Cognition Flashcards
What is cognition?
Cognition refers to all the processes involved in human thought.
Cognition is the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses.
What are the six domains of cognitive function?
- Perceptual motor function
- Language
- Learning and memory
- Social cognition
- Complex attention
- Executive function
What three terms are related to cognition?
Perception, memory, and executive function
What is perception?
Perception is the interpretation of the environment and is dependent on the acuity of sensory input?
What is memory?
Memory is the retention and recall of past experiences and learning.
Memory is a SERIES of different neural subsystems, each of which has a unique localization in the brain.
What is declarative memory?
Declarative memory is the ability to consciously learn and recall information.
What is declarative EPISODIC memory?
The ability to recall information about specific events.
What is declarative SEMANTIC memory?
Declarative semantic memory refers to memory of knowledge, words, and facts.
Declarative semantic memory provides for long-term storage of large amounts of information.
What is immediate memory of “attention span”?
Immediate memory, or attention span, refers to the memory of very small amounts of information.
What is working memory?
Working memory allows a small amount of information to be actively maintained and manipulated for a short period of time?
What is the amount of information that working memory can use?
Approximately four chucks or meaningful units.
What is procedural memory?
Procedural memory refers to the retention and retrieval of motor skills.
Procedural memory requires extensive training and provides for long-term storage of a moderate amount of information.
What is executive function?
Executive function is the higher thinking processes that allow for flexibility, adaptability, and goal directedness.
Executive function determines consciousness, supervises voluntary activity, and is future-oriented.
What is the scope of cognition?
It’s a spectrum that can change over time and is expressed on a continuum.
Cognitive impairment, if present, can range from mild to severe.
What is intact cognition?
Intact cognition refers to an individual that exhibits cognitive behaviors that are considered within the normal range for age and culture.
What is impaired cognition?
Impaired cognition refers to cognition below the expected normal range to function.
Impaired cognition signifies an observable or measurable disturbance in one or more of the cognitive processes.
What does impaired cognition result from?
Impaired cognition results from an abnormality within the brain or a factor interfering with normal brain function.
What is basic cognitive functioning?
Basic cognitive function is perception, pattern recognition, and attention.
What is higher order cognitive function?
Higher order cognitive function is characterized by learning, comprehension, insight, problem solving, reasoning, decision making, creativity, and metacognition (thinking about thinking).
What is the brain responsible for?
The brain is responsible for multiple processes, including those that involve purposeful thought and responses and those that are automated and occur w/o purposeful thought (e.g., breathing, heart rate, hormonal control, temperature regulation).
The cerebrum is…
The cerebrum is divided into two hemispheres (right and left) and each hemisphere has four lobes (frontal, parietal, temporal, and occipital)
The limbic system supports…
The limbic system supports cognitive processing, a structure that overlaps the cerebrum and diencephalon; the ability to reason, function intellectually, express personality, and purposefully interact with the external environment.
The hippocampus…
plays a key role in committing information to long-term memory.
The cerebral cortex is…
The cerebral cortex is primarily responsible for carrying out such functions, in which highly sophisticated neurons & neurotransmitters deliver information through complex networks
What is the functional difference of infants and children?
Their brain stem and spinal cord are fully developed, but the limbic system & cerebral cortex are in undeveloped states at birth.
What behavior of newborns is controlled by the lower brain?
Crying, feeding, and sucking are newborn behaviors controlled by the lower brain
What three primary changes influence the developing brain?
Increase in brain mass, neuronal synaptic connections, and myelination are the primary changes that influence the developing brain.
Brain mass…
triples in weight during the first year
Neuronal-synaptic connections…
- The number of neurons in the brain increases until approximately two years of age.
- A massive explosion of neuronal-synaptic connections develop after birth and continues through childhood and adolescence. This fuels the progression of cognitive developmental milestones.
Myelination…
Myelination has a direct impact on cognitive development because it is needed for efficient neurotransmission of signals between neurons within the brain.
The size and weight of the brain and the number of neurons decrease with…
aging
Cognitive impairment, or intellectual loss, is…
not a part of normal aging and is indicative of disease
A decline in memory is…
associated with aging, but the extent and degree is highly variable
What are the characteristics of DELIRIUM?
Delirium:
1. has RAPID ONSET
of hours to days
2. most frequent complication of hospitalization in the elderly
3. symptoms ted to come and go; often more prominent at night
4. usually REVERSIBLE with treatment of underlying illness
What are the characteristics of DEMENTIA?
Dementia:
1. develops over YEARS & MONTHS
2. primary dementia is IRREVERSIBLE and is NOT secondary to another disease
3. acquired and PROGRESSIVE DETERIORATION of all cognitive functions including impairment in memory, judgement, calculation ability, attention span, and abstract thinking
Patients with dementia need…
quiet environment with minimal unfamiliar stimulation
What are the characteristics of cognitive impairment (not dementia)?
Cognitive impairment (not dementia) is characterized by:
1. greater radiation of cognitive function than expected for an individual’s age & education, but does not interfere with functional ability
2. is not a medical diagnosis, it is simply a recognized state between NORMAL cognitive function and TRUE cognitive impairment
Individuals with mild cognitive impairment are at a higher risk of…
Individuals with mild cognitive impairment are at a higher risk of progressing to dementia compared to the general population
What is the MAIN CONCERN for a patient with cognitive impairment?
Safety is the MAIN concern for a patient with cognitive impairment
Focal cognitive disorders are characterized by…
a single affected area of cognitive function; the area involved may be memory, language, visuospatial ability, or executive function
Intellectual disabilities are…
limitations of cognitive functions and below average intelligence, limitations in conceptual skills, social skills, and ADL’s
How does cognitive processing develop in those with intellectual disabilities?
Cognitive processing NEVER fully develops in patients with intellectual disabilities and the symptoms are identified before 18 years of age.
Learning disabilities are often…
identified during childhood and characterized by challenges in taking data signals in and processing the information received
What populations are at risk for cognitive impairment?
The primary risk is advancing age, aka the elderly.
Children, women, and men are also at risk.
What are the pediatric risk factors for cognitive impairment?
Pediatric patients are at risk prenatally, perinatally, and postnatally.
Genetic syndromes; toxicity; metabolic conditions; maternal disease; events during labor that lead to hypoxic ischemic injury and brain malfunction.
What are the risk factors for cognitive impairment in women?
overall poor health status, dependency, lack of social support, and insomnia.
What are the risk factors for cognitive impairment in men?
a history of stroke or diabetes
What are the individual risk factors for cognitive impairment?
Personal behaviors, environmental exposures, congenital and genetic conditions, physical disability or reduced mobility, and health conditions are all individual risk factors for cognitive impairment.
What personal behaviors contribute to the risk of cognitive impairment?
anything related to chemical exposure or risk of traumatic brain injury.
e.g., substance abuse, high-risk activities and omission of basic safety measures (not wearing a seatbelt or helmet)
What environmental exposures contribute to the risk of cognitive impairment?
lead exposure, lead based paint, pesticides
What congenital or genetic conditions contribute to the risk of cognitive impairment?
congenital conditions are PRESENT at BIRTH
genetic conditions EXIST at BIRTH, but may or may not be present at birth
examples are maternal conditions (fetal alcohol syndrome), birth injuries (cerebral palsy), chromosomal abnormalities (Down syndrome), genetic conditions evident in infancy (galactosemia), or those that emerge later in life (Huntington disease)
How does physical disability, or reduced mobility, contribute to impaired cognition?
cognitive function declines faster following disability or slow gait in basic and fundamental ADL’s
Health conditions that contribute to individual risk for cognitive impairment
- fluid and electrolyte imbalance, systemic or intracranial infection, fever/pain, hypoglycemia and anoxia can cause delirium that is reversible with treatment
- stroke and intracranial tumor can cause irreversible long-term amnestic
- cardiovascular disease, COPD, depression, type 2 diabetes are found to be significant risk factors for cognitive impairment
- changes in cognition may occur as an adverse effect of medical treatments & medications
Cognitive assessment of an adult includes:
- observing patient for wakefulness, alertness, and appropriate response to introductions and to the environment as the health history is begun
- speech pattern and content are noted; memory, logic, and judgement are assessed
- assess history of intracranial disease or trauma, substance abuse, or use of medications that can impair cognition, envrionmental or occupational exposure to hazards (e.g., lead or insecticides), any headache or behavior changes.
Cognitive assessments of infants and children require…
Asking parents about prenatal and birth history of the infant or child.
Examination of general patient includes…
- posture and body movements should be relaxed; slump posture and slow movements while walking and dragging feet could indicate dementia
- observe patient’s dress and hygiene (is it appropriate for weather, setting, gender/age?)
Which assessment provides initial clues to an individual’s cognitive functioning?
examination of general appearance
What do you expect to see in the examination of a patient’s behavior with regular cognitive functioning?
patient is alert, awake, and aware of the environment
facial expressions should be appropriate, conversation is fluent, articulate and of moderate pace
What do you expect to see in the examination of a patient’s behavior with impaired cognitive functioning?
patient may present as lethargic, obtunded (reduced response to stimuli), and/or with stupor, or confusion
When is a patient considered orientated?
Patient is orientated when they are aware of date, time, and location
Mini-Mental State Exam is…
a short (5-10 min.), standardized cognitive assessment tools used across care settings to screen for:
dementia, delirium, cognitive impairment occurring during illness, and to monitor response to treatment
The MMSE consists of…
11 cognitive tasks that cover: time/place orientation, immediate recall, short-term memory recall, serial 7’s, reading/writing/drawing/verbal/motor comprehension
Three Words Three Shapes Test
recall of three words written down by the patient followed by three shapes drawn by the patient
What diagnostic tests are used for diagnosing COGNITIVE IMPAIRMENT?
there are NO laboratory tests that diagnose cognitive impairment
they are used to assess the presence of associated disease or contributing factors, NOT diagnose cognitive impairment.
What are primary prevention methods for cognitive impairment?
promoting healthy lifestyle through teaching and community programs that emphasize the importance of:
optimal nutrition, exercise, social activity, regular medical care, avoidance of substance abuse, and genetic counseling (pregnancy)
What are secondary prevention strategies for cognitive impairment?
mini-mental state examination, hand tapping test, three words three shapes test, etc.
