Instructor Outline
Understanding Cognitive Disorders
Understanding Cognitive Disorders
Time: 3 Hours
Required Teaching Aids for this module
PowerPoint or Overhead Projector, Handouts and Newsprint of Writing Board
Slide 1
Understanding Cognitive Disorders
Q: What are cognitive disorders? (problem with memory, attention, etc.)
Q: Why are cognitive disorders relevant to mental Illness? (affect behavior and
personality)
Slide 2
Goals
 To familiarize trainees with common types of cognitive disorders
 To improve trainee understanding of the functional impairment of persons with
cognitive disorders
 To identify common co-occurring other disorders
 To identify how approaches to persons with cognitive disorders may be modified
Slide 3
Definition
 Cognitive disorders = disorders in which the central feature is the impairment of
memory, attention, perception, and/or thinking processes.
 Cognitive disorders sometimes underpin other mental disorders such as
depression, paranoia and hallucinations
 Some disorders are transient and others are persisting and progressive
Slide 4
Background
 Used to be called “organic brain disorders”
 Meant a dysfunction of the brain
 Today are referred to as “cognitive disorders”
 Better reflects nature of problems
 Person with cognitive disorder often requires some accommodation in approach
and planning
 Certain types of disorders may require immediate medical attention
Instructor Outline
Understanding Cognitive Disorders
Slide 5
Screening for Cognitive Disorders
 Mental Status : brief interview used to assess cognitive disorders
 5 major components:
 Appearance and behavior
 Mood and affect
 Thought
 Perception
 Sensorium and Intellect
 Sensorium = consciousness and awareness of surroundings
Often, more profound disorders are known to you by the person’s history. Eg DD
Slide 6
Cognitive Disorders
 There are multiple types of cognitive disorders. These include:
 Delirium, dementia including traumatic brain injury and development disabilities
Slide 7
Delirium
 Features
 Key feature is disturbed consciousness
 Associated features include:
 Clouded sensorium – no clear awareness of surroundings
 Problems with attention
 Disturbance in memory
 Incoherent speech
 Perceptual disturbances (e.g., hallucinations)
Slide 8
Delirium (cont.)
 Course
 Acute onset (within hours or days) and transient course (days to a few weeks)
 No such things as life-long delirium
 Can be superimposed on another disorder (e.g., dementia)
Slide 9
Course (cont.)
 Tends to occur more in certain people:
 Elderly
 Medically ill (e.g., cancer; AIDS)
 Dementia
 Substance Abusers
Instructor Outline
Understanding Cognitive Disorders
Slide 10
Delirium (cont.)
 Causes
 Drugs: intoxication, withdrawal, poison
 Delirium tremens = tremors and vivid hallucinations of vermin associated with
alcohol withdrawal
 Medications
 Infection
 Head injury
 Various kinds of brain trauma (e.g., stroke)
Slide 11
Delirium (cont.)
 Responding to Delirium
 Attending to precipitating problem
 Treating medical condition; counteracting effects of substance withdrawal; using
antipsychotic med
 Recognizing people at risk and paying special attention to those cases to avoid
delirium
 Usually requires professional intervention
Slide 12
Dementia
 Features
 Key feature of most dementia is gradual impairment of multiple cognitive abilities
including memory, language, and judgment
 With impaired social/occupational functioning
 Often global cognitive impairment – (e.g., vocabulary and language)
 First signs: personality change and memory loss
Slide 13
Dementia (cont.)
 Statistics and course
 Incidence is highest in older adults, but can onset at almost any age
 Not accurate to give one prevalence rate, because it differs by age group:
 65-74: 1.29%
 75-84: 3.83%
 85+: 10.14%
Slide 14
Statistics
 Incidence is about the same for males and females
 Onset varies by type of dementia
Instructor Outline
Understanding Cognitive Disorders
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e.g., Alzheimer’s vs. vascular dementia
People over age 75 at increased risk for dementia
Dementia (cont.)
Example: Alzheimer’s Disease (most common)
Development of multiple cognitive deficits manifested by both:
Memory impairment
One (or more) of the following:
Aphasia
Apraxia
Agnosia
Disturbance in executive functioning
Slide 15
Criteria (cont.)
 Significant impairment and decline
 Gradual onset and continuing decline
o Rule out other dementias and mental disorders (depression)
Slide 16
Alzheimer’s (cont.)
 Onset usually in 60’s or 70’s
 Early signs in 40’s and 50’s (presenile dementia)
 Definitive diagnosis can only be made on autopsy where confirms:
 Gross atrophy of the brain
 Neurofibrillary tangles
 Senile plaques
Slide 17
Dementia (cont.)
 Causes of dementia
 Direct cause linked to type of dementia
 Plaques and tangles  Alzheimer’s
 Blocked artery  vascular dementia
 Genetic factors linked to some dementias
 Multiple genes  Alzheimer’s risk
 Single dominant gene  Huntington’s disease
 Head trauma (Traumatic Brain Injury)
Slide 18
Causes (cont.)
 Vascular dementia can be influenced by diet as well as genetic factors (link to
heart disease)
 Psychosocial factors
Instructor Outline
Understanding Cognitive Disorders
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Higher education level is associated with lower dementia risk
Social resources and family support can improve life for patients with dementia
Slide 19
Dementia (cont.)
 Treatment of dementia
 Limited – some drugs can improve cognitive functioning, but only temporary
 Psychosocial treatments
 Memory wallet
 Memory skills training
 Teach to use navigational cues to avoid getting lost
 In more progressed cases, more active care giver roles required
Slide 20
Traumatic Brain Injury (TBI)
 50 to 70% of persons with TBI resulting in hospitalization are intoxicated at the
time of the injury
 50% of TBI survivors return to alcohol and/or drug use after the injury
 TBI occurs in about 2% of population
 TBI is heavily associated with certain types of other disorders including substance
abuse, personality disorder and ADHD
Slide 21
Developmental Disability
 A condition that begins before the age of 21 and is likely to continue indefinitely.
 Caused by a mental or physical impairment
 Results in substantial impairment in functional abilities including language,
learning, decision making, self care and other areas.
 Types of disabilities include: Mental retardation, autism, cerebral palsy and other
disorders
Slide 22
Developmental Disabilities and Cognitive Functioning
 Cognitive issues in various levels of mental retardation
 Cognitive issues in Autism Spectrum Disorder
 Cognitive issues in Asperger’s Disorder
 Cognitive issues in Pervasive Developmental Delay
 Cognitive issues in childhood TBI
 Cognitive issues in lead poisoning, drug addiction in-utero, fetal alcohol
syndrome
Instructor Outline
Understanding Cognitive Disorders
Slide 23
Learning Disabilities
 Defined: a disorder in one or more of the basic psychological processes involved
in understanding or in using written or spoken language. A learning disability
may manifest itself in an imperfect ability to listen, think, speak, read, write, spell,
or do mathematical calculations
 Common Learning Disabilities: ADHD, Dyslexia, developmental reading and
writing disorders
Slide 24
Common co-occurring mental disorders
 It is estimated that 40% or more of persons with cognitive disorders have other
mental disorders. These include:
 Depression and anxiety (most common)
 Substance Dependence (particularly with persons with TBI)
 Persons with milder levels of mental retardation are at higher risk of substance
abuse
 Persons with cognitive disorders are at higher risk of victimization and trauma
Slide 25
Impact of Cognitive Impairment
 Neuropsychological deficits contribute to the inattention, distractibility and
apparent lack of motivation early in services. Apparent lack of motivation may be
more based in difficulties processing information.
 Understanding the cognitive weaknesses and strengths is useful for making and in
providing realistic with realistic expectations about service goals and
expectations.
Slide 26
Lessons Learned about persons with cognitive disorders
 Slowed mental processing = increased stress and anxiety
 Word finding difficulty = decreased verbal communication
 Poor retrieval = loss of learned information
 Executive difficulty = poor self-cueing, difficulty with understanding, empathy,
planning and problem solving
 Executive difficulty = poor impulse control, failure to learn from negative
experience, poor self guidance, diminished or limited social skills
Slide 27
Practical tips for interviewing a person with Cognitive Disorders
 Often persons with cognitive disorders experience a high degree of shame and
embarrassment about their limitation and will attempt to hide it.
 Listening Skills (LISTEN CAREFULLY)
 Look at the person to whom you are speaking
 Interest yourself in the conversation
Instructor Outline
Understanding Cognitive Disorders
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Speak less than half the time
Try not to interrupt or change the topic
One question at a time
Simple and clear language
Clarify what is said
Notice body language and facial expression
Don’t rely on verbal instructions or promises
Use visual aids to support learning and retention
Slide 28
More Tips
 Break tasks into smaller steps, and give directions verbally and in writing;
 giving the clients more time to finish certain tasks that may require reading or
writing;
 Make sure the person with reading problems has written materials read out loud
so they better understand
 Make sure the person with listening difficulties has materials in writing
 When possible allow the person to review information with a trusted other person
 Modifying services for persons with cognitive impairments
 Summary
 Cognitive disorders involve an impairment of memory, attention, perception, and
thinking that represents an impairment in functioning
 With adaptations of services and approach persons with disabilities can
successfully participate in services
Slide 29
Modifying services for persons with cognitive impairments
Model
Concent.
Impairmnt
Memory
Impairmnt
Executive
Impairmnt
Motivatiional
Summarize:
Verbal Cues,
Nonverbal
Cues
Familiarization,
notes, audio tape,
rehearsal,
homework
Role play
Paper/pen problem
solving
Coaching
Behavioral
Repeat info
Provide Verbatim Coaching
Use Nonverbal & written materials Role Plays
verbal cueing
Memory books
Homework
Instructor Outline
Understanding Cognitive Disorders
Slide 30
Summary
 Cognitive disorders involve an impairment of memory, attention, perception, and
thinking that represents an impairment in functioning
 With adaptations of services and approach persons with disabilities can
successfully participate in services
Slide 31
QUESTIONS