Class 5 - Cognition Flashcards
Cognition
- Human thought
- How info is received, processed, stored, and then used
6 domains of cognitive function
- Perceptual motor function
- Language
- Learning and memory
- Social cognition
- Complex attention
- Executive function
Perception
- Interpretation of the environment
- Related to awareness
- Depends on sensory input
- Attention is focus on a particular area
Memory types
- Declarative episodic memory
- Declarative semantic memory
- Immediate memory-attention span
- Working memory
- Procedural memory
Declarative episodic memory
A clear memory of an entire scenario - think of an episode of a show that you remember
- Long term memory
Declarative semantic memory
Long term memory that is for knowledge. You’re working hard to remember this information
Immediate memory-attnetion span
forget right away when the information is done being used - the info you used during an exam and you forget it all immediately after you’re done
Working memory
Maintain for a short period of time
Procedural memory
This will take a long time - riding a bike or drive a car for the first time
Executive function
- Higher order of thinking that is future oriented
- Flexibility, adaptibility, goal directedness
- Determines contents of consciousness
- Supervises voluntary activity
Higher order cognitive function
- Learning
- Comprehension
- Problem-solving
- Reasoning
- Decision making
- Creativity
- Metacognition
Basic order cognitive function
- Perception
- Pattern recognition
- Attention
When does significant changes to cognitive developemnt occur?
Infancy to adolescence
Cerebral cortex
- Ability to reason, function intellectually, express personality, and purposefully interact with the world
- Neurons and neurotrandmitters deliver information
Age-related differences: Infants and children
- Brain stem and spinal cord are fully developed
- Limbic system and cerebral cortex are underdeveloped at birth
- Myelination occurs throughout childhood and into young adulthood
Age-related differences: Older adults
- Size and weight of the brain and number of neurons decrease
- Cognitive impairment or intellectual loss is not part of normal aging, rather it is indicative of disease
- Decline in memory is associated with aging, but the extent and degree varies
What is delirium?
A state of disturbed consciousness and altered congition with a rapid onset of a few hours or days
Delirium: Individuals experience
- Dulled awareness
- Reduced ability to focus, sustain and shift attention
- Memory and judgement impaired
- Disorientation
- Change in speech
- Emotional swings
- Restlessness
Delirium: Caused by
- Undelrying condiitons
- Dehydration
- Electrolyte imbalances
- Infection
- Pain
- Fever
- Hypoxia
- Sleep deprivation
- Adverse effects of medications
- Most frequent complication of hospitalization
Delirium: Symptoms
- Varibale over 24 hours
- Mood swings
- Disturbed sleep
- Reduced attention span
- Decreased memory
- Hallucinations
- Tremors
Dementia
- Gradual and progressive decline in mental functioning
- Some are associated with changes in mood and behaviour
Dementia effects to short term
Short term memory, language, judgement, reasoning, and abstract thinking
Dementia effects to long term
Long term memory and the ability to perform familiar tasks
Dementia may have
Paranoia, depression, delusions of theft
Dementia: Difficulty with
- Executive functioning (speaking and walking)
- Sleep disturbances
- Agitation
- Wandering
Depression
Cluster of depressive symptoms is present on most days, most of the time, for at least 2 weeks, and when the intnsity of hte symptoms is out of the ordinary for that person
Depression: Biologically
Biologically based illness that affects a person’s thoughts, feelings, behaviour, and even their physical health
9 Risk factors for inadequate cognition
- Advanced age
- Brain trauma
- Disease or disorder (tumour, hypoxia, stroke)
- Environmental exposure (lead)
- Substance use disorder
- Genetic diseases
- Depression
- Medications
- Fluid and electrolyte imbalance
6 Consequences of cognitive impairment
- Loss of short- and/or long-term memory
- Disorientation to person, place, time, and context
- Impaired reasoning and decision-making ability
- Imapired language skills
- Uncontrollable or inappropriate emotions such as severe agitation and aggression
- Delusions and hallucinations
6 General management tools
- Primary prevention
- Secondary prevention (screening)
- Collaborative interventions
- General management
- Pharmacologic agents (medications)
- Family and caregiver support
What is primary prevention?
- Promote a healthy lifestyle
- Gentic counselling
- Educating healthcare providers about latest evidence
Screening/Assessment for Cognitive Impairment
- Detect early
- General survey
- Glasgow Coma Scale
- Mini Mental State Examination (MMSE)
- Confusion Assessment Method (CAM)
General survey: Physical
- Age, gender
- LOC
- Skin colour
- Facial features
General survey: Behaviour
- Facial expressions
- Mood and affect
- Speech
- Dress
- Personal hygiene
General survey: Body structure
- Stature
- Nutrition
- Symmetry
- Posture
- Position
- Body build and contour
General survey: Mobility
- Gait
- Range of motion
Assessing LOC
- General survey
- A and O x4? (person, place, time, and context)
- Hand grasps
Glasgow coma scale
Eye opening response
Verbal response
Motor response
Response to painful stimuli
- Localizes
- Withdraws
- Grimaces
- Abnormal posturing (decerebrate [more serious]/decorticate)
- No response, flaccid
Confusion assessment method
1 and 2 and either 3 or 4
CAM: Feature 1
- Acute onset and fluctuating course
- This feature is usually obtained from a family member or nurse and is shown by positive responses to the following questions:
- Is there evidence of an acute change in mental status from the patient’s baseline?
- Did the (abnormal) behaviour fluctuate during the day, that is, tend to come and go, or increase and decrease in severity
CAM: Feature 2
- Inattention
- This feature is shown by a positive response to the following question:
- Did the patient have difficulty focusing attention, for example, being easily
distracted, or having difficulty keeping track of what was being said
CAM: Feature 3
- Disorganized thinking
- This feature is shown by a positive response to the following
question: - Was the patient’s thinking disorganized or incoherent, such as rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject?
CAM: Feature 4
- Altered level of consciousness
- This feature is shown by any answer other than “alert” to the following question:
- Overall, how would you rate this patient’s level of consciousness? Alert (normal), vigilant (hyper-alert), lethargic (drowsy, easily aroused), stupor (difficult to arouse), or coma (unarousable)
