Cognitive Disorders Flashcards
What does cognition refer to?
- 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
What cognitive disorders results in decreased cognitive functioning?
Dementia, delirium and amnestic disorders (head trauma’s, “blacking out” after binge drinking, etc)
What is delirium?
- Acute cognitive impairment
- Can be hypoactive/mild, hypoactive/severe, hyperactive or mixed (most common)
- Considered a medical emergency
- Affects all aspects of cognition
What is delirium caused by?
- Medical conditions (infection, response following surgery, fluid/electrolyte/metabolic disturbances)
- Substances (prescribed or illicit, polypharmacy, etc.)
- Unknown factors
What is the difference between hypoactive and hyperactive delirium?
- 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.
What is dementia?
- Global, chronic cognitive impairment
- Pervasive
- Degeneration disorder of CNS
- Not an illness, but symptom of an illness
What are the different types of dementia?
- 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
What is the difference between normal memory loss with age and dementia?
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.
What is the hippocampus responsible for?
Formation of memories (a hippo coming on campus would be memorable!)
What is the parietal lobe responsible for?
Sensation, sensory processing
What is the frontal lobe responsible for?
Thought processing, language output, programming of activities, prioritization, personality and behaviour
What is the temporal lobe responsible for?
Language, comprehension, learning, short-term memory
What is the cerebellum responsible for?
Movement, muscle coordination
Compare and contrast dementia and delirium:
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
How do we treat delirium?
- 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
What are risk factors for delirium?
- 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
What is the diagnostic criteria for delirium?
- Behavioural changes (agitation?)
- Onset (quick vs. slow)
- Fluctuations during the day (are their sleeping patterns altered?)
- Impaired consciousness
What is the presentation of delirium?
- Dependent on type
- Disorientation
- Changes to concentration and focus
- Impacted speech and motor function
- Difficulty sleeping
- Poor social cues
How do we treat delirium?
- Physiological (support symptoms)
- Psychological (reduce stimulation)
- Social
What is the prognosis for delirium?
- Reversible if treated
- Often causes complications
What is the etiology of dementia?
- Depends on type
- Multiple theories (plaques, cell death, genetics)
What are the risk factors or dementia?
- 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
What is the diagnostic criteria for dementia?
- 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.)
What is the presentation for dementia?
- Onset
- Physiological (changes to mood and behavior)
- Psychological
- Social (isolation, change in relationships)
What are the priorities in caring for an individual with dementia?
- 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
What are some general tips for working with someone with dementia?
- 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
What is the prognosis for dementia?
Essentially a terminal cognitive disorder that occurs over time
What are the stages of Alzheimer’s?
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
What is Alzheimer’s type of dementia?
- 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
What is vascular dementia?
- 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
What is Lewy Body dementia?
- 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
What is Parkinson’s dementia?
Motor difficulties occur before any motor decline
What is frontotemporal lobe dementia?
- 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
What medical conditions can lead to dementia over time?
- AIDS
- Head trauma
- Parkinson’s
- Huntington’s
- Hypothyroidism
- Meningitis
- Syphilis
- Creutzfeldt-Jakob
- Hydrocephalus
How do we assess cognitive functioning?
- 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)
