Cognitive Disorder

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Post Graduate College of Nursing Punjab,
Lahore.
Subject: Mental Health Nursing
Presented to: Madam Farzana Iqbal
Presented By: Aashi Aslam, Abida Parveen,
Abida Ramzan, Amna Alam, Amna Hanif,
Amy David, Arifa Iftikhar,
Date : September 12, 2022
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Learning Objectives
• At the end of this presentation we will be able to :
• Define cognitive disorders and their categories.
• Discuss their risk factors and causes.
• Distinguish between Delirium and Dementia in terms of symptoms.
• Describe diagnostic criteria of cognitive disorders.
• Explain nursing and pharmacological management and prognosis.

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 Cognitive Disorder
Definition:
A cognitive disorder is a disruption or impairment in these higher-level
functions of the brain. Cognitive disorders can have devastating effects
on the ability to function in daily life. They can cause people to forget
the names of immediate family members, to be unable to perform daily
household tasks, and to neglect personal hygiene.
(Davis, 2005)

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Categories of cognitive Disorders:
The primary categories of cognitive disorders are:
1.Delirium
2.Dementia
3.Amnestic Disorders

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 Delirium
Delirium is a syndrome that involves a disturbance of consciousness
accompanied by a change in cognition. Delirium usually develops over a
short period, sometimes a matter of hours, and fluctuates, or changes,
throughout the course of the day. Clients with delirium have difficulty
paying attention, are easily distracted and disoriented, and may have
sensory disturbances such as illusions, misinterpretations, or
hallucinations
(APA, 2000).

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 DSM-IV-TR Diagnostic criteria:
Symptoms of Delirium
• Difficulty with attention
• Easily distractible
• Disoriented
• May have sensory disturbances such as illusions, misinterpretations, or
hallucinations
• Can have sleep–wake cycle disturbances
• Changes in psychomotor activity
• May experience anxiety, fear, irritability, euphoria,
or apathy
(Adapted from DSM-IV-TR, 2000) 7
 Common causes of Delirium:
• Physiologic or Metabolic
Hypoxemia, electrolyte disturbances, renal or hepatic failure, hypoglycemia or
hyperglycemia, dehydration, sleep deprivation, thyroid or glucocorticoid disturbances,
thiamine or vitamin B12 deficiency, vitamin C, niacin, or protein deficiency,
cardiovascular shock, brain tumor, head injury, and exposure to gasoline, paint
solvents, insecticides, and related substances.
• Infection
Systemic: sepsis, urinary tract infection, pneumonia Cerebral: meningitis, encephalitis,
HIV, syphilis
• Drug-related
Intoxication: anticholinergics, lithium, alcohol, sedatives, and hypnotics
Withdrawal: alcohol, sedatives, and hypnotics
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 Treatment and Prognosis
The primary treatment for delirium is to identify and treat
any causal or contributing medical conditions. Delirium is
almost always a transient condition that clears with successful
treatment of the underlying cause. Nevertheless,
some causes such as head injury or encephalitis may leave
clients with cognitive, behavioral, or emotional impairments even after
the underlying cause resolves.

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 Psychopharmacology:
• Clients with quiet, hypoactive delirium need no specific
pharmacologic treatment aside from that indicated to the specific
condition
• An antipsychotic medication, such as haloperidol (Haldol), may be
used in doses of 0.5 to 1 mg to decrease agitation. Sedatives and
benzodiazepines are avoided because they may worsen delirium.
• Adequate food and fluid intake IV fluids or TPN

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 Other Medical Treatment:
While the underlying causes of delirium are being treated, clients also
may need other supportive physical measures.
1)Adequate nutrition
2)Adequate fluids intake
3)Intravenous fluids or even total parenteral nutrition may
be necessary.
4) If a client becomes agitated and threatens to dislodge
intravenous tubing or catheters, physical restraints may be
necessary so that needed medical treatments can continue.
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 Nursing management:
Promoting client’s safety
Managing client’s confusion
Controlling environment to reduce sensory overload
Promoting sleep and proper nutrition

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 Dementia
Definition
Dementia refers to a disease process marked by progressive
cognitive impairment with no change in the level of consciousness. It
involves multiple cognitive deficits, initially, memory impairment, and
later, the following cognitive disturbances may be seen
(Graziani & Sweet, 2017):

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Multiple cognitive defects of dementia

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Comparison of delirium and dementia

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 Most common types of dementia
Alzheimer disease is a progressive brain disorder that has a gradual onset
• but causes an increasing decline in functioning, including loss of speech,
• loss of motor function, and profound personality and behavioral changes
• such as paranoia,
Vascular dementia has symptoms similar to those of Alzheimer disease,
• but onset is typically abrupt, followed by rapid changes in functioning; a
• plateau, or leveling-off period; more abrupt changes; another leveling-off
• period; and so on. Computed tomography or magnetic resonance imaging
• usually shows multiple vascular lesions of the cerebral cortex and
• subcortical structures resulting from the decreased blood supply to the
• brain.
• delusions, hallucinations, inattention to hygiene 16
Continued……
• Parkinson disease is a slowly progressive neurologic condition
characterized by tremor, rigidity, bradykinesia, and postural instability.
It results from loss of neurons of the basal ganglia.
• HUNTINGTON DISEASE is an inherited, dominant gene disease that
primarily involve cerebral atrophy, demyelination, and enlargement of
the brain
• Prion diseases are caused by a prion (a type of protein) that can
trigger normal proteins in the brain to fold abnormally. They are rare,
and only 300 cases per year occur in the United states
• Pick disease is a degenerative brain disease that particularly affects
the frontal and temporal lobes and results in a clinical picture similar
to that of Alzheimer disease 17
 Etiology
• Causes vary, though the clinical picture is similar for most dementias
• Often, no definitive diagnosis can be made until completion of
postmortem examination.
• Metabolic activity is decreased in the brain
• Genetic component for some forms: Huntington
• Infections: HIV, Creutzfeldt Jacob disease

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 Risk factors
Many factors can eventually contribute to dementia. Some factors, such
as age, can’t be changed. Others can be addressed to reduce risk.
• Age
• Family history
• Down syndrome
• Vitamin and nutrition deficiencies
• Excessive alcohol use
• Cardiovascular risk factors
• Depression and diabetes
• Air pollution and smoking
• Head trauma and medication that can worsen memory 19
 Stages of Dementia
1. Stage 1-Early stage
2. Stage 2- Middle stage
3. Stage 3- Late stage

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 Stage 1 (Early stage)
2 to 4 year of disease
Forgetfulness
Declining interest in environment
Hesitancy in initiating action
Poor performance at work

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 Stage 2 ( Middle stage)
 2 to 12 years of disease
Progressive memory loss
Hesitate in response to questions
Has difficulty in following simple instruction
Irritable , anxious
Wandering
Neglect personal hygiene
Social isolation

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 Stage 3 (Final stage)
After 12 years of disease onwards till death
Marked loss of weight because of inadequate intake of food
Unable to communication
Does not recognize family
Incontinence of urine and feces
Loss the ability to stand and walk
Death is usually causes by aspiration pneumonia

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 DSM-IV-TR Diagnostic criteria:
Symptoms of Dementia
• loss of memory (initial stages, recent memory loss such as forgetting
food cooking on this stove; latter stages, remote memory loss such as
forgetting names of children's , occupation)
• Deterioration of language function (forgetting names of common
objects such as chair and tables
• Loss of ability to think abstractly and to plan
• Loss of executive function
(Adapted from DSM-IV-TR, 2000)

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 Diagnosis
Following tests are used for diagnosis:
 Cognitive assessment evaluation- mini mental status examination-
shows cognitive impairment
 Functional dementia scale ( to indicate degree of dementia)
 Magnetic resonance imaging of the brain shows structural and
neurologic changes
 Spinal fluid analysis shows increased beta amyloid deposits

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 Treatment and Prognosis
• the underlying cause of dementia is identified so that treatment can
be instituted.
• Improvement of cerebral blood flow may arrest the progress of
vascular dementia in some people
• For degenerative dementias, no direct therapies have been found to
reverse or retard the fundamental pathophysiological processes.
• Replenishment therapy ( modest therapeutic effects; temporarily slow
the progress of dementia)

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 Drugs Used to Treat Dementia
Name Nursing considerations
I. Donepezil (Aricept) I. Monitor for nausea, diarrhea,
and insomnia. Test stools
periodically for
gastrointestinal bleeding
II. Rivastigmine (Exelon) II. Monitor for nausea, vomiting,
abdominal pain, and loss of
appetite
III. Memantine (Namenda
III. Monitor for hypertension,
pain, headache, vomiting,
constipation, and fatigue.
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 NURSING INTERVENTIONS
For Dementia
Promoting client’s safety and protecting from injury
Promoting adequate sleep, proper nutrition and hygiene, and activity
Structuring environment and routine
Providing emotional support
 Promoting interaction and involvement

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 Complications
Dementia can effect many body systems and, therefore, the ability to
function. Dementia can lead to:
• Poor nutrition
• Pneumonia
• Inability to perform self care tasks
• Personal safety challenges
• Death

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 Prevention
there’s no sure way to prevent dementia, but there are steps you can take
that might help:
• Keep your mind active
• Be physically and socially active
• Quit smoking
• Get enough vitamins
• Manage cardiovascular risk factors
• Treat health conditions
• Maintain a healthy diet
• Get good quality sleep
• Treat hearing problems 30
 Amnesia
Definition
 It can be defined as a dense loss of memory for recent events but
with preserved intelligence and personality ,memory can be either
totally or partially lost according to the extent of damage that was
caused .
 Amnestic disorders are characterized by disturbance in memory that
results directedly from the physiological effects of a general medical
condition or presenting effects of a substance such as alcohol or
others drugs
 (APA, 2000).
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 Symptoms of Amnesia
• difficulty recalling facts, events, places, or specific details (which can
range from what you ate this morning to the name of the current
president)
• an impaired ability to learn new information
• confusion
• an inability to recognize locations or faces
• confabulation, in which your brain subconsciously invents false
memories to fill in memory gaps

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 Causes of Amnesia
• Head injury.
• Severe illness.
• High fever.
• Seizures.
• Emotional shock or hysteria.
• Alcohol-related brain damage.
• Certain drugs, such as barbiturates or heroin.
• General anesthetics

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 Types of Amnesia
The most common types of amnesia are:
1. Anterograde amnesia: A person with anterograde amnesia cannot
remember new information. This usually results from brain trauma,
such as a blow to the head that causes brain damage. The person
will have their full memory from the time before the injury.
2. Retrograde amnesia: In retrograde amnesia is when a person
cannot remember events that occurred before their trauma, In rare
cases, both retrograde and anterograde amnesia can occur
together.

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Continued…..
• 3. Transient global amnesia: This is a temporary loss of all memory
and, in severe cases, difficulty forming new memories. This is very
rare and more likely in older adults with vascular (blood vessel)
disease.
• 4. Traumatic amnesia: This refers to memory loss resulting from a
hard blow to the head, for instance, in a car accident. The person may
experience a brief loss of consciousness or coma. This type of
amnesia is usually temporary.

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 Treatment of Amnesia
● Treatment of Amnesia
● Psychotherapy or cognitive behavioral therapy (CBT) may help some
people with amnesia.
● Hypnosis can be an effective way of recalling forgotten memories

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 Prevention of Amnesia
A person can help reduce the risk of amnesia by:
• wearing protective headgear during activities that could result in a
brain injury, such as cycling, skating, skiing, or playing contact sports
• Getting medical attention if there’s a high fever, stiff neck, or severe
headaches, which can be a sign of an infection affecting the brain
• wearing a seatbelt while traveling in a motor vehicle, and never
driving while under the influence of alcohol or drugs.

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 References

 Videbeck, S. L. (2020). Psychiatric-mental health nursing (9th ed ,