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COGNITIVE AND MENTAL DISORDERS DUE TO A GENERAL MEDICAL CONDITION (DGMC )

COGNITIVE AND MENTAL DISORDERS DUE TO A GENERAL MEDICAL CONDITION (DGMC ). Yard. Doç.Dr. N. Berfu AKBAŞ. “Clinically significant deficit in cognition and memory that represents a significant change from a previous level of functioning” DELIRIUM DEMENTIA AMNESTIC DISORDER

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COGNITIVE AND MENTAL DISORDERS DUE TO A GENERAL MEDICAL CONDITION (DGMC )

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  1. COGNITIVE AND MENTAL DISORDERS DUE TO A GENERAL MEDICAL CONDITION (DGMC ) Yard. Doç.Dr. N. Berfu AKBAŞ

  2. “Clinically significant deficit in cognition and memory that represents a significant change from a previous level of functioning” • DELIRIUM • DEMENTIA • AMNESTIC DISORDER • COGNITIVE DISORDERS DGMC

  3. DELIRIUM Disturbance of consciousness and a change in cognition with sudden onset. Abnormalities of mood, perception, behaviour, tremor, nystagmus, incoordination, urinary incontinance “It’s a syndrome, not a disease!” Other names: acute confusional state, acute brain syndrome, metabolic encephalopathy, toxic psychosis, acute brain failure

  4. Important to recognize; • %90 postcardiotomy • %40-50 after hip fracture surgery • %30 AIDS • %20 after severe burns • %15-20 in general medical wards • Advanced age ( >65-%30-40) • 1 year mortality %50 ( poor prognostic sign)

  5. Etiology: • CNS disease ( epilepsy, brain trauma, infections, neoplasms, vascular disorders) • Systemic Diseases ( arrhytmias, hypoglycemia, hypoxia, hepatic-uremic encephalopathies, endocrine dysfunction, fever, sepsis) • Post-operative states • Drugs and poisons • Electrolyte imbalance of any cause

  6. Major neurotransmitter: Acetylcholine • Neuroanatomical area: Reticular Formation ( attention and arousal )

  7. AMNESTIC DISORDERS • Usually damage to the diencephalic and middle temporal lobe structures( mamillary bodies, hippocampus) • Commonly bilateral • Traumatic, infection, infarction, hypoxia • Transient amnestic disorder; pathology in the vertebrobasilar system, acute intoxications, seizures.

  8. Mood Disorder due to a GMC • Drugs ( alcohol, antipsychotics, antidepressants, metoclopramide, H2-receptor antagonists, antiHT, sex steroids, glucucorticoids, levodopa, bromocriptine) • Tumors ( pancreas, cerebral..) • Cerebral trauma • İnfection( meningitis, HIV, UTI, pneumonia, syphilis) • Cardiovascular disease • Hypoxemia, renal-hepatic failure • Vit B12, Vit D deficiency • Epilepsy, Multiple sclerosis, Parkinson, Huntington Disease • SLE • Thyroid disease

  9. DEMENTIAS • Impairment in intellectual functioning in 1)memory 2)cognition; language, personality, judgement, abstraction, information synthesis… • %50-Alzheimer type, %25 multi-infarct • SUBCORTICAL D: basal ganglia, thalamus, brain stem ( movement disorders ) memory defects are delayed • CORTICAL D: memory, language, agnosia, apraxia- Alzheimer D. • MIXED D: Multi-infarct D., Lewy body Disease( psychotic and Parkinsonian features)

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