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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 Fluctuates during day, worse at night “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 ) • EEG: diffuse slowing of background activity • TX: treat the underlying cause!! • Psychotic features: haloperidol • Insomnia: benzodiazepines( lorazepam)

  7. DEMENTIA • Multiple cognitive defects ( impairment in memory, general intelligence,learning, language,problem solving, orientation, perception, attention, judgement ) without impairment in consciousness. • >65, %5 have severe, %15 mild dementia. • Time of death after onset of symptoms: 5-9 years • %60- Alzheimer type, after that vascular dementia most common

  8. Psychiatric and Neurological Changes • Personality • Hallucinations and delusions • Mood • Cognitive changes( aphasia, apraxia, agnosia, seizures, primitive reflexes

  9. AMNESTIC DISORDERS • Retrograde Amnesia: inability to recall previously learned information • Anterograde Amnesia: impairment in the ability to learn new information • Usually short-term, recent memory impaired • İmmediate and remote memory intact. • The specific cause determines the course and prognosis

  10. Thiamine Deficiency ( Korsakoff’s Syndrome) • Hypoglycemia • Seizures • Head trauma • Cerebral Tumors • SVA • Herpes Simplex Encephalitis • Hypoxia • ECT • Multiple Sclerosis • Alcohol • Benzodiazepins

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