to focus on abilities of an individual ( Nathan & Gorman, 2015). The most commonly used is CBT   which has proven to be highly effective in teaching clients some of the strategies that are essential for the management of the effects caused by impairment with the respective diminished capacity. As suggested by Jensen & Padilla (2017), environmental modification to eliminate barriers and clusters that are likely to cause falls or impair physical functioning is also applied in clinical and home settings. As noted by Werner & Coveñas (2015), the decisions regarding treatment lie solely on the hands of either the designated decision maker of a patient or the patient and require maximum collaboration with other medical providers.

 

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