Cognitive Disorders

1
Cognitive Disorders

• Differentiating delirium, amnestic disorders, and
  dementia (see Figure 11.5 in text)
• Descriptions
• Causes
• Treatments

2
DSM-IV Criteria for Cognitive Disorders

• Delirium cloudy consciousness with
  disorientation, memory deficits, perceptual
  disturbances, language deficits
• - Rapid onset
• - Short duration
• - Sometimes lucid, other times impaired
• - Personality is unchanged
• - Hallucinations/delusions common
• - Anxious and fearful during disorientation

3
DSM-IV Criteria for Delirium

• Disturbance of consciousness, reduced ability to
  focus, sustain, or shift attention
• Change in cognition, memory, or language, not
  explained by preexisting, evolving dementia
• Disturbance develops over short period (hours or
  days)

4
Causes of Delirium

• Brain tumors
• Blows to the head
• Systemic diseases
• Intoxication
• Withdrawal from certain drugs
• Severe stress
• Sleep deprivation
• Sensory deprivation
• Forced immobilization

5
Examples and Treatments of Delirium

• Examples
• Seen in 10-15 of ER patients
• Seen during substance intoxification/
  withdrawal
• Sheets are crawling with bugs
• Police are running through the house
• Treatments
• Remove the cause tumor, drug in system, severe
  stress or sleep deprivation, and symptoms
  typically disappear

6
DSM-IV Criteria for Cognitive Disorders

• Amnestic disorders loss of past memories,
  inability to form new ones
• Always have a known cause medical condition or
  substance i.e., Korsakoffs Syndrome resulting
  from prolonged alcohol abuse
• May have the experience of constanting meeting
  new people or having new situations because they
  fail to form new memories

7
DSM-IV Criteria for Amnestic Disorders

• Development of memory impairment manifested by
  inability to learn new information, inability to
  recall old information
• Memory disturbance causes impairment in
  functioning
• Memory disturbance does not occur during delirium
  or dementia

8
Causes of Amnestic Disorders

• Traumatic brain injury
• Stroke
• Exposure to toxic substances
• Brain disease
• Chronic substance abuse
• Nutritional deficiency (vitamin B1)

9
DSM-IV Criteria for Cognitive Disorders

• Dementia multiple cognitive deficits,
  forgetfulness, disorientation, difficulty with
  concrete thinking, preservation

10
DSM-IV Criteria for Dementia

• Multiple cognitive deficits and one or more of
  the following
• Aphasia language disturbance
• Agnosia failure to recognize familiar
  objects
• Apraxia motor disturbance

11
Types of Dementia

• Vascular dementia caused by stroke
• Substance-induced dementia ie, alcohol
• Dementia due to medical conditions including
• Parkinsons disease dopamine deficiency,
  psychomotor slowness
• Picks disease frontal/temporal lobe atrophy
  leading to disinhibition
• Huntingtons disease involves basal ganglia
• HIV disease - subcortical, generalized symptoms
• Creutzfeldt-Jakob disease slow growing virus
• Head injury, brain disease
• Dementia of Alzheimers type (DAT) diagnosed
  only by exclusion of other causes

12
Tools in Diagnosing Dementia

• CT scan cross-sectional images of brain
• MRI picture of brain structure created through
  magnetic images
• PET scans uses radioactive glucose metabolism
  to visualize activity level of brain
• SPECT scans monitors brain activity by
  examining blood flow

13
Facts About Dementia

• Alzheimers (DAT) is most common, accounting for
  50 of all cases
• Prevalence increases with age
• 1 percent at age 65 years
• Over 10 percent by late 80s
• More common in women and lower SES groups
• By the year 2040, 9 million people in the U.S.
  will suffer from dementia

14
Typical Progression of Dementia

• Mild memory disturbance and forgetfulness (often
  unrecognized or covered up initially)
• New learning is impacted
• Recent memories fade, confusion over daily
  activities, meals
• Distant memories fade, including familiar family
  or friends
• Personality changes including irritability, depres
  sion,
• childish behaviors
• Confusion, disorientation, aphasia, apraxia,
  agnosia
• Loss of control of bodily functions (infantalized)

15
Treatment of Dementia

• Goals
• Preserve independence self esteem
• Keep up social contacts
• Provide as much enjoyment meaning as
  possible
• Medications e.g., Aricept (slows progression)
• Modifications to environments to promote
  independence
• Hand rails for apraxia
• Labeling things to organize/address
  forgetfulness
• Use community services like meals on wheels