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Diagnosis, Treatment and Care of Patients with Cognitive Impairments

Enrolled on:

CE1009 | Contact Hours: 2

COURSE OBJECTIVES

The purpose of this course is to educate health care professionals about various cognitive impairments, including but not limited to dementia and Alzheimer’s Disease. After this course, you will be able to:

1. Identify the different types and causes of cognitive impairments.
2. Explain how patients are diagnosed with cognitive impairments.
3. Identify the different interventions/treatments available to patients with cognitive impairments.
4. Develop appropriate care plans for patients with cognitive impairments.

RELEASE DATE

05/19/2022

EXPIRATION DATE

05/19/2024

AUTHOR

Rachel Botkin, PT, MPT

CRITERIA FOR SUCCESSFUL COMPLETION

All learners must complete the entire activity and complete the evaluation to receive contact hours.

APPROVAL STATEMENT (ACCREDITATION INFORMATION)

This nursing continuing professional development activity was approved by the Ohio Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. (OBN-001-91).

In addition to states that accept American Nurses Credentialing Center (ANCC) courses, CE Leaders is an approved provider by the Florida Board of Nursing, and a registered provider with the Arkansas State Board of Nursing, District of Columbia Board of Nursing, Georgia Board of Nursing, Kentucky Board of Nursing, New Mexico Board of Nursing, South Carolina Board of Nursing and West Virginia Board of Registered Nurses (Provider # 50-33450).

RELEVANT FINANCIAL RELATIONSHIP

No one with the ability to control content of this activity has a relevant financial relationship with an ineligible company.

INTRODUCTION

When you go to work everyday, you always think of what needs to be completed throughout the day, in which order it has to be done, how much time you need to spend to complete each task, and if you are able to complete all the tasks assigned to you within the allotted period of time. Should you check your emails first or sort the documents that are piled up on your desk or listen to the voicemails to see which needs immediate attention? All these thoughts are examples of cognition. Cognition refers to the mental process by which external or internal input is transformed, reduced, elaborated, stored, recovered and used (1). There are 6 main types of cognitive processes:

1. Language – Language is our daily communication of reading, speaking, listening and writing. Via these formats we can communicate and comprehend a variety of situations.
2. Attention -The ability to concentrate on one thing/item/task at a time. It could be a thought, no thought (i.e. meditation) or a physical object.
3. Perception – Perception taps into old stored information and new information to enable the brain to process, make sense of, respond to and perceive different situations. Perception involves touch, smell, sight and hearing to optimally function. All of this information is then transformed into outputs such as conversation, flavor detection and new ideas.
4. Memory – This is the hub of stored knowledge. Our brains are able to pick and choose which bits of knowledge to store in our memory. In a similar way to perception, memory allows us to recall and recognize objects, which in turn offers up the best way to respond and react to different situations.
5. Learning – When we learn, we process new information and gain new knowledge. When stored information from the past meets new information, our brain’s ability to store knowledge is boosted.
6. Higher reasoning – this cognitive process involves small day- to- day as well as larger decision making, planning your schedule or plotting your lifeplan, solving big and small problems and as the name suggests; reasoning.

There are currently approximately 5.8 million people in the United States with Alzheimer’s Disease (AD), the most common form of dementia, and this number is expected to triple by 2060 (2). This represents an enormous healthcare cost, both in medical treatment and caregiving. Nurses represent one of the key providers to people with cognitive deficits and their families/caregivers.

According to research led by Archana Singh-Manoux from the Centre for Research in Epidemiology and Population Health in France and University College London in the UK, cognitive functions can start to deteriorate at age 45. Another study suggests that cognitive decline can start at 20 and 30 years of age but is most common to people at advanced ages of 70 or older (3).

What are the different types of cognitive impairments? How is a patient diagnosed with cognitive impairment? Are there treatments/interventions available for each impairment? Most importantly, how can you, as a nurse, care for a patient with cognitive impairment?

RESOURCES

1. Bygraves M. What is cognition? Peak. Published August 1, 2019. Accessed February 6, 2022. https://blog.peak.net/2019/08/01/what-is-cognition/.

2. What is Alzheimer’s disease? Cdc.gov. Published April 7, 2021. Accessed February 6, 2022. https://www.cdc.gov/aging/aginginfo/alzheimers.htm.

3. Singh-Manoux A, Kivimaki M, Glymour MM, et al. Timing of onset of cognitive decline: results from Whitehall II prospective cohort study. BMJ. 2012;344(jan04 4):d7622. doi:10.1136/bmj.d7622.

4. Gauthier S, Reisberg B, Zaudig M, et al. Mild cognitive impairment. Lancet. 2006;367(9518):1262-1270. doi:10.1016/s0140-6736(06)68542-5.

5. Portet F, Ousset PJ, Touchon J. What is a mild cognitive impairment? Rev Prat. 2005;55(17):1891-1894. Accessed March 6, 2022. https://www.nia.nih.gov/health/what-mild-cognitive-impairment.

6. Mini-mental state examination. Shirley Ryan AbilityLab. Accessed February 20, 2022. https://www.sralab.org/rehabilitation-measures/mini-mental-state-examination.

7. Using the mini-cog©. Mini-cog.com. Accessed February 17, 2022. https://mini-cog.com/about/using-the-mini-cog/.

8. GPCOG. Com.au. Accessed February 20, 2022. http://gpcog.com.au/index/more-about-the-gpcog.

9. What is dementia? Symptoms, types, and diagnosis. National Institute on Aging. Accessed February 13, 2022. https://www.nia.nih.gov/health/what-is-dementia.

10. Stages of Alzheimer’s & Dementia: Durations & Scales Used to Measure Progression (GDS, FAST & CDR). Dementiacarecentral.com. Accessed February 20, 2022. https://www.dementiacarecentral.com/aboutdementia/facts/stages/.

11. How Structural & Chemical Changes in a Brain with Alzheimer’s Affects Level of Functioning. Dementiacarecentral.com. Accessed February 17, 2022. https://www.dementiacarecentral.com/caregiverinfo/brain-changes/.

12. What are frontotemporal disorders? Causes, symptoms, and treatment. National Institute on Aging. Accessed February 17, 2022. https://www.nia.nih.gov/health/what-are-frontotemporal-disorders.

13. Overview of Cerebral Function. MSD Manual Professional Edition. Accessed February 22, 2022. https://www.msdmanuals.com/professional/neurologic-disorders/function-and-dysfunction-of-the-cerebral-lobes/overview-of-cerebral-function.

14. Seux ML. Vascular Dementia. In: Pathy’s Principles and Practice of Geriatric Medicine. John Wiley & Sons, Ltd; 2012:895-901.

15. What is Alzheimer’s disease? Cdc.gov. Published April 7, 2021. Accessed February 22, 2022. https://www.cdc.gov/aging/aginginfo/alzheimers.htm.

16. What is Lewy body dementia? Causes, symptoms, and treatments. National Institute on Aging. Accessed February 22, 2022. https://www.nia.nih.gov/health/what-lewy-body-dementia-causes-symptoms-and-treatments.

17. Can genes cause dementia? Alzheimer’s Society. Accessed February 17, 2022. https://www.alzheimers.org.uk/about-dementia/risk-factors-and-prevention/can-genes-cause-dementia.

18. Interventions. Dementia.ie. Accessed February 13, 2022. https://dementia.ie/interventions/.

19. Thomas N, PT, DPT. Dementia and physical therapy - in motion O.c. Inmotionoc.com. Accessed February 17, 2022. https://www.inmotionoc.com/dementia-and-physical-therapy/.

20. Managing older patients with cognitive impairment. National Institute on Aging. Accessed February 17, 2022. https://www.nia.nih.gov/health/managing-older-patients-cognitive-impairment.

21. Engaging Dementia. The Sonas Programme. Accessed February 20, 2022. https://engagingdementia.ie/sonas-programme/.

22. Aimee Spector, Stephen Davies, Bob Woods, Martin Orrell, Reality Orientation for Dementia: A Systematic Review of the Evidence of Effectiveness from Randomized Controlled Trials, The Gerontologist, Volume 40, Issue 2, 1 April 2000, Pages 206–212, https://doi.org/10.1093/geront/40.2.206.

23. Simon Douglas, Ian James and Clive Ballard. Non-pharmacological Interventions in Dementia, Volume 10, APT 2004, Pages 171-177, https://doi.org/10.1192/apt.10.3.171.

24. Jones, Gemma M.M. A review of Feil's validation method for communicating with and caring for dementia sufferers, Current Opinion in Psychiatry: July 1997 - Volume 10 - Issue 4 - p 326-332.

25. Neal M, Barton Wright P. Validation therapy for dementia. Cochrane Database Syst Rev. 2003;(3):CD001394. doi:10.1002/14651858.CD001394.

26. Thuné-Boyle ICV, Iliffe S, Cerga-Pashoja A, Lowery D, Warner J. The effect of exercise on behavioral and psychological symptoms of dementia: towards a research agenda. Int Psychogeriatr. 2012;24(7):1046-1057. doi:10.1017/S1041610211002365.

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