Y.Dana Presentation Cognitive Disorders

Cognitive Disorders
Yrzabek Dana GM073

Objectives
Define cognitive disorders.
Discuss differences between reversible and
irreversible cognitive disorders.
Discuss the non-dementia cognitive disorders.
Discuss difference between delirium and dementia.
Discuss the various dementias and their symptoms.
Discuss treatment for the various cognitive disorders.

Cognitive Disorders
● Involve “assaults” on the human brain
● Cognition is associated with memory
and learning.
● The loss of memory and learning is
the common thread in all cognitive
disorders
● Some cognitive disorders are
temporary or “reversible” and some
are permanent or “irreversible”.

Classification
◻ Mild cognitive disorder

◻ Delirium
◻ Major cognitive disorder (or dementia)
1. Non demential cognitive disorders
3 Types: MCI, Delirium, and Pseudodementia
2. Dementia
Reversible Dementias (2 types: Normal Pressure

Hydrocephalus & Vitamin B12 Deficiency)
Irreversible Dementias (9 irreversible dementias: Alzheimer’s

Disease, Vascular Dementia, Frontotemporal Lobe Dementia,
Parkinson’s Dementia, Diffuse Lewy Body Disease, Creutzfeldt-
Jakob Disease, AID’s Dementia, Wernicke’s/ Korsakoff’s
Syndrome, & Huntington’s Disease.)
Cognitive Disorders
• A collection of pathologies resulting in the
disturbance of memory recall and formation
from baseline
• Delirium - acute, fluctuating course with

altered consciousness
• Dementia – chronic linear course,
characterized by other cognitive deficits
• Amnesia – memory impairment in the
absence of other cognitive impairments

● Mild Cognitive Impairment (MCI):
◦ Subtle onset
◦ NOT the result of normal aging
◦ Sometimes referred to as the zone between
normal aging and Alzheimer's Disease.
◦ Forgetfulness is the hallmark symptom!
◦ It is not a DSM-IV-TR diagnosis
Delirium
• Reduced clarity of awareness with inability to focus, maintain or shift
attention
• Often accompanied by other cognitive deficits
• Disorientation to place, time, and situation
• Memory: Perseverating, short-term memory loss
• Language: dysarthria, word-finding, aphasia
• Perception: Misinterpretations, illusions, hallucinations
• Sleep: insomnia, circadian rhythm changes
• Emotion: heighten state, fear/anxiety, paranoia, restless, irritable
• Acute and definite shift from baseline
• Over half of patients return to pre-delirium status
• Often precedes worsening of condition in elderly and
chronically ill
Causes of Delirium
• Most cases of delirium are secondary to
another disease process
• Decompensated dementia
• Medication, anesthesia, chemical use/withdrawal
• Infection (sepsis, influenza, UTI)
• Electrolyte imbalances (Na+, glucose)
• Sleep deprivation
• Physiological stress
• Hypothermia, ICU patients
Dementia
• The occasional ‘senior moment’ is normal, further impairment
represents a pathology
• Significant memory impairment with one or more of the

following cognitive deficits that prevent independent
functioning
• Aphasia, apraxia, agnosia, impaired executive functioning
• Prevalence: increases by 10% for each decade over 65

• Dementia develops more slowly than delirium and is characterized by
multiple cognitive deficits, including memory impairment.
• Dementias are usually primary, progressive, and irreversible—even the
reversible ones after a certain extent.
• Alzheimer’s disease accounts for 60% to 80% of all dementias in the US.
Causes of dementia
• Course progression specific to the underlying
disease
• Alzheimer’s Disease: neuro tangles and plaques
• Vascular: damage to blood vessels and capillaries in
cerebrum
• Pick’s/Frontal-Temporal Lobe: organic degeneration
• Parkinson’s: deterioration of dopaminergic neurons in
substantia nigra
• Huntington’s disease: inherited genetic neuro-
degeneration
• Spongiform Encephalopathy: prion infection
• Korsakoff: chronic heavy alcohol use
• Head trauma, AIDS, end stage of medical conditions
Assessment
• Daily routine
• Physical health
• Interview family
and caretakers
• Resources/stressors
• Verify information
• Impact on general
functioning
• Short and long
term changes
Stages of Dementia
• Mild: delayed ability to learn new information
• Pt. makes efforts to compensate for deficits
• Moderate stage: memory loss confined to short
term
• Forgets location of objects, getting lost, or misses details of
current activity
• Confabulates for unknown information
• Severe: long term memory loss
• Recognize family, recall life history
• Labile mood, inappropriate emotions
• Wander in familiar settings
• End Stage: Globally impaired mental abilities,
• impaired bodily functions, movement,
• no discernable language
● Alzheimer’s Disease:
◦ Most prevalent dementia
◦ Diagnosed after all other disorders have been ruled out.
◦ Age is most significant risk factor.
◦ History of head injury, lower educational level, being female are
also risk factors.
◦ 4 stages: Mild, Moderate, Severe, and Late.
◦ Cholinergic Hypothesis: level of acetylcholine is reduced in the
brain.
◦ Genetics plays a role as well: genes on chromosomes 1, 14, 19,
and 21 have been linked to this disease.
◦ Brain Atrophy: the Alzheimer’s brain is also shrinking, weighing
about two thirds the weight of the normal brain.
● Alzheimer’s Disease Continued:
◦ The 4 “A’s”:
● Agnosia: impaired ability to recognize or identify familiar
objects and people in the absence of a visual or hearing
impairment.
● Aphasia: language disturbances are exhibited in both
expressing and understanding spoken words.
● Amnesia: inability to learn new information or to recall
previously learned information.
● Apraxia: inability to carry out motor activities despite intact
motor function.
◦ Misinterpreting the environment through visual hallucinations,
delusions, and misidentification.
◦ Sundowning: phrase that describes the period, usually in the
afternoon and early evening, during which a patient becomes
more agitated and less redirectable.
◦ Loss of ability to care for oneself is particular difficult for all
parties.

Prevention
• Nutrition:
• Vitamin B deficiency
• Bouts of hypoglycemia
• Mental Activity
• Provide mental stimuli with learning language, music,
mental puzzles
• Physical Activity
• Daily exercise and hobbies
• Social Activity
• Family and friend interactions
• Pharmacological
Pharmacological Interventions
• Medications can prevent deterioration, but
cannot return lost abilities
• Cautious dosing
• Prevent breakdown of acetylcholine
• Early stages, GI and hepatic side effects, limit NSAID use
• Donezepil (aricept), rivastigmine (exelon), and
galantamine (razadyne)
• N-Methyl-D-Aspartate antagonist, limit
glutamate release to prevent neuro-corrosion
from calcium ions
• Moderate to severe stages, limit if renal impairment
• Mematine (Namenda)
Interventions
• Think fundamental and instinctual
• Creature comforts
• Natural bodily rhythms
• Safety precautions
• falls, pulling medical devices, wandering/elopement
• Frequently mention time, place, person etc.
• Maintain consistent routine
• Remove obnoxious stimuli
• Foley, noise from hall
• Communication: literal word choices
• one-step directions, 2 item choices, picture boards
References
◻ American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 1st edn
(American Psychiatric Association, 1952).
◻ Ganguli, M. et al. Classification of neurocognitive disorders in DSM‐5: a work in progress. Am. J.
Geriatr. Psychiatry 19, 205–210 (2011).
◻ 6. Sachdev, P. S. Is DSM‐5 defensible? Aust. N. Z. J. Psychiatry 47, 10–11 (2013).
◻ 7. Sternberg, R. J. & Sternberg, K. Cognitive Psychology 6th edn (Cengage Learning, 2009).
◻ 8. Sachdev, P., Andrews, G., Hobbs, M. J., Sunderland,M.&Anderson,T.M.Neurocognitive disorders:
cluster 1 of the proposed meta‐ structure for DSM‐V and ICD‐11. Psychol. Med. 39, 2001–2012
(2009).
◻ 9. Mesulam, M.‐M. (Ed.). Principles of Behavioral and Cognitive Neurology 2nd edn (Oxford
University Press, 2000).
◻ 10. Lezak, M. D., Howieson, D. B. & Loring, D. W. Neuropsychological Assessment 4th edn (Oxford
University Press, 2004).

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Cognitive Disorders

Yrzabek Dana GM073

Discuss differences between reversible and

irreversible cognitive disorders.

Discuss the non-dementia cognitive disorders.

Discuss difference between delirium and dementia.

Discuss the various dementias and their symptoms.

Discuss treatment for the various cognitive disorders.

◻ Mild cognitive disorder

3 Types: MCI, Delirium, and Pseudodementia

Reversible Dementias (2 types: Normal Pressure

Irreversible Dementias (9 irreversible dementias: Alzheimer’s

• Delirium - acute, fluctuating course with

● Mild Cognitive Impairment (MCI):

• Significant memory impairment with one or more of the

• Prevalence: increases by 10% for each decade over 65

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