Cognitive Disorders

1. 14 Cognitive Disorders

2. Learning Objectives 1. Describe the characteristics of and risk factors for cognitive disorders. 2. Distinguish between delirium and dementia in terms of symptoms, course, treatment, and prognosis. 3. Apply the nursing process to the care of clients with cognitive disorders. 4. Identify methods for meeting the needs of people who provide care to clients with dementia. 5. Provide education to clients, families, caregivers, and community members to increase knowledge and understanding of cognitive disorders. 6. Evaluate your feelings, beliefs, and attitudes regarding clients with cognitive disorders.

3. 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”.

4. What are Cognitive Disorders? • Delirium • Dementia • Amnestic disorders

5. Etiology • Delirium • An underlying systemic illness • Dementia • Classified as to the cause or area of brain damage • Amnestic disorders • Head trauma, hypoxia, encephalitis, thiamine deficiency, and substance abuse

6. Theories • Genetics • Dementia of Alzheimer’s type • Binswanger’s disease is a form of small vessel vascular dementia caused by damage to the white brain matter • Dementia from Huntington’s disease : is a neurodegenerativegenetic disorder that affects muscle coordination and leads to mental decline and behavioral symptoms • Dementia from Pick’s disease a type of Frontotemporal Dementia, is a rare neurodegenerative disease that causes progressive destruction of nerve cells in the brain

7. Theories (cont'd) • Infection • Delirium • Dementia from Creutzfeldt–Jakob disease a degenerative neurological disorder that is incurable and invariably fatal • Parkinson’s disease • Amniotic disorders

8. Theories (cont'd) • Vascular insufficiency—Binswanger’s Disease • Brain tissue destroyed • Symptoms absent until 100–200 cc of brain tissue destroyed • Underlying systemic illness or injury • Delirium • Amnestic disorders

9. 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

10. S&S • Difficulty paying attention, are easily distracted and disoriented, and may have sensory disturbances such as illusions, misinterpretations, or hallucinations. • An electrical cord on the floor may appear to them to be a snake (illusion). • They may mistake the banging of a laundry cart in the hallway for a gunshot (misinterpretation). • They may see “angels” hovering above when nothing is there (hallucination). • Experience disturbances in the sleep–wake cycle, changes in psychomotor activity, and emotional problems such as anxiety, fear, irritability, euphoria, or apathy

12. Etiology • Delirium almost always results from an identifiable physiologic, metabolic, or cerebral disturbance or disease or from drug intoxication or withdrawal

14. Treatment • Sedation to prevent inadvertent self-injury may be indicated. An antipsychotic medication, such as haloperidol (Haldol), may be used to decrease agitation. • Sedatives and benzodiazepines are avoided because they may worsen delirium. • Clients with impaired liver or kidney function could have difficulty metabolizing or excreting sedatives. • The exception is delirium induced by alcohol withdrawal, which usually is treated with benzodiazepines

15. Dementia • is a mental disorder that involves multiple cognitive deficits, primarily memory impairment, and at least one of the following cognitive disturbances.

17. Treatment • Treat the underlying cause;For example, the progress of vascular dementia, the second most common type, may be halted with appropriate treatment of the underlying vascular condition (e.g., changes in diet, exercise, control of hypertension, or diabetes). • Improvement of cerebral blood flow may arrest the progress of vascular dementia in some people

19. Amnestic disorders Are characterized by a disturbance in memory that results directly from the physiologic effects of a general medical condition or the persisting effects of a substance such as alcohol or other drugs

20. S&S • The memory disturbance is sufficiently severe to cause marked impairment in social or occupational functioning and represents a significant decline from previous functioning. • Confusion, disorientation, and attentional deficits are common

21. Differentiating Types of Cognitive Disorders • Delirium • Acute confusional state characterized by disruptions in thinking, perception, & memory • Dementia • Chronic state characterized by declines in multiple cognitive areas, including memory

22. Differentiating Types of Cognitive Disorders (cont'd) • Amnestic disorders • Uncommon cognitive disorder characterized by amnesia

23. Delirium and Dementia Differences • Delerium • Fluctuating consciousness • Ability to pay attention/respond • Short-lived • Rapid onset • Can be linked to a cause • May be reversible

24. Delirium and Dementia Differences (cont'd) • Dementia • Stable levels of consciousness • Steady attentiveness • Chronic • Slow insidious onset • Undetermined cause • Generally irreversible

26. difference between dementia and amnestic disorders • The main difference between dementia and amnestic disorders is that once the underlying medical cause is treated or removed, the client’s condition no longer deteriorates

27. Depression • Depression can be masked by symptoms suggestive of dementia • The term pseudodementia is used to describe the reversible cognitive impairments seen in depression • Pseudodementia is characterized by an abrupt onset, rapid clinical course, and client complaints about cognitive failures

28. Assessment • Delirium • Fluctuating levels of consciousness • Disorientation and sundowning is a psychological phenomenon associated with increased confusion and restlessness in patients with some form of dementia • Impaired reasoning • Poor attention span • Altered sleep–wake cycle • Alternating patterns of motor behavior

29. Assessment (cont'd) • Dementia • Memory impairment • Cognitive impairment • Aphasia, which is deterioration of language function. • Apraxia, which is impaired ability to execute motor functions despite intact motor abilities

30. • Agnosia, which is inability to recognize or name objects despite intact sensory abilities • • Disturbance in executive functioning, which is the ability to think abstractly and to plan, initiate, sequence, monitor, and stop complex behavior • Poor judgment • Decline in previous abilities

32. Interventions for Delirium • Introduce self and call client by name at each contact • Maintain face-to-face contact • Use short, concrete phrases • Keep room well lit

33. Interventions for Delirium (cont'd) • Keep environmental noise low • Set limits on behavior • 1:1 staffing as needed

38. Interventions for Dementia • Gently orient the client • Educate family about home safety • Maintain optimal nutrition • Bowel and bladder training • Utilize nonverbal forms of communication • Structure the environment to support cognitive functions

43. NEUROPSYCHIATRIC TREATMENTS • First treat medical problems • Second environmental interventions • Third neuropsychiatric medications • Cognitive impairment • Psychotic symptoms • Depressive symptoms • Insomnia symptoms • Anorexia symptoms • Parkinsonian symptoms

44. Cognitive Disorder Treatment • Psychopharmacology: Namenda (affects NMDA receptors), Aricept (inhibits acetylcholine breakdown), Cognex (cholinesterase inhibitor), Exelon (a brain-selective acetylcholinesterase inhibitor), Reminyl (reversible cholinesterase inhibitor)

45. Supporting Optimal Memory Functioning • Environmental reminders • Reminiscence activities: involves exchanging memories with the old and young, friends and relatives with HCPs • Triggers for semantic memory • Support cognitive strengths • Assist to cope with cognitive deficits

46. Caregiver Difficulties • Wandering behaviors • Sundowning disorientation • ADLs • Medication management • Burnout and fatigue

47. Caregiver Resources • Family meetings • Alzheimer’s Disease and Related Disorders Association (ADRDA) • Caregiver support groups • Attorney • Identify community resources • ID bracelet for the client

48. Self-Awareness • Caring for clients with cognitive disorders can be difficult and frustrating at times. • Self-awareness inventory in your text • The responses are designed to help you to become more successful in working with cognitively impaired clients and their families.