Chapter 14 Cognitive Diorders

An abrupt-onset type of confusional state marked by: fluctuations in LOC, Inability to pay attention w/interaction, disorganized thinking, agitation or quiet hypoactive behavior. Ex. "quickly falls back to sleep."

3 components to cognition that are disrupted by delirium are?

Shows decreased ability to distinguish and integrate sensory info and to differentiate it. Hallucination, dreams, illusions, imagery.

Fragmented and disorganized to the extent that person unable to reason, judge, abstract, solve problems.

Impaired in all 3 aspects- unable to form memories or store and retrieve (register, retain or recall info).

Change in cognition develops in ____ or ____ and tends to ____ during the day.

Attention/wakefulness- difficulty w/alertness or maintaining _____, ______, ______ - ability to pull oneself back to a task.

Wakefulness-decrease during day leads to drowsy w/naps. Has ______, ______, and ______ at night.

_______ behavior go between extremes of hyperactive to hypoactive. May have _______, disjointed w/ ______ vocalization and ______. _________.

1. State of consciousness-fluctuates 
2. Stability-ability to pay attention/respond changes hour to hour 
3. Duration-can be short lived 
4. Rate of onset-develops rapidly 
5. Cause-traced to recent source

1. As attentive as they can be/ no clouded consciousness until terminal stages. 
2. Stable manner of paying attention. 
3. prolonged; 
4. insidious/gradual process 
5. can't link to any other cause

Mental disorder involving functional declines in multiple cognitive areas, inc. memory along w/behavioral and psychological symptoms.

______ is the 5th leading cause of death in age >65

______ increase w/age and is associated with dementia and cognitive impairment, can imp language. Assess _______ -Don't assume sleep disturbance is due to _________.

Loss of language

Can't express thoughts in writing

Can't understand written language (eventually loss of all verbal ability)

Loss of purposeful movement w/out loss of muscle power or coordination in general. No motor/complex tasks.

Loss of sensory ability to recognize objects- 1st everyday objects- then loved ones or own body parts.

Memory loss. No recent events, both recent and past eventually.

Difficulty remember words over time

3 stages of DAT- use MMSE
_____Early DAT 
_____Moderate DAT 
_____Severe DAT

Slowing of movements in DAT

Avg course in DAT is _____years w/ range ______ years. The earlier the onset= _______.

Complex tasks more difficult r/t recent decrease in memory. Decreased concentration/ inc. distractibility, dec. accurate judgement, time disorientation, but memory about people and places remain. Dec personal appearance, help w/pick out clothes. Limited planning-incomplete verbal/written reports @ work. Verbal skill dec. object/name finding dec. Dec. Speech in noisy environment. May accuse others of wrongdoing-persecution. Frightened by own confusion-cover up and rationalize sxs. Poor driving skills d/t misperception and errors judgement leads to accidents. Hypertonia- muscle twitching-inc. Depression worsens sxs and should be treated.

Progressive/remote/recent memory loss. Can't retain new info. Can't recognize family members or past significant events = loss of remote memory. Dec. behaviors and often unacceptable. Poor impulse control leads to tantrums/outbursts. Quick mood shifts-flat affect to irritability. Dec. Comprehension of language, interactions and significance of objects. LOC minus 3. Wandering, diff. tracking sequence of events- bathing, dressing, toileting. Psychotics sxs common. Misidentification syndrome frequently occurs in which familiar peeps are seen as unfamiliar and vice versa. sleep cycle impaired, dec. total sleep time and frequent awakening. Accidents common-falls, injuries d/t diff. with sharp objects.

Hyper orality-placing everything w/in reach in mouth. Binge eating. Hypermetamorphis the need to compulsively touch everything in enviorment. Motor skills seriously dec. Emotional responses dwindle to no response.

Treatment for Alzheimer's focus on SxS ______, ______, _______ & to lesser extent _______.

2 main medications for Alzheimer's are ______, and ________. These slow progression but don't treat disease.

_________ is useful in storing memory. ___________ is an enzyme that breaks down __________.

________ receptors helps with info processing, storage and retrieval.

2nd most common late onset dementia after DAT. ________ are abnormal concentrations of protein that dev. inside nerve cells and appear as masses that displace other cell components. May overlap w/DAT. Hard to differentiate from Parkinson's.

1) spontaneous parkinsonism or extrapyramidal SxS 
2) Persisten or recurrent visual hallucination. 
3) Fluctuating cognition

When caring for a patient with Dementia w/Lewy bodies be careful w/____________. These pts unusually sensitive - can be severe/fatal. Tardive dyskinesia or neuroleptic malignant syndrome. Ex. Haliperiodl ____. Seroquel _____.

Abrupt onset & episodic w/mult. remissions. ONe sided weakness, emotional outbursts, decline in intellectual fx., hx of HTN, DM or CVD. Brain tissue destroyed by intermittent emboli. SxS are absent until 100 cc - 200 cc of brain tissue destroyed.

Genetic, progressive, degenerative disorder. Motor & cognitive changes, chorea & dementia. Hereditary nervous disease-age 40 - 50. Loss of nerve cells in brain. Chorea = quick, jerky, purposeless, involuntary movements. Life span avg = 15 years after dx. Co-Q10 to DM or platelet disorder.

Rare. Cerebral atrophy in frontal/temporal lobes. Temporal type = talkative, lighthearted, joyous, anxious, hyper attentive. Frontal type= locked in inertia, emotional dullness, lack of initiative. As progresses affects memory/language. Worsens rapidly. Life span after dx= 7 years

Infectious, transmissible. Degenerative dementia affects cerebral cortex thru cell destruction and overgrowth. Very rapid onset and involuntary movements, cerebellar ataxia, diffuse myoclonic jerks, visual/neuro abnormal. Caused by prion- small protein particle resistant to treatment/sterilization. May be genetic spread is iatrogenic after corneal transplant and post injection of growth hormone for infected cadaver. Test CSF for elev. protein.

Came out when mad cow disease did. (Bovine spongiform encephalopathy). Caused by same agent. Transmit by blood transfusion, contaminated beef. Shows spongiform changes in cerebellum.

Subcortical vascular dementia. Caused by widespread microscopic damages to layers of brains white matter. Arteries narrowed by atherosclerosis. Coexists w/DAT. Don't smoke/drink- slows progression.

Affective disorders-depression. May recover. Suspect this if abrupt onset, course rapid & pt. C/O cognitive failure. Most clients w/dementia fail to perceive their deficits.

Progressive-cognitive dysfunction, forgetfulness, loss of concentration/slowness of thought, decrease motor performance- loss of balance, muscle weakness, dec. fine motor skills-handwriting. Behavior change-apathy, withdrawal, dysphoric mood and regressed behavior. HA, seizures. Confused w/psychiatric depression lead to bedridden w/in months.

UNCOMMON cognitive disorder. Short/long term memory deficits. Inability to learn new info or recall past events, confabulation, apathy, bland affect.

Frequently associated w/amnesia. Can be substance induced. Deficits can worsen over yrs even if abstinents from substances.

Medication: Slows rate of cognitive decline

Medication for dementia w/lewy bodies- decreases SxS of depression when present.

Medication for picks disease- decrease problematic mood swings and agitated behavior.

Medication for vascular dementia w/psychosis- reduce or eliminate delusion/hallucination.