Cognitive disorders

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 Are caused by temporary or permanent damage to neurons, resulting in
dysfunction of cognitive processes (higher brain function) including
memory, reasoning, orientation, perception, and attention.
Personality and behavior is also affected

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Organic Brain syndrome
used to refer to constellation of psychological or behavioral signs
and symptoms without reference to causes (e.g. delirium,
dementia)
Organic Mental disorder
designates a particular organic brain syndrome in which the
cause is known or presumed (e.g. alcohol withdrawal or delirium)

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 Cognitive disorders are most common among the elderly
population
The severity of symptoms can be affected by physical,
psychosocial, environmental and cultural factors.
The factors are:
Acute and chronic disease processes
Presence of other mental disorder

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 Poverty, poor nutrition or social isolation
Substance abuse or dependence; taking multiple
prescription drugs

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Dementia
A chronic, progressive disorder characterized by severe
impairments in cognitive processes and personality and
behavioral dysfunctions.

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Symptoms of Dementia
a. Aphasia the loss of language ability
b. Apraxia an impaired ability to carry out motor activities
despite intact sensory function
c. Agnosia the failure to recognize or identify common
objects despite intact sensory function
d. Confabulation filling in memory gaps with detailed fantasy
believed by the affected individual

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e. Sundown syndrome - increased disorientation at night
f. Catastrophic reactions responses of fear or panic with strong potential
to harm self or others
g. Perseveration phenomenon repetitive behaviors, including pacing and
echoing others words
h. Hyperorality the need to taste and chew objects small enough to be
put in mouth

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i. Memory losses
j. Disorientation to time, place and person
k. Decreased ability to concentrate
l. Difficulty making decisions
m. Poor judgment

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Types of Dementia
Dementia, Alzheimers Type
Vascular (multi-infarct) dementia characterized by symptoms
of dementia within the first year of focal neurologic symptoms
Other types of dementia are associated with general medical
conditions such as parkinsons disease, picks disease,
huntingtons chorea and creuzfeldt-jakobs disease

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Onset and Course
A chronic disorder with slow onset and generally poor
prognosis

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Etiology
Factors associated with dementia may include:
- Untreated or untreatable acute condition
- Vascular disease
- Parkinsons disease
- Genetic disorders
- Prion disease
- Infection with HIV
- Structural disorders of brain tissue

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Management
Treatment is directed toward a long-term goal of maintaining quality of
life for this progressive, degenerative disorder
Multidisciplinary team approach
Family focus
Community-focused management
-pharmacologic intervention

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 The goals of pharmacologic intervention are to slow the rate
of the clients decline with medications that increase
acetylcholine levels and help maintain neuronal functioning
and to manage behavior and distressing symptoms.

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Dementia, Alzheimers Type
Research is ongoing. No single cause is implicated. Believed to have
multiple causative factors.
Factors are:
Pathophysiology
Presence of amyloid plaques in brain tissue or presence of neurofibrillary
tangles in neurons

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 Presence of both plaques is associated with nerve cell destruction, loss of
connections between neurons and finally, cerebral atrophy

Genetics
- Familial alzheimers disease has an early onset (30 40 yrs. Old) 20%
of all cases has been associated with abnormal genes on chromosomes
1, 14 and 21

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 Presence of apolipoprotein E4 on chromosome 19
Toxin model
Aluminum exposure to the brain
Neurotransmitter or receptor abnormality
- Loss of acetylcholine

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Stages And Related Symptoms
Mild Stage
Behavior
-difficulty completing tasks, decline in goal-directed
activity, lack of attention to personal appearance and
ADL, withdrawal from usual social activities, frequently
searching for misplaced objects; may accuse others of
stealing

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Affect
Anxious
Depressed
Frustrated
Suspicious
Fearful

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 Cognitive Changes
-Recent Memory Losses,
-time disorientation,
-decreased ability to concentrate,
-difficulty making decisions, poor judgment

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 Moderate Stage
Behavior
Socially inappropriate behavior, self-care deficits,
wandering and pacing, hoarding objects, hyperorality, sleep-
wake cycle disturbance
-Affect
Labile moods, flat, apathetis, catastrophic agitation, paranoia

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 Cognitive changes
Recent and remote memory losses
Confabulation
Disorientation to time, place and person
Some degree of agnosia, apraxia and aphasia

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 Severe Stage
Behavior
Decreased abilty for ambulation and other motor
activites
Decreased swallowing ability
Complete self-care deficits
Absence of caregiver recognition

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 Affect
Flat, apathatic, occasional catastrophic reactions may occur
Cognitive changes
All cognitive changes continue with increased severity of
amnesia, agnosia, and aphasia

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Delirium
Is an acute disorder characterized by cognitive
impairment, attention deficit and a reduced level of
orientation

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Symptoms of Delirium
Impaired consciousness and cognition; reduced ability
to maintain attention
Disorganized thinking and rambling speech
Disturbance of sleep-wake cycle
Psychomotor changes

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Types of Delirium
Delirium due to general medical condition
Substance-induced delirium
Delirium due to multiple etiologies
Delirium not otherwise specified

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Onset and Course

An acute disorder with rapid onset which usually can be

reversed with prompt treatment

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 Factors associated with delirium may include:
Acute or chronic illness
Hormonal and nutritional factors
Sensory impairments
Medications
Drugs interfering with the cholinergic system and the
neurotransmitters acetylcholine affect memory,
learning, attention and wakefulness
Surgical procedure

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Management
Treatment is focused on identifying and treating the underlying
cause while supporting the clients physiologic processes and
promoting safety.
Acute hospital-based care is generally indicated.

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Amnestic Disorders
Are characterized by severe memory impairment and
the inability to learn new material; confabulation and
apathy may be present.

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Symptoms of Amnestic Disorders
Impaired ability to learn new information
Inability to recall previously learned information or past events
Profound amnesia may result in disorientation to place and time,
but rarely self
Lack of insight into the memory deficits
Apathy, lack of initiative

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Types of Amnestic Disorders
Amnestic disorder due to a general medical condition
Substance-induced persisting amnestic disorder

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Onset and Course
Amnestic disorder can occur suddenly or it may be
chronic.
If the disorder is caused by a chronic condition, the
course is similar to that of dementia

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Etiology
Factors associated with amnestic disorders include:
Head trauma, hypoxia, and acute CNS
infections
Chronic thiamine deficiency associated with
alcoholism ( korsakoff syndrome)

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Management
Treatment is similar to that of delirium if the amnestic
disorder is an acute problem; it is similar to that of
dementia if the amnestic disorder is chronic.

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Nursing Interventions
Maintain Safety
Provide emergency measures as necessary
Anticipate environmental safety hazards and remove objects
of risk
Minimize risk of cardiovascular problems with proper diet,
medications, exercise and rest
Monitor drugs and drug interactions, ensuring safe doses for
elderly clients. Pay special attention to medications with
anticholinergic properties

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 Respond to Cognitive deficits
Call client by name and introduce yourself. Use short, clear
messages. Give directions one at a time.
Support client memory by using calendars, orientation boards,
signs and labels as needed
Avoid stressful demands and limit client decision-making
Offer activities within clients ability

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 Avoid or limit socially embarrassing situations; support and
maintain clients dignity
Do not reinforce or agree with hallucination, illusions or
delusions. Respond to and focus on feelings of client
Use reminiscence techniques to encourage client to capitalize
on more intact memories. Encourage client to talk about past
events
Use validation therapy when client no longer responds to
reality orientation techniques

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 Maintain level of functioning for ADL
Promote balance of rest and activity
Support client in self-sufficiency, use cues and positive
reinforcement
Assist with toileting on structured schedule, use disposable pants as
needed to preserve clients dignity
Maintain balanced diet and ensure adequate fluid.

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 Avoid and Minimize catastrophic reactions
Maintain consistency of structure and routine
Decreased environmental stimuli when client is anxious
Do not approach rapidly or touch client if client is irritable, agitated
or suspicious
When client is agitated, remain with client and maintain calm,
supportive manner.

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