WEEK 10

NEURODEVELOPMENTAL INTELLECTUAL AND DEVELOPMENTAL

DISORDERS in INFANTS, DISABILITIES (IDDs)
● Intellectual disability
CHILDREN and disorder or general learning
ADOLESCENCE disability
● Formerly known as mental
retardation
NEURODEVELOPMENTAL DISORDERS
● Characterized by
● Disorders first diagnosed in infancy or
below-average intelligence or mental ability
childhood
and a lack of skills necessary for day-to-day
● Impairments of the growth and development
living.
of the brain or the central nervous system.
● Has limitations in two areas.
● Affects emotion, learning ability,
○ Intellectual functioning.
self-control and memory which unfolds as
○ Adaptive behaviors.
an individual develops and grows.
DSM
CATEGORIES OF NEURODEVELOPMENTAL
● DSM 5 - severity is defined by the ability to
DISORDERS
meet the demands of daily life, as compared
– The DSM 5 categories includes:
with peers.
● Intellectual disability disorders (IDD)
● DSM IV-TR - severity is defined by IQ test.
● Autism spectrum disorders (ASD)
● IQ TEST is use to measure human
● Attention deficit hyperactivity disorder
intelligence
(ADHD)
● Intellectual Disability is defined by an IQ
● Motor disorders
under 70
● Communication disorders
● The average IQ is 100, with the majority of
● Specific learning disorders
people scoring between 85 and 115.
● Elimination disorders
SCORING:
● 70 below – intellectually disabled
WHAT CAUSES NEURODEVELOPMENTAL
● 70- 79 – borderline/ deficiency intelligence
DISORDERS?
● 80 – 89 – dullness
● GENETIC FACTORS : such as genetic
● 90 – 109 – average or normal intellect
mutations and metabolic conditions during
● 110-119 – superior intelligence
conception.
● 120 – 140 – very superior intelligence
● PRENATAL FACTORS : such as nutritional
● 140 & above – genius or almost genius
deficiencies and maternal infections during
pregnancy.
● PERINATAL FACTORS : such as those due
to complications that arise during labor,
typically a lack of oxygen (hypoxia).
● POSTNATAL FACTORS: such as traumatic
brain injury, infections like meningitis or
exposure to environmental toxins after birth.
● SOCIAL FACTORS: Deprivation from social
and emotional care causes severe delays in
TREATMENT AND MANAGEMENT FOR ID
brain and cognitive development.
Primary goals of treatment:
● to develop the child's potential to the fullest
DIAGNOSING NEURODEVELOPMENTAL
● to allow them to participate in as many
DISORDERS
aspects of their social and community life as
— The neurodevelopmental examination provides
possible
information about how a child is learning, growing,
● Treat the underlying cause of ID
and developing over time.
- Ex: phenylketonuria - restricting
● Developmental tests
phenylalanine in the diet
● Neurologic examination
● Treat comorbid physical and mental
● Brain imaging
disorders with the aim of improving the
● Physical examination
patient's functioning and life skills.
● LABORATORY TESTS are procedures in
● Behavioral and cognitive intervention
which samples of blood, urine and other
○ special education
bodily fluid or tissues is examined to get
○ psychosocial supports
information about a child’s health

GLOBAL DEVELOPMENTAL DELAY
● It is an intellectual developmental disorder
characterized by significant delay in two or
more developmental domain.
● Diagnosed when children are less than 5
year old
● 6 main areas of development in which kids
can have delays
- Language or speech
- Vision
- Gross motor and fine motor skills
- Thinking and cognitive skills
- Social and emotional skills
- Daily skills
UNSPECIFIED INTELLECTUAL DISABILITY
● It is characterized by the
presence of associated sensory
of physical impairments, such
as blindness or prelingual
deafness; locomotor disability;
or presence of severe
behavioral problem or
comorbidity with mental disorder.
● This category should only be used in
exceptional circumstances and requires
reassessment after a period of time
● This category is reserved for children over
the age of 5 years
AUTISM SPECTRUM DISORDER
● Autism spectrum disorder is previously
categorized as one of the different types of
pervasive developmental disorders which
previously includes:
- Autistic Disorder
- Rett’s Disorder
- Childhood Disintegrative Disorder
- Asperger’s Disorder
- PDD not otherwise specified
● In DSM 5, previous PDDs such as Rett
disorder, childhood disintegrative disorder,
and Asperger disorder are now viewed on a
continuum of autism spectrum
AUTISM SPECTRUM DISORDER (ASD)
● Formerly known as mindblindness.
● It is a developmental disability
characterized by significant impairment in
social, communication and behavior
● Onset: identified usually by 12 months and
not later than 3 years old
● Incidence: 5x more prevalent in boys than in
girls
● Characteristic: impairment of reciprocal
interaction skills
● Etiology: Unknown but could be genetic or
mechanical trauma of the birth process
itself.
SIGNS AND SYMPTOMS OF AUTISM
– Each child with autism may have slightly different
symptoms.
● DIFFICULTY WITH SOCIAL
INTERACTIONS
- Unaffectionate
- Prefer to be alone
- Inappropriate attachments to objects
- Lack of interest in the environment
- Inappropriate laughing or giggling
- Upset by minor changes in routine
- Avoid eye contact
● DIFFICULTY WITH COMMUNICATION
- Difficulty in expressing needs
- Unrelated responses to questions
- Delayed or does not develop language
(echolalia)
- May not use language to communicate
instead may use gestures
- Produce abnormal intonation pronoun
reversal
● STEREOTYPE BEHAVIOR
SPAN
- S - Sustained repetitive motor movements
○ spin objects or self
○ Rocking
○ hand or finger flapping
○ body twisting
- P - Prefer sameness
○ preoccupied usually with lights,
moving objects or parts of objects
- A - Apparent insensitivity to pain
- N - No real fear of dangers
HOW IS AUTISM DIAGNOSED?
— For the first two years of life, the child should be
checked for the following:
developmental deficits:
● 12 months: No babbling, pointing, or
gesturing/ not responding to own name
● 14 months: not showing interest by pointing
to object or people
● 18 months: No single word spoken/ doesn’t
play pretend games
 ● 24 months: No two-words spoken, just ASPERGER’S SYNDROME
repeating words or sounds of others ● AS is considered to be on the mild end of
● 3 – 4 months: no eye contact the autism spectrum.
● Loss of any language or social skills at any ● Children with AS exhibit 4 primary
age symptoms:
1. Obsessive focus on a narrow topic of
HOW IS ASD TREATED? interest.
1. Reduce behavioral symptoms 2. Having difficulty with social interaction
● Reduce temper tantrums, aggressiveness, 3. Engaging in repetitive behavior
self-injury, hyperactivity and stereotyped 4. Focusing on rules and routines
behaviors ● Incidence: common among boys
- Haloperidol (Haldol) ● Onset: appears to have a later onset
- Risperidone (Risperdal) ● Some people with AS are classified as
● Diminish self-injury, hyperactivity and high-functioning.
obsessive behaviors ● High-functioning autism means they don’t
- Catapres (Clonidine) have delayed language skills and cognitive
- Anafranil (Clomipramine) development that is typical of many people
2. Promote learning and development with ASDs.
● Behavior change programs. ● Often, individuals diagnosed with AS have
- These programs teach social , movement, normal or above normal intelligence and are
and cognitive skills. They can help a child frequently able to be educated in
change behavioral problems. mainstream classrooms and hold jobs.
● Special education programs. ● AS cannot be cured. Early diagnosis and
- These focus on social skills, speech, intervention can help a child make social
language, self-care, and job skills. connections, achieve their potential, and
3. Family therapy: lead a productive life.
● Parental education
SAVANT SYNDROME
● rare condition
RETT DISORDER ● When an individual with multiple cognitive
● Rett syndrome is a rare genetic neurological disabilities has extraordinary proficiency in
and developmental disorder that affects the one isolated skill
way the brain develops, causing a
progressive loss of motor skills and speech CHILDHOOD DISINTEGRATIVE DISORDER
● Incidence: Common in girls ● Also called Heller’s Syndrome or Dementia
● Children with Rett disorder develop normally Infantialis
for the first 6 to 18 months of age, and then ● A rare condition characterized by late onset
lose skills they previously had — such as of developmental delays (or severe and
the ability to crawl, walk, communicate or sudden reversal) in language, social
use their hands. function and motor skills
● marked regression in multiple areas of
RETT DISORDER AUTISM functions after at least 2 years of normal
growth and development
Common in girls Common in boys
● Incidence: common in boys
Loss of previously Delayed/ inappropriate
● Cause: Unknown
acquired language language development
Loss of hand function Preserved hand function
Ataxia is common Ataxia is rare
Seizure is common Seizure is not common
Microcephaly Normal/ large head
Delayed physical growth Normal physical growth
& function and function
ATTENTION DEFICIT TREATMENT FOR ADHD
HYPERACTIVITY DISORDER
1. PSYCHOPHARMACOLOGY
Stimulants
ADHD
- use to reduce hyperactivity, inattentiveness,
● ADHD is a neurodevelopmental disorder
impulsivity and lability of mood
characterized by inattention, or excessive
CARDS
activity and impulsivity, which are otherwise
● C – Cylert (Pemoline)
not appropriate for a child's age
- Last drug to be prescribed due to its
● Incidence: Common among boys
hepatotoxicity (liver damage)
● Onset: Before age 6–12years
● A – Adderall (Amphetamine)
● Diagnosis: Usually identified and diagnosed
- SE: addictive
when the child begins pre-school
● R – Ritalin (Methylphenidine)
● Characterized by:
- SE: have a high potential for abuse and
- H - Hyperactivity
dependence
- I – Inattentiveness
● D – Dexedrine (Dextroamphetamine)
- D – Distractibility and impulsivity
- SE: insomnia, loss of appetite, weight loss,
irritability & increase self-injury during the
SIGNS & SYMPTOMS OF ADHD
highest dose week
● A – Academic performance is poor
Non-stimulant drugs
● D – Development of family and peer
● S – Strattera (Dapoxetine)
relationship is restrained
- help to increase the ability to pay attention,
○ Disruptive and intrusive at home
concentrate, stay focused, and stop
which causes friction with siblings
fidgeting
and parents
- an antidepressant (selective norepinephrine
● H – Hyperactive and impulsive behavior
reuptake inhibitor) approved in 2002
○ Inability to sit still
- SE: loss of appetite. N/V, fatigability,
○ Fidgets
abdominal distress
○ talks excessively
○ run or climbs excessively
2. PSYCHOTHERAPY AND PSYCHOSOCIAL
○ often on the go
INTERVENTIONS
○ blurts out answers/interrupts
● Behavioral therapy
conversation
- aims to help the child change his/her
● D – Difficulty sustaining attention and
behavior
concentration
● Cognitive behavioral
○ misses details
- therapy aims to teach the child mindfulness
○ Doesn’t seem to listen
techniques to improve focus and
○ Easily distracted
concentration.
○ Often forgetful in daily activities
● Specific behavioral
○ Often losses necessary things
- classroom management interventions aims
○ severe – 2 to 3 seconds and mild – 2
to help the child manage his/her symptoms
to 3 minutes
and improve his/her functioning at school
○ Makes careless mistakes in school
and with peers.
works
● Support groups
○ Has difficulty with organization
- aims connect with others who have similar
○ Avoids task requiring mental effort
problems and concerns
Causes:
● Parenting education
● Both genetic and environmental factors
- Family and marital therapy aims to help
Diagnostic method:
family members and spouses find better
● Based on symptoms after other possible
ways to handle disruptive behaviors, to
causes were ruled out
encourage behavior changes, and improve
Treatment:
interactions with the patient.
● Medication, behavioral interventions,
- Parenting skills training aims to teach
special education and parental education
parents the skills needed to encourage and
reward positive behaviors in their children.
 CAUSES OF ADHD
● Brain anatomy and function. A lower level
of activity in the parts of the brain that
control attention and activity level may be
associated with ADHD.
● Genes and heredity. ADHD frequently runs
in families.
● Prematurity increases the risk of
developing ADHD.
● Prenatal exposures, such as alcohol or
nicotine from smoking, increase the risk of
developing ADHD.
● Toxins in the environment may lead to
ADHD in rare cases.
NURSING INTERVENTIONS FOR ADHD
1. Ensure safety of client and that of others
● Stop unsafe behavior
● Provide close supervision
● Give clear directions about acceptable and
unacceptable behavior
2. Improved role performance
● Give positive feedback for meeting
expectations
● Manage the environment (ex: provide a
quiet place free of distractions for task
completion
3. Simplifying instructions/directions
● Get child’s full attention
● Break complex tasks into small steps
● Allow break
4. Structured daily routine
● Establish a daily schedule
● Minimize changes
5. Client/family education and support
● Listen to parent’s feelings and frustrations
MOTOR DISORDERS
DSM 5 classification of Motor Disorders
includes:
1. Developmental Coordination Disorder
2. Stereotypic Movement Disorder
3. Tic Disorder
● Provisional Tic Disorder
● Persistent (Chronic) Motor or Vocal Tic
Disorder
● Tourette’s Disorder
● Other Specified Tic Disorder
● Unspecified Tic Disorder
1. DEVELOPMENTAL COORDINATION
DISORDER
● Also known as motor skills disorder,
motor coordination disorder or motor
dyspraxia
● It is diagnosed when motor skills problems
significantly interfere with academic
achievement or activities of daily living.
● Onset: may be first identified when the child
is a preschooler or kindergartner
● Impairment can be extremely disabling both
in academic settings (school) as well as in
everyday life due to impairment of
functioning
SIGNS AND SYMPTOMS
● Children with this disorder have variable
symptoms, depending on the age of
diagnosis
● Young infants may present with non-specific
findings, such as hypotonia (floppy baby) or
hypertonia (rigid baby).
● Older infants may be delayed in their ability
to sit, stand or walk.
● Toddlers may have difficulty feeding
themselves.
● Older children may have a hard time
learning to hold a pencil, and tend to knock
over drinking glasses more often than
expected.
● As children with this disorder age, they often
avoid physical activities, especially those
requiring complex motor behaviors
TREATMENT
● Multimodal treatment that involves
occupational therapy and physical therapy
to improve their motor skills
● Special gym activities at school to promote
hand-eye coordination, motor development
and improve specific skills.
● Medical treatment which includes screening
and management for potential comorbid
conditions such as:
- Speech and language disorders
- Tourette's syndrome
- ADHD
- Mood disorders
- Psychosis
- Autism spectrum disorders
- Developmental disabilities
- Learning disorders.
2. STEREOTYPE MOVEMENT DISORDER.
● Characteristics: repetitive, purposeless
movements that is non-functional thus
interfere with the normal daily activities or
may results in self-injury.
● Stereotypic movements may include:
- Body rocking
- Biting fingernails
- Biting oneself
- Twirling self
- Twirling objects
- thumb sucking
- teeth grinding
- nose picking
 - breath holding ● Characteristic: Rapid, recurrent,
- air swallowing uncontrollable movements or vocal outburst
● Onset: First seen within the first three years (but not both)
of life ● Affect less than 1% of children and may be
related to a more complex tic disorder called
CAUSES Tourette's disorder.
● Cause: Unknown To be diagnosed, a person must:
● Genetic factor ● Have one or more motor tics or vocal tics
● Social isolation may lead to self-stimulation but not both.
in the form of stereotypic movements ● have tics that occur many times a day
● Environmental stress, such as difficulty in nearly every day or on and off throughout a
school or at home period of more than a year.
● Due to certain medications ● have tics that start before age 18 years.
● Head injury ● have symptoms that are not due to taking
medicine or having other medical conditions
TREATMENT OF STEREOTYPE MOVEMENT that can cause tics
DISORDER ● not have been diagnosed with Tourette
● Behavioral strategies - to reduce repetitive syndrome
movements and minimize the risk for
self-harm. TOURETTE’S DISORDER
● Differential Reinforcement is a therapy to Diagnostic criteria:
modify the child’s behavior through positive ● Have two or more motor tics and at least
reinforcement one vocal tic although they might not always
● Medical treatment - focus on screening and happen at the same time.
managing potential comorbid conditions ● Have had tics for at least a year. The tics
can occur many times a day (usually in
3. TIC DISORDERS bouts) nearly every day, or off and on.
● Tic disorder is characterized by a sudden, ● Have tics that begin before age 18 years.
rapid, recurrent, non-rhythmic, stereotyped ● Have symptoms that are not due to taking
motor movement or vocalization medicines or having other medical condition
● Example of (Ex: seizures, Huntington disease or
motor tics post-viral encephalitis
- Blinking ● Onset: between ages 2 and 15, with the
- neck jerking average being around 6 years of age.
- Grimacing ● Incidence: Males are about 3-4 x more
- Coughing likely than females
- shoulder shrugging Treatment:
● Example of vocal tics ● Psychotherapy- to improve school, work or
- clearing of the throat social life
- Grunting ● Medication: clonidine, neuroleptics,
- Sniffing ● Treat comorbid disorders
- snorting ● Deep brain stimulation

PROVISIONAL TIC DISORDER Common motor tics seen in Tourette syndrome

● Previously known as TRANSIENT TIC
DISORDER
Simple tics Complex tics
● Characterized by single or multiple vocal or
motor tics, but for no longer than 12 months Eye blinking Touching or smelling
● Have tics that start before age 18 years. objects
● Provisional tics go away by themselves in Head jerking Repeating observed
less than a year. However, some may get movements
worse with anxiety, tiredness, and some Shoulder shrugging Stepping in a certain
medications. pattern
● Affects up to 10 % of children during the Eye darting Obscene gesturing
early school years.
Nose twitching Bending or twisting
PERSISTENT TICS DISORDER Mouth movements Hopping
● Also known as CHRONIC MOTOR OR
VOCAL TIC DISORDER
Common vocal tics seen in Tourette syndrome
Simple tics Complex tics
Grunting Repeating one's own
words or phrases
Coughing Repeating others' words
or phrases
Throat clearing Using vulgar, obscene or
swear words
Barking
COMMUNICATION DISORDERS
COMMUNICATION DISORDERS
● Communication disorders involve persistent
problems related to language and speech.
Language competence involves two main
elements
1. PRODUCTION - ability to encode one's
ideas into language forms and symbols.
2. COMPREHENSION - ability to understand
meanings that others have expressed using
language.
● Speech refers to production of sounds
produced orally.
TYPES OF COMMUNICATION DISORDERS
— DSM 5 Classification of Communication
disorders includes:
1. Language disorder
2. Speech sound disorder
3. Childhood-onset fluency disorder
4. Social (pragmatic) communication disorder,
LANGUAGE DISORDER
● Previously known as expressive and mixed
receptive-expressive language disorders
● involves deficits in language production or
comprehension causing limited vocabulary
and an inability to form sentences or have a
conversation
● Onset: Symptoms first appear in the early
developmental period when children begin
to learn and use language
● Cause: genetic and could be associated
with other neurodevelopmental disorders
● Treatment: Speech and language therapy
and Psychotherapy
SPEECH SOUND DISORDER
● Previously known as PHONOLOGICAL
DISORDER
● Characterized by persistent difficulty
producing words or sounds correctly
● Onset: Symptoms begin early in life
● Cause: Unknown but could be genetic
● Treatment: Speech and language therapy.
CHILDHOOD-ONSET FLUENCY DISORDER
● Previously known as stuttering
● It is a disturbance of fluency and patterning
of speech with sound and syllable repetition
● Onset: between the ages of 2 and 7, with
80 to 90 percent of cases developing by age
6.
● Symptoms can be exacerbated by stress,
anxiety, or feeling self-conscious
● Cause: Unknown
● Treatment: Speech and language therapy
and CBT
SOCIAL COMMUNICATION DISORDER
● It is a new condition described in DSM 5
● Also called pragmatic communication
● Characterized by persistent difficulties in the
social uses of verbal and nonverbal
communication
● Symptoms: problems in understanding and
using language for social purposes
● Cause: Unknown
● Treatment: Speech-language therapy to
promote social communication skills
SPECIFIC LEARNING DISORDER
● Also referred to as LEARNING DISORDER
or LEARNING DISABILITY,
● It is characterized by problems in one of
three areas, reading, writing and math,
which are foundational to one’s ability to
learn.
● Onset: begins during school-age
● Cause: Unknown
● Treatment: Special education in school and
CBT
Diagnostic criteria:
– The child have difficulties in at least one of the
following areas for at least six months despite
targeted help:
● Difficulty reading
● Difficulty understanding the meaning of
what is being read
● Difficulty with spelling
● Difficulty with written expression
● Difficulty understanding number concepts,
number facts or calculation
● Difficulty with mathematical reasoning
ELIMINATION DISORDERS NURSING PROCESS FOR CHILDREN
WITH NEURODEVELOPMENTAL
ELIMINATION DISORDERS DISORDERS
● Characterized by
inappropriate elimination of
NURSING DIAGNOSIS SAMPLE
urine or feces
● Risk for injury
● Onset: usually first
● Impaired verbal communication
diagnosed in childhood or
● Impaired social interaction
adolescence.
● Impaired physical mobility
● Self care deficit
ENURESIS
● Ineffective impulse control
● Commonly known as BEDWETTING.
● Impaired bladder elimination
● Characterized by repeated voiding of urine
● Constipation
into inappropriate places
● Bowel incontinence
● NOCTURNAL ENURESIS - bedwetting at
night, is the most common type of
NURSING CARE FOR CHILDREN WITH
elimination disorder.
PSYCHIATRIC DISORDERS
● DIURNAL ENURESIS
daytime wetting
Ensuring the child’s safety
Diagnosed: when the child
● Stop unsafe behavior.
is 5 years or older
● Provide close supervision.
● Cause: Medical
● Give clear directions about acceptable and
conditions, stress, developmental delays
unacceptable behavior.
● Treatment: Urine alarm, bladder training
Improved role performance
and reward
● Give positive feedback for meeting
expectations.
ENCOPRESIS
● Manage the environment by provide a quiet
● Also known as stool soiling or fecal
place free of distractions for task completion
incontinence
Simplifying instructions/directions
● Characterized by repeated passage of feces
● Get child’s full attention
into inappropriate places
● Break complex tasks into small steps.
● Diagnosed: children ages
● Allow breaks.
4 and older who have
● Step by step instructions
already been toilet trained.
Structured daily routine
● Incidence: affects boys
● Establish a daily schedule.
more than girls
● Minimize changes.
● Cause: chronic
Client/family education
constipation
● Educate family members about the
● Treatment: Manage constipation, behavior
disorders and on the medications the child
modification
is taking.
● Offer emotional support
TREATMENT FOR ELIMINATION DISORDERS
● Arrange for family counseling to help
parents better understand the disorder. This
also assist them with their coping
mechanisms.
● Provide referrals for early intervention and
special education programs to increase
child’s capacity to learn, communicate, and
relate to others.
NURSING CARE TIPS FOR CHILDREN WITH ● Help the child accept responsibility for
AUTISM SPECTRUM DISORDER behavior rather than blaming others,
● Choose words carefully when speaking to becoming defensive, and wanting revenge.
verbal autistic child because they are likely ● Use role-playing so he can practice ways of
to interpret words concretely. handling stress and gain skill and
● Advise parents to have close, face-to-face confidence in managing difficult situations.
contact with child to promote ● Instruct patients on how to deal with child’s
communication. demands. This might include learning how
● Maintain a regular and predictable daily to
routine to prevent outbursts. Prepare child
for changes of routine.
● Educate parents on behaviors that signal
tantrums such as increased hand flapping.
Emphasize the importance of intervening
and anticipating needs before a tantrum
occurs.
● Advise patients on ways to provide a safe
environment for the child (e.g. installing
locks and gates).
● Educate family members on the
medications (e.g. stimulants, selective
serotonin reuptake inhibitors, lithium, etc.)
the child is taking.
● Offer emotional support and information to
parents.
● Arrange for family counseling to help
parents better understand the disorder. This
also assist them with their coping
mechanisms.
● Provide referrals for early intervention,
home care assistance, and support groups,
as needed. Early intervention and special
education programs increase child’s
capacity to learn, communicate, and relate
to others. This also reduce the severity and
frequency of disruptive behaviors. Special
schools for behavior modification is alright
but educational mainstreaming is preferred.

NURSING CARE TIPS FOR CHILDREN WITH

ADHD
● Establish a trusting relationship with child
and family by conveying your acceptance.
● Provide clear behavioral guidelines,
including consequences for disruptive and
manipulative behavior.
● Talk to the child about making acceptable
choices.
● Teach child on effective problem-solving
skills, and have him or her demonstrate
them in return.
● Identify abusive communication (e.g.
threats, sarcasm, and disparaging
comments). Encourage child to stop using
them.
● Teach child on constructive methods of
releasing negative feelings to express anger
appropriately.
 WEEK 11 ● HYPOYGLYCEMIA
- low blood sugar can lead to temporary
NEUROCOGNITIVE
impairment in memory. In most cases,
DISORDERS memory should improve back to normal
soon after the sugar levels return to normal.
● HYPERGLYCEMIA
NEUROCOGNITIVE DISORDERS - high blood sugar has been linked with
● Formerly called COGNITIVE DISORDER longer term effects on memory
● It occurs when there is impairments or ● GENERAL MEDICAL CONDITION
disruptions in cognitive functions that - Seizures
interferes with normal functioning of an - Head trauma/injuries (closed and
individual. penetrating)
- Brain tumors
MEDICAL ASSESSMENT AND DIAGNOSTIC - Brain inflammation
PROCEDURES - Hypoxia/Anoxia
● Medical history - Multiple Sclerosis
● Physical exam - ECT
● Neurological tests - Neurotoxins
● Laboratory screening tests ● SUBSTANCE-INDUCED PERSISTING
● Brain scans AMNESTIC DISORDER
- CT scan - Ingestion of a substance.
- MRI - Benzodiazepines and other
- PET sedative-hypnotics
- SPECT - Over the counter medications
(antihistamines, cough syrups)
TYPES OF NEUROCOGNITIVE DISORDERS - Specific substance should be recorded
● DSM IV-TR when coding (i.e., cocaine-induced
● ADD + C persisting amnestic disorder).
○ Amnestic Disorder - Can code as “unknown” substance-
○ Delirium induced
○ Dementia ● TRAUMA OR STRESS
○ Cognitive disorders - Severe psychological trauma or stress can
● DSM 5 cause DISSOCIATIVE
● DMM DISORDERS/DISSOCIATIVE AMNESIA.
○ Delirium - Formerly known as PSYCHOGENIC
○ Major Neurocognitive Disorder AMNESIA
(Dementia) - Example: being the victim of a violent crime,
○ Mild Neurocognitive Disorder rape
- With this condition, the mind rejects
1. AMNESTIC DISORDER thoughts, feelings, or information that are
● Amnestic disorder can also be simply called too overwhelmed to handle.
AMNESIA Types of dissociative disorder
● Characterized by disturbance in memory ● Dissociative amnesia
that can be temporary or permanent. ● Dissociative identity disorder
● It can be caused by damage to areas of the ● Dissociative fugue
brain that are vital for memory processing.
○ Left brain hemisphere DISSOCIATIVE AMNESIA CAN ALSO BE
○ Hippocampus CLASSIFIED AS:
○ Cerebral cortex ● Localized amnesia
- No memory of a specific traumatic event
CAUSES OF AMNESTIC DISORDERS that took place
● ALCOHOL ABUSE ● Selective amnesia
- Short-term alcohol use can cause - Remember only selective part/s of events
BLACKOUT. This is a temporary form of that occurred in a defined period of time
anterograde amnesia. ● Generalized amnesia
● Long-term alcoholism can cause - Complete amnesia for one’s whole life
WERNICKE- KORSAKOFF SYNDROME
(ALCOHOL DEMENTIA).
 TYPES OF MEMORY IMPAIRMENT ● DTs usually lasts for 2 to 3 days, but
symptoms may linger for as long as a week.
1. ANTEROGRADE AMNESIA ● About 5% of people in alcohol withdrawal
● Is forgetting recent memories or inability to get DTs. If untreated, delirium tremens can
form new memories. cause a heart attack, stroke, and death.
● Can be temporary:
- Ex: blackout caused by too much alcohol. SYMPTOMS OF ALCOHOL WITHDRAWAL
● Can be permanent: ● 3 – 24 hrs. after the last drink – called
- Ex: One can experience it if the “The SHAKES” or “Mild Tremors”
hippocampus is damaged because - S – sweating
hippocampus plays an important role in - H – hypertension, and increased pulse and
forming memories. heart rate
- A – anxiety, confusion, agitation
2. RETROGRADE AMNESIA - K–none
● Is forgetting further events or inability to - E - excessive vomiting/ nausea
recall existing or, previously made - S – seizures/ tremors / startled behavior
memories. ● 36 – 72 hrs. after the last drink – results to
● Affect recently formed memories first. “DELIRIUM TREMENS” - hallucination (48
Older memories, such as memories from hours)
childhood, are usually affected more slowly.
Diseases such as dementia cause gradual 3. DEMENTIA
retrograde amnesia.
MAJOR NEUROCOGNITIVE DISORDER
WERNICKE-KORSAKOFF SYNDROME ● previously called DEMENTIA
● Also known as ALCOHOL DEMENTIA ● It is a condition in which higher brain
● It is a set of neurological conditions that functions are impaired as a result of
result from THIAMINE (Vitamin B1) neuronal damage.
DEFICIENCY. ● It is characterized by impairments in
● Wernicke's syndrome/encephalopathy memory, speech, reasoning, intellectual
represents the "acute" phase function, and/or spatial-temporal
● Korsakoff's syndrome represents the awareness.
"chronic" phase.
MILD NEUROCOGNITIVE IMPAIRMENT (MCI)
● Describe deficits that are more severe than
2. DELIRIUM are seen with normal aging but are
● Characterized by serious disturbance in insufficient to warrant a diagnosis of
mental abilities that results in confused dementia
thinking and reduced awareness of the ● Nevertheless, patients with MCI have an
environment. increased risk (approximately 10% per year)
● The disturbance of awareness tends to of developing dementia
develop over hours to days, and typically
fluctuates in the course of the day, often DIFFERENCE OF MAJOR & MILD
worsening in the evening. NEUROCOGNITIVE DISORDER
MAJOR MILD
CAUSES OF DELIRIUM NEUROCOGNITIVE NEUROCOGNITIVE
● Medical condition DISORDER IMPAIRMENT
● Substance intoxication 1.There is significant 1.There is modest
● Substance withdrawal (delirium tremens) decline in a cognitive cognitive decline in a
● Exposure to neurotoxins function as assessed by cognitive function as
● Combination of these factors a clinician, reported by assessed by a clinician,
significant person, etc. reported by significant
DELIRIUM TREMENS person, etc.
● Also known as ALCOHOL WITHDRAWAL 2. Cognitive deficits 2. Cognitive deficits do
DELIRIUM (AWD), interfere with daily not interfere with capacity
activities for independence in daily
● A severe type of withdrawal from alcohol. activities
● Symptoms appear 2 to 4 days after the last
3. Cognitive deficits do 3. Cognitive deficits do
drink, But some symptoms may not show up not occur not occur
until up to 10 days after giving up alcohol. exclusively in the context exclusively in the context
of a delirium of a delirium
4. The cognitive deficits 4. The cognitive deficits B. CREUTZFELDT-JACOB DISEASE (CJD)
are not better explained are not better explained - also known as subacute spongiform
by another mental by another mental encephalopathy or neurocognitive disorder
disorders disorders due to PRION DISEASE
- Early symptoms include memory problems,
FACTORS that CAUSES DELIRIUM and behavioral changes, poor coordination, and
DEMENTIA visual disturbances.
- Later symptoms include dementia,
DELIRIUM involuntary movements, blindness,
● PHYSIOLOGICAL AND METABOLIC weakness, and coma.
CONDITIONS - About 70% of people die within a year of
HE iS BRAVE diagnosis. - Onset- 40-60.
- H- Hypoxemia 3. SUBSTANCE-INDUCED DEMENTIA
- E- Electrolyte imbalance - dementia is related to the persistent or
- iS- Sleep disturbances prolong use of:
- B- Brain tumor - Alcohol
- R- Renal/Hepatic failure - Inhalants, sedatives, hypnotics and
- A- Any head injury anxiolytics
- V- Vitamin deficiency - Medication such as anticonvulsants.
- E- Exposure to noxious substances (paints, - Toxins such as lead, mercury, carbon
solvents, insecticides) monoxide insecticides, and industrial
● INFECTIONS solvents.
Systemic PUS 4. DEMENTIA DUE TO HEAD TRAUMA
- P – Pneumonia - A head trauma is any sort of injury to the
- U – UTI brain, skull, or scalp. Common head injuries
- S – Sepsis include concussions, skull fractures, and
Cerebral HEMS scalp wounds.
- H – HIV - A traumatic brain injury (TBI) can increase
- E – Encephalitis the risk of dementia by 80 percent, even 15
- M – Meningitis years after an accident.
- S – Syphilis - A concussion or other traumatic brain injury
● DRUG RELATED (TBI) can increase the risk of developing
Drug Withdrawal HAS dementia even 30 years later, according to
- H – Hypnotics a 2018 study.
- A – Anticholinergics 5. DEMENTIA DUE TO GENETIC FACTOR
- S – Sedatives ● HUNTINGTON’S DISEASE
Drug Intoxication LASH - an inherited, dominant gene disease that
- L – Lithium involves cerebral atrophy and enlargement
- A – Anticholinergics of the brain ventricles.
- S – Sedative characterized by:
- H – Hypnotics - choreiform movements (facial contortions,
twisting, turning and tongue movements),
DEMENTIA - personality changes, memory loss,
1. MEDICAL CONDITIONS: - decreased intellectual functioning and other
- Fluid and electrolyte imbalances signs of dementia
- Cardiopulmonary insufficiency - Symptoms can develop at any time, but
- Endocrine disorders they often first appear when people are in
- Renal/hepatic failure their 30s or 40s.
- Vascular Diseases - If the condition develops before age 20, it's
● VASCULAR DEMENTIA called juvenile Huntington's disease.
- CT/MRI shows multiple vascular lesions of 6. DEMENTIA DUE TO DECREASE
the cerebral cortex and sub-cortical METABOLISMS AND FUNCTIONS IN THE BRAIN
Structures resulting to decrease Blood
supply to the brain ALZHEIMER’S DISEASE
2. INFECTIOUS DISEASE ● progressive mental deterioration due to
A. HIV INFECTION neurofibrillary tangles and senile plaques
- Characterized by mild sensory impairment deposit in the nerve cells
to gross memory and cognitive deficits to ● It is the most common cause of premature
severe muscle dysfunction senility that can occur in middle or old age.
 ● Onset is insidious followed by rapid
changes in functioning characterized by:
a. Increase decline in functioning: loss of
speech and motor function
b. Profound personality and behavioral
changes:
- delusion
- Hallucination
- paranoia
- inattention to hygiene, etc.
● Late onset (after 65 years old) average
duration of 8-10 years
DIAGNOSING ALZHEIMER’S DISEASE
● CT, MRI, PET, SPECT Scans show atrophy
of cerebral neurons, senile plaque deposits
and fibrillary tangle resulting to enlargement
of the 3rd and 4th ventricles of the brain.
EPIDEMIOLOGY
● In 2020, as many as 5.8 million Americans
were living with Alzheimer’s disease.
● Younger people may get Alzheimer’s
disease, but it is less common.
● The number of people living with the
disease doubles every 5 years beyond age
65.
● This number is projected to nearly triple to
14 million people by 2060.1
● Symptoms of the disease can first appear
after age 60, and the risk increases with
age.
PARKINSON’S DISEASE
● Due to loss of dopaminergic neuron in the
substantia nigra
● Characterized by impaired movements such
as tremor, rigidity, motor slowing,
bradykinesia, postural instability.
● Other symptoms include impaired cognitive
functions, memory and executive
functioning.
PICK’S DISEASE
● degenerative brain disease that affects the
frontal and temporal lobes resulting to
clinical picture similar to Alzheimer’s
disease.
● This disease is one of many types of
dementias known as frontotemporal
dementia (FTD) caused by frontotemporal
lobar degeneration (FTLD).
● Early manifestations includes loss of social
skills and inhibitions, emotional blunting and
language abnormalities
● Later manifestations includes difficulty with
language, behavior, thinking, judgment, and
memory and personality changes.
● Onset is commonly seen in adults aged 50-
60; death occurs 2 -5 years.
LEWY BODY DEMENTIA
● "Lewy body disease is one of the most
common causes of Dementia in the elderly.
● Lewy body disease exists either in pure
form or in conjunction with other brain
changes, including those typically seen in
Alzheimer's disease and Parkinson's
disease thus hard to diagnose because
these diseases have similar symptoms.
● Scientists think that Lewy body disease
might be related to these diseases, or that
they sometimes happen together.
● The disease usually begins between the
ages of 50 and 85 and gets worse over
time.
● The disease has no cure thus treatment
focuses on drugs that help reduce
symptoms."
STAGES OF DEMENTIA
STAGE I - MILD
● last 2 – 4 years
- F – Forgetfulness
- O – Occupational & social setting is less
enjoyable
- L – Losses objects frequently
- D – Difficulty finding words
STAGE II - MODERATE
● may last several years
- C – Confusion is apparent
- O – Oriented to person, time & place
- P – Progressive memory loss
- R – Requires assistance to perform tasks
because the client losses ability to live
independently
- A – Ability to recall information is loss
(address, number
STAGE III - SEVERE
● nursing home care or hospital facility is
needed
- P – Personality changes
- ​> Anger, irritability, loss of inhibitions,
hypersexualities, vulgarities
- O– Obvious loss of memory as manifested
by aphasia, anomia, agnosia, etc.
- W – Wanders at night and difficulty to go
back home (get lost) due to memory loss
and confusion
- E – Even name of spouse and children can’t
recall
- R – Requires assistance for ADL
 NURSING PROCESS cannot perceive underestimate risks
DELIRIUM DEMENTIA potentially harmful and unrealistically
situations) appraise their
HISTORY - medical illness, - medical and drug
abilities resulting to
prescribed history
high risk for injury)
medications, - mental status
alcohol, illicit drugs, examination can ROLE & - clients are unlikely ROLE
OTC. provide information RELATIONSHI to fulfill their roles - work performance
- Perform 4AT about the client’s PS during the course is greatly affected
cognitive abilities of delirium however because of memory
they may regain and cognitive deficits
MOTOR Hyperkinetic APRAXIA – loss of
delirium their previous level RELATIONSHIP
BEHAVIOR ability to perform - results to “Role
- hyperactive, of functioning
purposeful activities reversal”
motor restlessness despite intact motor
Hypokinetic abilities SELF-CONCE clients may feel - Client may be angry
delirium - neglect personal PT guilt, shame and or frustrated with
- sluggish and hygiene humiliated and this themselves for
lethargic may result to long- misplacing objects or
Mixed delirium term problems with forgetting important
- fluctuating self- concept, if things OR angry to
behavior delirium has others for taking their
L - Loud, rapid and APHASIA- inability resulted from things
SPEECH
scream alcohol, illicit drug - Client may be
to understand and
I - incoherent, use or overuse of depressed for getting
express language
irrelevant prescribed old and losing their
ECHOLALIA –
P - perseveres on a repetition of the medications functioning
single topics and words PHYSIOLOGIC Sleep Disturbances N - Nap during the
confabulate of others and SELF- - daytime day and wander at
- pressured speech PALILALIA – CARE sleepiness night (sleep pattern
involuntary repetition CONSIDERATI - nighttime agitation disturbance)
of words, syllables, ON Eating and I - ignore internal
phrases or sounds elimination cues,hunger or thirst
slurred speech and disturbances C – can’t bath, dress
total loss of language - ignore or fail to and groom
function during the perceive internal themselves
late stage body cues such as E - experience bowel
hunger, thirst, and and bladder
THOUGHT - disorganized L - loss of cognitive elimination incontinence and
PROCESS and thought process functions
difficulty cleaning
CONTENT - thought content is Ex: inability to solve
themselves after
fragmented and problems, take
elimination
illogical actions and perform
- delusions tasks such as
believing that their planning, budgeting, DELIRIUM DEMENTIA
altered sensory decision making, - is characterized by - is characterized by co
perceptions are sequencing, disturbance of deficits primarily memory
real monitoring or stop consciousness and impairment develops
complex behavior cognitive abilities that gradually
I - impaired abstract develops rapidly over a short
thinking period of time.
D - delusions of
iS – Sensorium is clouded - Sensorium is clear
persecution as
- altered level of - forgetfulness (primary
dementia progresses
consciousness (primary sign)
INTELLECTUA Cannot focus, AGNOSIA – inability sign) - Impairment of attention
L sustain or shift to recognize objects - inability to think clearly and only in severe stage
PROCESSES attention effectively and person concentrate dementia
ANOMIA – inability - confusion, impaired
- Loss of recent to remember names attention
and remote of everyday objects
R – Reversible usually cause - Irreversible/Some
memory - attention and
by general medical reversible. Usually caused
concentration is
conditions, medications by neurologic or other
impaired
intoxication or withdrawal, medical conditions
Loss of recent
etc.
memory then remote
memory A – Acute onset (rapid onset - Gradual/ Progressive.
and short duration), Duration: years to years
JUDGMENT - impaired - impaired judgment
Duration: days to weeks
judgment (client (they may
P – Perception & thought - Perception is impaired bathroom if client - checking and
process is impaired H- H- Hallucination (V) does not make changing pads
hallucination (V & T) I - illusion requests frequently to avoid
I- Illusion P – Paranoia 4. Encourage some infection
D - Delusion – Prognosis is (persecutory delusion) exercise during 4. Encourage mild
good - Prognosis is poor day like sitting, physical activities
walking in hall, or such as walking
I – Involve young and old - Involve older adult other activities
- Inappropriate , slow and or elderly people client can manage
frequently incoherent speech
- Struggle to find the
appropriate word
DELIRIUM Manage client’s 1. Provide structured
D – Disorientation to time - Orientation to person,
- Acute confusion, environment and
(date) and place though time and place then
confusion disturbed routine
sometimes variable deteriorate at the later
- Disturbed thought process - Provide familiar
stage
sensory and surrounding and
S – Sundowning – - Sundowning – symptoms perception misconceptions routine to help
symptoms always almost worse at night - Disturbed 1. Approach client eliminate confusion
worse at night thought calmly and speak and promote role
processes in a clear low voice performance
and use simple 2. Promote social
NURSING DIAGNOSIS & INTERVENTIONS DEMENTIA words interaction
- Ineffective 2. Allow adequate - staying socially
DIAGNOSIS DELIRIUM DEMENTIA role time for client to engaged with friends
Risk for injury Promote client’s Promote client’s performance comprehend and and family has been
safety safety - Impaired respond shown to boost self
1. Teach client to 1. Offer self and social 3. Allow client to esteem
request assistance support in interaction make decision 3. Provide emotional
for activities performance - Impaired when able support
(getting out of bed, of ADL and preserve verbal 4, Provide orienting - show acceptance,
going to the client’s dignity communicatio cues such as be kind and
bathroom) 2. Avoid n calling client by respectful
2. Provide close environmental - Impaired name, placing - convey
supervision to triggers such as memory calendar and clock reassurance by
ensure safety strangers, or in the client’s approaching
during performance changes in daily room, introducing client in a calm and
of ADL routine to prevent self when supportive manner
3. Respond anxiety and talking - use supportive
promptly to client’s suspicion which may 5. Use supportive touch when
call for lead to agitation or touch if appropriate appropriate
assistance erratic behavior that 6. Reduce 4. Promote
compromise safety. environmental interaction and
stimulation such as involvement
noises, tv, radio, - Plan activities
Promote sleep, visitors, etc. to according to client’s
- Disturbed Promote adequate
proper nutrition, reduce client’s interest and abilities
sleep pattern sleep, proper
Hydration, confusion - Reminisce with
- Risk for fluid nutrition, hydration,
7. Provide well
volume deficit elimination, and elimination and client about the past
activities lighted environment - If client is
- Risk for hygiene , and activity
to minimize nonverbal, remain
imbalance
1. Monitor sleep environmental alert to
nutrition: less 1. Monitor sleep
pattern. misperceptions nonverbal cues
than body pattern
- Discourage (illusions) - Employ techniques
requirements - Daily physical
daytime napping activity helps client of distraction, time
to help sleep at to sleep at night away,going along
night 2. Monitor food and and reframing to
2. Monitor fluid and fluid intake, calm clients who are
food intake. - Provide assistance agitated, suspicious
- Provide prompts to eat and drink or confused
assistance to adequate amounts of
eat and drink food and fluids
adequate amounts 3. Monitor elimination
of food and fluids pattern
3. Monitor - Remind client to
elimination pattern. urinate; - provide
- Provide periodic pads or diapers as
assistance to needed;
 DISTRACTION – rechanneling client’s attention - QUETIAPINE (Seroquel)
and energy to a more neutral topic. ● Mood stabilizer to stabilize affective lability
TIME AWAY – leaving the client for a short period and to diminish aggressive outburst
and then returning to them to re-engage in - LITHIUM CARBONATE
interaction - VALPROIC ACID (Depakote)
GOING ALONG – providing emotional reassurance - CARBAMAZEPINE (Tegretol
to clients without correcting their misperception or 3. CHOLINESTERASE INHIBITOR
delusion ● Slow the progression of dementia
Ex: “There’s no need to worry; the children are just ● Cholinesterase inhibitors, also called
fine” acetylcholinesterase inhibitors, block the
REFRAMING - offering explanations for events or normal breakdown of acetylcholine.
situations ● Acetylcholine is the main neurotransmitter
Ex: “The lady has many problems, and she yells found in the body and functions in both
sometimes because she’s frustrated peripheral and central nervous system
CARE
OUTCOME ● C - COGNEX (Tacrine)
- 40-160 mg orally/day divided into 4 doses
DELIRIUM DEMENTIA - monitor liver enzymes for hepatotoxic
• The client will be: effects
The client will be:
• Free of injury. - monitor for flu-like symptoms
• Free of injury.
• Demonstrate increased • Maintain an adequate ● A - ARICEPT (Donepezil
orientation and reality balance of - 5 -10 mg orally/day
contact. activity and rest. - monitor for nausea, diarrhea and insomnia
• Maintain an adequate • Maintain adequate - Test stole periodically for GI bleeding
balance of activity and nutrition and fluid
● R - REMINYL (Galantamine)
rest. balance.
• Maximize his/her level of - 16-32 mg orally/day divided into 2 dose
• Maintain adequate
nutrition and fluid balance. functioning - monitor for nausea, vomiting, loss of
• Return to his or her appetite, dizziness and syncope
optimal level of ● E - EXELON (Rivastigmine)
functioning - 3 – 12 mg orally/day divided into 2 doses
• Client and caregivers or - monitor for nausea, vomiting, abdominal
family must pain and loss of appetite
understand health care
practices to avoid
recurrence.

TREATMENT: DELIRIUM
1. The primary treatment for delirium is to
identify and to treat any casual or
contributing medical conditions
2. Antipsychotic drug
- Haloperidol (Haldol) 0.5-1 mg to decrease
agitation
3. Sedatives and benzodiazepines should be
avoided because they may worsen delirium
except for alcohol withdrawal (Valium,
Ativan, Librium)

TREATMENT: DEMENTIA
1. Identify and treat the underlying cause
Ex: Vascular dementia – change diet, exercise,
control of hypertension or diabetes
2. PSYCHOPHARMACOLOGY
● Antidepressants – for depressive symptoms
● Antipsychotics – to manage symptoms of
hallucinations, delusion & paranoia
- HALOPERIDOL (Haldol)
- OLANZAPINE (Zyprexia)
- RISPERIDONE (Risperdal)
QUIZ 10 Neurocognitive Disorders
1.A client who was brought to the emergency room
by ambulance begins to trash about on the
stretcher, slapping the sheets and yelling. "Go away
bugs, go away!" Assessment reveals disorientation,
a blood pressure of 189/75 mm Hg, and a pulse of
86 bmp. The friend who accompanied the client to
the hospital states, "he was drinking a lot when I
say him 4 days ago and asked me for money to get
liquor, but l didn't have any cash to give him."
Based on an analysis of these findings, the nurse
suspects that the client is experiencing which of the
following?
A. delirium
B. dementia
C. alcohol withdrawal
D. amnesia
C. Vascular Dementia
D. Wernicke's syndrome
6.Mr Roy, a 65 years old man with a diagnosis of
dementia stage Il, is admitted to the health care
facilty unit. Mr Roy's food intake is only marginally
adequate, in part because of his inability to sit at
the table and concentrate for the length of time
necessary to eat the meal. Which approach would
be most likely to ensure a nutritionally adequate
intake?
A. Offer small amounts of food whenever he
appears ready to eat.
B. Order 6 small, nutritionally balanced meals
C. Feed Mr. Roy in the time of his choice
D. Order a full liquid diet that will take him less
time to eat

2.When a client experiencing alcohol withdrawal

the client rashes in bed and yells. "Go away bugs,
go away," the nurse would expect to classify this
behavior as reflective of which of the following
nursing diagnoses?
A. Disturbed Thought Processes
B. Ineffective Coping
C. Disturbed Sensory Perception
D. Risk of injury

3.The nurse is teaching a family caregiver how to

help a client with early dementia complete activities
of daily living (ADL's). Which information should be
included in the teaching?
A. Tell the client that the ADLs must be
finished by 9am
B. Perform ADL's for the client
C. Give the client ample time to perform the
ADLs as independently as possible
D. Have the client plan a schedule for ADLs

4.When working with a client who has dementia,

the primary intervention by the nurse is to ensure
that the client:
A. Is offered dietary choices to stimulate
appetite
B. Remains in a safe and secure environment
to prevent injury
C. Discusses feelings of fear and loss to
prevent low self-esteem and anxiety
D. Meets other clients with dementia to prevent
social isolation

5.A condition known as the acute phase of delirium

dementia that result from Thiamine (Vitamin B1)
Deficiency?
A. Lewy body disease
B. Korsakoff's syndrome