Post- esther | Nursing homework help
Respond in a positive way to your colleagues by comparing the differential diagnostic features of the disorder you were assigned to the diagnostic features of the disorder your colleagues were assigned.
NOTE: Bellow is attached the document with my assigned disorder
Vascular Neurocognitive Disorder
Cognitive disorders of vascular etiology are a diverse group of disorders with various pathologies and clinical manifestations, reviewed broadly below the category of vascular cognitive disorders (VCD). The variety of vascular cognitive impairment is identified by Mild Vascular Cognitive Disorder classifications and Vascular Dementia or Major Vascular Cognitive Disorder (Sachdev et al., 2014). When diagnosing major or mild vascular neurocognitive disorder (NCD), numerous criteria must be met. The first criteria for vascular NCD that need to be completed are that major or mild NCD criteria are met (APA, 2013). Once it is determined that an individual is suffering from a major or mild NCD, then the criteria of whether the disorder is vascular-related can be explored. This criterion comprises that the clinical features are reliable with a vascular etiology. As suggested by either the onset of cognitive deficits related to cerebrovascular events or evidence of decline is seen in intricate attention and frontal-executive function (APA, 2013). According to the DSM-5, the third criterion is that there is evidence of cerebral vascular disease from a person’s history, physical examination, or neuroimaging aligned with the deficit. Definitively, the symptoms cannot be better supported by systemic disorder or another brain disease (APA, 2013).
Furthermore, there are also subcategories for diagnosing vascular NCD, consisting of probable and possible vascular NCD. In probable vascular NCD, an individual is diagnosed when one or more of the following are presented: Clinical criteria are supported by neuroimaging, the neurocognitive syndrome is temporally related to a cerebrovascular event, or both clinical and genetic evidence of cerebrovascular disease is present (APA, 2013). If none of these appear, possible vascular NCD should be diagnosed as an alternative, as the clinical criteria can be met. However, there is no neuroimaging or temporal relationship to the neurocognitive syndrome established (APA, 2013). It is essential to differentiate between these based on the evidence submitted to the health care providers.
Psychotherapy and Psychopharmacologic Treatment
There are no medications approved by the Food and Drug Administration FDA to treat the vascular neurocognitive disorder. Medications used to treat Alzheimer’s disease may or may not be helpful. Treatments that have shown to be effective include medications such as acetylcholinesterase inhibitors and memantine. Meanwhile, individuals with vascular NCD typically display reduced acetylcholine levels in the cerebrospinal fluid and decreased cholinergic indicators in the brain, drugs such as donepezil, galantamine, and rivastigmine have been examined and applied to treat vascular NCD (Gabbard, 2014). Memantine is another drug utilized in the past to treat Alzheimer’s disease and has also been used in individuals with vascular NCD. This medication is applied based on its experimental efficiency in animal forms, but the available evidence is mixed for vascular NCD use (Gabbard, 2014). The general approaches to treating individuals with suspected vascular neurocognitive disorders are the same as those used to treat high blood pressure, heart attack, etc. Most often, the use of medications for these conditions, dietary changes, and, if possible, the use of an exercise program are the standard forms of treatment. For example, calcium channel blockers used to treat vascular NCD include nimodipine, nicardipine, lacidipine, and fasudil but the overall evidence for these medications is not compelling (Gabbard, 2014).
Unfortunately, no psychotherapy is currently recommended for the treatment of vascular NCD. Every individual living with dementia is unique. Like the rest of the population, cognitive behavioral therapy (CBT) is likely to work for some individuals with dementia and not for others. In general, greater cognitive impairment levels may make it more challenging to engage with CBT; however, it may be possible to tailor CBT according to an individual’s functional status. Approaches typically focus on caregiver training and therapy to help them communicate and cope with a family member who suffers from vascular NCD. In some instances, speech therapy, such as cognitive-communication treatment, is used to maximize the individual’s quality of life and communication success (ASLHA, 2020).
Risks Versus Benefits
Despite psychotherapy and psychopharmacologic treatments, there are risks and benefits. The main advantage of treatment in vascular NCD can manage components to assist prevent, decelerate, or delay the progression of deterioration of cognitive abilities. It is imperative to note that even with therapy, only limited benefits in cognitive skills are pointed out (Gabbard, 2014). While this may not appear encouraging, even little improvement can suggest a lot to both the families and individuals suffering from vascular NCD. Based on the medication recommended, there can be heightened risks depending on the individual. For example, acetylcholinesterase inhibitors such as donepezil can cause bradycardia (Stahl, 2014). This can be mainly affecting the older adult. These risks require to be weighed with the potential benefits that the individual may encounter when initiating treatment like acetylcholinesterase inhibitors and memantine
American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Washington, DC: Author.
American Speech-Language-Hearing Association. (ASLHA). (2020). Treatment of Dementia.
Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC:
American Psychiatric Publications.
Sachdev, P., Kalaria, R., O’Brien, J., Skoog, I., Alladi, S., Black, S. E., Blacker, D., Blazer, D.
G., Chen, C., Chui, H., Ganguli, M., Jellinger, K., Jeste, D. V., Pasquier, F., Paulsen, J., Prins, N., Rockwood, K., Roman, G., Scheltens, P., & Internationlal Society for Vascular Behavioral and Cognitive Disorders (2014). Diagnostic criteria for vascular cognitive disorders: a VASCOG statement. Alzheimer disease and associated disorders, 28(3), 206–218. https://doi.org/10.1097/WAD.0000000000000034
Stahl, S. M. (2017). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (6th ed.). New
York, NY: Cambridge University Press.