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 

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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

References

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. 

https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589935289§ion=Treatment.

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.