Cognitive Disorders

Question 1

What does cognition refer to?

Answer 1

• A system of interrelated abilities to perceive, reason, judge, as well as our intuition and memory
• Allows us to be aware of ourselves and our surroundings

Question 2

What cognitive disorders results in decreased cognitive functioning?

Answer 2

Dementia, delirium and amnestic disorders (head trauma’s, “blacking out” after binge drinking, etc)

Question 3

What is delirium?

Answer 3

• Acute cognitive impairment
• Can be hypoactive/mild, hypoactive/severe, hyperactive or mixed (most common)
• Considered a medical emergency
• Affects all aspects of cognition

Question 4

What is delirium caused by?

Answer 4

• Medical conditions (infection, response following surgery, fluid/electrolyte/metabolic disturbances)
• Substances (prescribed or illicit, polypharmacy, etc.)
• Unknown factors

Question 5

What is the difference between hypoactive and hyperactive delirium?

Answer 5

• Hypoactive is when someone may appear depressed, lethargic, disoriented, etc. This has a high mortality rate since it is easy to dismiss
• Hyperactive is the more common delirium that we think of, like someone being agitated, altered to sleep, disorientated, taking out IV’s, etc.

Question 6

What is dementia?

Answer 6

• Global, chronic cognitive impairment
• Pervasive
• Degeneration disorder of CNS
• Not an illness, but symptom of an illness

Question 7

What are the different types of dementia?

Answer 7

• Alzheimer’s (shrinking the cortex of the brain, affecting all parts of the brain)
• Vascular dementia
• Dementia related to medical conditions
• Dementia related to substance uses
• Dementia with mixed/unknown causes

Question 8

What is the difference between normal memory loss with age and dementia?

Answer 8

Normal memory loss can include difficulty with word finding, losing keys, forgetting names, etc.
- Dementia is more marked, obscure changes, like being unsure what to do with keys, putting milk in the microwave, etc.

Question 9

What is the hippocampus responsible for?

Answer 9

Formation of memories (a hippo coming on campus would be memorable!)

Question 10

What is the parietal lobe responsible for?

Answer 10

Sensation, sensory processing

Question 11

What is the frontal lobe responsible for?

Answer 11

Thought processing, language output, programming of activities, prioritization, personality and behaviour

Question 12

What is the temporal lobe responsible for?

Answer 12

Language, comprehension, learning, short-term memory

Question 13

What is the cerebellum responsible for?

Answer 13

Movement, muscle coordination

Question 14

Compare and contrast dementia and delirium:

Answer 14

DEMENTIA VS DELIRIUM

ONSET: slow vs. sudden
SYMPTOMS: stable with sun downing vs. fluctuates during the day
DURATION: until death vs. hours, days, weeks
ORIENTATION: disorientation persistent vs. disorientation is intermittent
SLEEP WAKE CYCLE: fragmented sleep vs. alert at night, drowsy in day
MEMORY: impaired recent and long term vs. global memory failure

Question 15

How do we treat delirium?

Answer 15

• Investigation into cause of delirium (assessment, blood tests, medication profile, etc.)
• Ensure oxygenation of tissues
• Support normal sleep patterns
• Ensure nutrition intake
• Essentially, priorities is to eliminate/correct cause and provide symptomatic and supportive measures

Question 16

What are risk factors for delirium?

Answer 16

• 80% of people near death experience delirium
• AIDS and Cancer patients are high risk for delirium
• 10-30% of hospital patients, regardless of age, will experience delirium (making hospitalization a risk factor)
• 60% of delirium cases are older adults
• Pain
• Cardiac surgery

Question 17

What is the diagnostic criteria for delirium?

Answer 17

• Behavioural changes (agitation?)
• Onset (quick vs. slow)
• Fluctuations during the day (are their sleeping patterns altered?)
• Impaired consciousness

Question 18

What is the presentation of delirium?

Answer 18

• Dependent on type
• Disorientation
• Changes to concentration and focus
• Impacted speech and motor function
• Difficulty sleeping
• Poor social cues

Question 19

How do we treat delirium?

Answer 19

• Physiological (support symptoms)
• Psychological (reduce stimulation)
• Social

Question 20

What is the prognosis for delirium?

Answer 20

• Reversible if treated

- Often causes complications

Question 21

What is the etiology of dementia?

Answer 21

• Depends on type

- Multiple theories (plaques, cell death, genetics)

Question 22

What are the risk factors or dementia?

Answer 22

• Age (10-15% aged 65+ develop dementia)
• Lifestyle factors causing stroke and cardiac events, leading to vascular dementia
• Females
• Down Syndrome
• Low socioeconomic status
• Parkinson’s and Huntington’s
• Heart disease

Question 23

What is the diagnostic criteria for dementia?

Answer 23

• Memory loss
• Aphasia (disturbed language)
• Agnosia (disturbed identification of objects)
• Apraxia (inability to execute motor functions)
• Disturbance of executive functioning (ability to think abstractly, plan, prioritize, etc.)

Question 24

What is the presentation for dementia?

Answer 24

• Onset
• Physiological (changes to mood and behavior)
• Psychological
• Social (isolation, change in relationships)

Question 25

What are the priorities in caring for an individual with dementia?

Answer 25

- Depends on stage of illness - Delay cognitive decline - Support family members - Protect patient from harm - Attend to physical harm - Tx physiological, psychological and social symptoms

Question 26

What are some general tips for working with someone with dementia?

Answer 26

- Treat the PERSON with dementia - Enter into their reality - Validate emotions - Avoid saying “no” - Avoid reasoning or arguing - Use simple, concrete sentences - Avoid saying “do you know…?” - Help make family visits meaningful - Understand their behaviours - Understand their emotional responses - Be flexible and modify the environment

Question 27

What is the prognosis for dementia?

Answer 27

Essentially a terminal cognitive disorder that occurs over time

Question 28

What are the stages of Alzheimer's?

Answer 28

STAGE 1 [MILD]: mild memory loss, sensory/motor not usually affected, pt recognizes there is a problem, anxiety/confusion, mild behavior problems STAGE 2 [MODERATE]: behavior problems increase (ex. sun-downing, perseveration, wandering), confusion, incontinence. STAGE 3 [SEVERE]: total incontinence, choking, emaciation, total care required, progressive gait disturbances that lead to non-ambulatory status

Question 29

What is Alzheimer's type of dementia?

Answer 29

- Most frequently seen in clinical practice - Approximately 80% of dementia related to Alzheimer's - Global memory impairment, especially in the beginning - More common in women - Difficulty with independently completing ADL's

Question 30

What is vascular dementia?

Answer 30

- Conditions causing cerebrovascular lesions that can lead to heart disorders, stroke, etc. - More sudden onset as it is usually in response to an illness or stroke - Presentation depends on portion of brain affected - Changes in declined executive functioning happens quicker than in Alzheimer's disease

Question 31

What is Lewy Body dementia?

Answer 31

- Personality changes - More rapid progression compared to Alzheimer's - Fluctuating day-to-day re: behaviour, personality, etc. - Motor difficulties (Parkinsonism), making them a risk for falls - Memory and cognitive changes occur before motor - Can have hallucinations

Question 32

What is Parkinson's dementia?

Answer 32

Motor difficulties occur before any motor decline

Question 33

What is frontotemporal lobe dementia?

Answer 33

- Impulsive, poor insight, and behaviour changes due to impaired executive function - Often still have intact memories and are aware of changes that have occurred to them - More common in younger patients - Slower onset and progression compared to vascular and Lewy Body

Question 34

What medical conditions can lead to dementia over time?

Answer 34

- AIDS - Head trauma - Parkinson's - Huntington's - Hypothyroidism - Meningitis - Syphilis - Creutzfeldt-Jakob - Hydrocephalus

Question 35

How do we assess cognitive functioning?

Answer 35

- MMSE - Orientation to person, place and time - Asking family and friends about changes - MOCA (instrumental assessment pieces) - Therapeutic conversion (allows us to see if thoughts are organized, can answer abstract questions, if memory is intact, etc.) - Observation while in group activities or with family (for social changes and/or impaired executive functioning) - Ask about mood (as it fluctuates with cognitive disorder)