Cognitive Disorders and Neurological Disorders

1. Cognitive Disorders and Neurological Disorders Assessment & Diagnosis SW 593

2. Introduction • Etiology related to physiological processes which are due to general medical conditions. • Some specific diagnoses are related to the use of one or more substances or exposure to a toxic agent. • The hallmark of delirium is a disturbance in consciousness (awareness of one’s environment and/or capacity to focus and direct one’s attention).

3. Delirium • Other disturbances in cognitive functioning (language disturbance, disorientation, memory deficits) may be present as well. • This condition develops over a relatively short period of time, and the intensity of symptoms fluctuates in the course of a day.

4. Delirium • Some of the most common risk factors for delirium include: • Use of a general anesthetic • Multiple medications • A history of drug/alcohol abuse • Sensory loss • Social isolation • Unfamiliar environments • Sleep deprivation • Central nervous system disorders; metabolic and cardiopulmonary disorders.

5. Dementia • The prominent symptoms for Dementia include: • Memory impairment • Other cognitive disturbances (language disturbances; apraxia, agnosia; and/or disturbances in executive functioning • Most dementias develop slowly and display a steadily deteriorating course. • Symptoms are directly related to the portion of the brain that is being affected.

6. Dementia • Dementia of the Alzheimer’s type impairment is focused in the parietal and temporal portions of the brain, which are central to memory function.

7. Amnestic Disorders • Characterized by memory impairment in the relative absence of other cognitive problems. • The most common medical conditions related to Amnestic disorders are a variety of brain traumas or diseases that damage the midbrain structures of maxillary bodies, hippocampus, and fornix.

8. Mental disorders due to a General Medical Condition • Two specific disorders: • Catatonic Disorder: describes clients who show significant disruptions in motor activity, extreme negativism, or mutism, oddities of voluntary movement, and/or mirroring behaviors. • Personality change: clients who display negative and persistent changes to their previous personality pattern. • These changes are usually associated with a variety of neurological, metabolic, or autoimmune disorders.

9. In all of the above diagnoses, the general medical condition should be listed on Axis III.

10. Assessment • When a practitioner conducts assessments related to these disorders, a crucial component is a thorough medical workup. • Prognosis for these medical conditions is determined by whether or not the underlying medical situation can be remedied. • Primary focus of assessment with these mental disorders is on cognitive functioning.

11. Cultural Considerations • A vast majority of persons with these conditions are the elderly of our society. • Regardless, of age, most individuals with these disorders are in need of assistance and considerable care giving. • Research indicates that family members provide 80% of the informal care that older persons and individuals with chronic disabilities receive.

12. Cultural Considerations • Caring for a person with a cognitive disorder can be an exhausting activity and there is ample evidence to suggest that cultural variations exist among different ethnic groups within our society in terms of the norms, values, and beliefs associated with care giving for family members. • Traditionally, African American, Asian/Pacific Islander, and Hispanic families have held strong beliefs about maintaining care giving responsibilities within the family unit.

13. Cultural Considerations • Ethnic minority families are often seen as under-utilizing resources available to them in the community. • As practitioners, be aware to culturally diverse philosophies of care giving. • All families may require support in coping with the stress of care giving, the type and degree of support may vary across cultures.

14. Cultural Considerations • Being able to establish a culturally sensitive relationship with the client and family will more likely lead to a successful long-term outcome in caring for the individual with the disability.

15. Social Support Systems • It should be evident that clients with these disorders require assistance to maintain functioning. • This dependency may become so pronounced that institutionalization becomes necessary. • Both the provision of assistance and the decision making about appropriate placement and care can cause substantial amounts of stress.

16. Social Support Systems • Along with these demands, care givers are typically grieving various losses associated with the client’s deterioration. • This accumulated physical, emotional, financial, and social stress is commonly referred to as care giver burden. • Female care givers experienced the greatest amount of loneliness and depression, with wives experiencing more loneliness than daughters.

17. Social Support Systems • Husbands also experienced loneliness but at lower levels than those of the female care givers.