Organic disorders are disorders associated with brain dysfunction.
Are also called cognitive disorders.
They include;
◦ Dementia
◦ Delirium.
1. Dementia
A
chronic mental disorder characterized by gradual loss of memory and
intellectual abilities, impaired reasoning, and deterioration of
personality with the course being progressive, stationary, or
reversible.
Clinical features
Has early and late signs.
Early signs and symptoms
Memory impairment for recent events and poor retention of new information.
Reduction in range of interests
Change in personality: the patient may be irritable or aggressive
Change in the mood. Mood may be labile.
Change in behavior i.e. restlessness and distractibility.
Poverty of thoughts and persecutory beliefs.
Late signs and symptoms of dementia
Further memory loss including memory for distant events
Disorientation especially in time but also in place and later in-person which may lead to wandering
Self-neglect and deterioration in self-care
Restlessness especially in the afternoon and evening.
Incoherence and mutism
Incontinence of urine and feces
Incidence
Is more common in the elderly than middle-aged.
Increases with age from 0.1% from those below 60 years to 15-20% to those who are 80 years.
Etiology
Significant loss of neurons and volume in brain regions devoted to memory and mental functioning.
Damage of the support structures of the nerve cells
Accumulation of beta-amyloid, an insoluble protein that form sticky patches in neurons
Deficiencies of vitamin B6,B12, and folate
Infections of the nervous system like encephalitis
Serious head injuries.
Excessive metal ions like zinc in the body.
Untreatable or irreversible forms of dementia
Degenerating disorders of the CNS.
Huntington's chorea: a hereditary disease marked by progressive degeneration of nerve cells in the brain
Parkinson disease
Alzheimer's disease.
Picks disease
Treatable or reversible forms of dementia
Vascular or multi-infarct dementia
Dementia resulting from intracranial space-occupying lesions
Dementia resulting from metabolic disorders like hepatic and renal failure.
Dementia resulting from endocrine disorders like Addison disease.
Dementia resulting from infections like AIDS, meningitis, and encephalitis.
Dementia resulting from vitamin deficiency like thiamine
Dementia resulting from Anoxia
Stages in the development of dementia
Dementia develops in threes stages.
1. Stage one (2-4)
Develop between 2-4 years.
Characterized by:-
◦ Forgetfulness
◦ Declining interest in the environment
◦ Poor performance at work.
2. Stage two: (2-12 yrs)
Characterized by:-
Progressive memory loss
Difficulty in following instructions
Hesitancy in response to questions
Irritable and anxious
Wandering
Neglect personal hygiene
Social isolation.
Stage 3:Final stage
Marked loss of weight because of inadequate intake of food.
Unable to communicate
Does not recognize family members
Incontinence of urine and feaces
Loss of ability to stand and walk
Risk factors for dementia
Family history of Alzheimer's disease
Increased age
Head trauma
Cardiovascular diseases
Investigations
Full hemogram
UECs
CT scan and MRI
Treatment of dementia
Treatment
of any reversible cause: hydrocephalus, renal failure, hypothyroidism,
brain lesions, subdural hematoma, Vit B6 and B12 , folate deficiencies.
Pharmacologic treatment :
Tacrine (Cognex), a cholinergic drug that improves cognitive functioning. However, its use is limited due to liver toxicity.
Antidepressants, antianxiety, and antipsychotics used to relieve associated symptoms like hallucinations and delusions.
Antiepileptic drugs for multi-infarct dementia
Benzodiazepines for insomnia and anxiety.
Nursing management
Assess the patient level of functioning to formulate appropriate plan of care.
Provide safety to the patient. Assess the patient level of disorientation to determine specific requirement for safety.
Maintain daily routines to include drawing up a fixed timetable for patient for waking up, toilet ,exercise and meals,
Provide
additional care during evening due to sun downing. This is a situation
where patient condition deteriorates during evening and additional care
must be
provided.
Orient the patient to reality in order to
decrease confusion. use calendar with large writing and a separate page
for each day. Provide newspapers which stimulate interest in events
Provide a well balance diet rich in protein, higher fiber with adequate amount of calories. Allow plenty of time for meals.
Provide daily personal hygiene to include brushing of teeth, bathing, keeping the skin clean and dry.
Provide
toilet habits and maintained it as a rigid routine. The patient should
be taken to urinate at a fixed interval depending on fluid intake and
season
Prevent accidents from falling, slipping in bathroom
and tripping over furniture by providing patients with firmly secured
shoes. Any floor covering must be firmly secured.
Decrease the amount of stimuli to the patient environment so that confusion may be less.
Help the patient devise methods to reduce memory defects e.g. by asking them to note down the daily activities.
Use simple explanations and face to face introduction and communication to the patient.
Provided sufficient fluid during the day and minimum amount of fluid at evening around 6pm
Keep calm environment with fixed schedules to prevent changes in mood which are unpredictable.
Provide identification tag for patients with Alzheimer's disease as they are prone to wandering due to disorientation
Multi-infarct dementia
A condition characterized by an alteration in due brain function due to destruction of brain tissues
Contributing factors
Advanced age
Cerebral emboli or thrombosis
Diabetes
Heart disease
High blood cholesterol
Hypertension
Signs and symptoms
Confusion
Wandering or getting lost in familiar places
Leg or arm weakness
Problems with recent memory
Loss of bladder and bowel control
Inappropriate emotional reaction such as laughing or crying inappropriately
Problems with recent memory
Difficulty in following instructions
Nursing interventions
Reduce unnecessary stimulation
Avoid changing patient room and moving furniture
Orient patient to the surrounding
Make environment as stable as possible
Alzheimer's disease
Alzheimer's disease is a degenerative brain disorder of unknown etiology which is the most common form of dementia
• Usually starts in late middle age or in old age
• Results in progressive memory loss, impaired thinking, disorientation, and changes in personality and mood.
Origin of Alzheimer's Disease
The
disease was first described by Dr. Alois Alzheimer, a German physician,
in 1906. Alzheimer had a patient named Auguste D, in her fifties who
suffered from what seemed to be a mental illness.
But when she
died in 1906, an autopsy revealed dense deposits, now called neuritic
plaques, outside and around the nerve cells in her brain.
Inside the cells were twisted strands of fiber, or neurofibrillary tangles.
Since Dr. Alois Alzheimer's was the first person who discovered the disease, AD was named after him.
Auguste D
Definition
Alzheimer’s
disease is a chronic, irreversible disease that affects the cells of
the brain and causes impairment of intellectual functioning.
Alzheimer's disease is a brain disorder which gradually destroys the ability to reason, remember, imagine, and learn.
Incidence
About 3 percent of men and women ages 65 to 74 have AD, and nearly half of those age 85 and older may have the disease.
Causes
• The cause of Alzheimer’s disease is not known.
However, several factors are thought to be implicated in this disease e.g.
Environmental factors
• Cigarette smoking.
• Certain Infections.
• Metals, industrial or other toxins.
• Use of cholesterol lowering drugs (statin).
Signs of Alzheimer's disease
Ten warning signs of Alzheimer's disease
1) Memory loss
2) Difficulty to performing familiar tasks
3) Problems with language
4) Disorientation to time and place
5) Poor or decreased judgment
6) Problems with abstract thinking
7) Misplacing things
8) Changes in mood or behavior
9) Changes in personality
10) Loss of initiative
Symptoms of Alzheimer's disease
• Confusion
• Disturbances in short-term memory
• Problems with attention and spatial orientation
• Personality changes
• Language difficulties
• Unexplained mood swings
Delirium (Acute organic syndrome)
Definition :Refers is acute organic mental disorder characterized by;
◦ (i) Impairment of consciousne
