Understanding Cognitive Disorders: Delirium, Dementia, Amnesia

1. Chapter 15 Cognitive Disorders

2. Cognitive disorders • Defined as when a human being can no longer understand facts or connect the appropriate feelings to events , they have trouble responding to complexity of life challenges • 3 main types: delirium, dementia and amnesia • Delirium and dementia most frequently seen by health care workers

3. Types of cognitive disorders • Delirium • A disturbance of consciousness and change in cognition such as impaired attention span and disturbances of consciousness over short period of time that fluctuate by minute, hour or time of day • Always secondary to another condition (med, drugs, toxic) • If not treated can induce permanent damage to neurons

4. Types of cognitive disorders • Dementia • Usually more insidious onset than delirium • Global deterioration of cognitive functioning (memory, judgment, ability to perform abstract thinking, and orientation) • Is often progressive and irreversible, depending on underlying cause • May be primary (Alzheimer Disease, vascular dementia, Pick’s Disease, Lewy body disease). These are irreversible

5. Disorders of memory

6. Types of cognitive disorders • Amnesic Disorder • Loss of both short term memory (including the ability to learn info) and long term memory, sufficient to cause some impairment in the persons functioning • Always secondary to underlying cause

7. Theory • Alzheimer Disease • No single cause identified, most likely genetic and nongenetic factors • Age: doubles every 5 yrs >65 yrs • Genetic: early onset familial: inherited ages 30-60 • Accounts for 70%-80% of all cases of dementia

8. Stages of Alzheimer disease • Stage 1: Mild • Loss of intellectual ability is insidious • Loss of energy, drive, initiative & has difficulty learning new things • Personality & social behavior intact • Depression may be present

9. Stages of Alzheimer disease • Stage 2: Moderate • Deterioration becomes evident • Cannot remember address or date • Memory gaps in patient history • Hygiene & dress inappropriate • Mood labile with bursts of paranoia, anger, jealousy & apathy

10. Stages of Alzheimer disease • Moderate to Severe • Unable to identify familiar objects or people • Needs repeated instructions to perform simple tasks • May wander • May pose danger to self and others • Incontinent • Sleep and is dependent on others for care • Institutionalization may be necessary

11. Stages of Alzheimer disease • Late • Agraphia: inability to read or write • Hyperorality (the need to taste or chew) • Hypermetamorphosis: must touch everything • Ability to talk and walk is lost • Stupor, coma and death

12. Medications • Cholinesterase inhibitors • Approved by FDA & have positive effects on cognition, behavior and function • Razadyne • Exelon • Aricept • Antagonist NMDA-glutamatergic ion channel making acetylcholine more readily available • Namenda

13. Nursing intervention • Goals • Increase communication, safety and self-care • Minimize confusion • Family teaching and support is crucial

14. Application of nursing process • Assessment • Diagnosis • Outcomes Identification • Planning • Implementation • Evaluation