Cognitive Disorders
Chapter 24
Videbeck (8th ed.)
Cognition
The brain’s ability to process, retain and use
information
Abilities include reasoning, judgement,
perception, attention, comprehension, memory
These cognitive abilities are essential for things
like making decisions, solving problems,
interpreting the world around us and processing
new information
Neurocognitive Disorders
 A cognitive disorder is a disruption or impairment in the
higher level functioning of the brain
 Adult cognitive disorders have been reconceptualized
as neurocognitive disorders
 The neurocognitive disorder (NCD) we will be focusing in
this module is Dementia. Delirium and Confusion will be
briefly mentioned as well.
Confusion
 Confusion is a state of reduced awareness. The patient may be easily
distracted by sensory stimuli, can alternate between drowsiness and
excitability
 Confusion also refers to an inability to think quickly and coherently; usually
refers to a loss of orientation (time, place, and person) and memory
 Acute Confusion: Abrupt onset of reversible disturbances of consciousness,
attention, cognition, and perception that develop over a short period of
time
Delirium
Delirium involves a
disturbance of
consciousness with a
change in cognition
Development is
usually rapid and may
fluctuate over the
course of the day
-Difficulty paying attention
-Easily distracted
-Disoriented (don’t know where they are)
-Sensory disturbances (illusions/hallucinations)
-May have anxiety, fear, irritability, euphoria
Etiology of Delirium
 Results from an identifiable physiologic, metabolic or
cerebral disturbance or disease
 May result from drug/alcohol intoxication or withdrawal
 Multiple causes may be responsible requiring careful
physical examination and diagnostic testing
Treatment and Prognosis
 Primary treatment relies on precise identification of causal factors
 True delirium is almost always transient and will clear with treatment of the
cause
 Depending on the cause, the patient may be cured completely with
proper medical treatment or in the case of head injury or encephalopathy,
may be left with residual impairment
 Psychopharmacologic treatment varies depending on the symptoms the
patient exhibits. Mild “hypoactive” delirium usually needs no
pharmacologic treatment
 Patients with agitation, psychosis or insomnia interfering with treatment may
require sedation to prevent inadvertent injury
 Short-acting benzodiazepines (Ativan) are preferred; long-acting benzos
are to be avoided as they may worsen delirium
Dementia
 Dementia is defined as a progressive cognitive
impairment with no change in the level of consciousness
 Cognitive deficits associated with dementia:
Early sign: memory impairment
Late: cognitive disturbances: aphasia, apraxia, agnosia
and impaired executive functioning
Deficits must show a decline from patient’s previous
functioning and must be severe enough to impair social or
occupational functioning
Dementia Onset and Clinical Course
 Clinical course of dementia is progressive
 Described in stages:
Mild – forgetfulness that exceeds normal, occasional forgetfulness
frequent loosing things; difficulty finding words; remains in the
home/community
Moderate – apparent confusion; can’t perform complex tasks; still
oriented to person/place and familiar people; looses ability
to live independently
Severe – personality/emotional changes occur; may wander, have
delusions, forget family members’ names; require assistance with
ADLs; most live in nursing facilities at this stage
Etiology & Common Types of Dementia
 Causes vary but clinical picture is similar
 Genetic component has been identified for some dementias (Huntington’s
disease and Alzheimer’s disease
 May be related to infection such as human immunodeficiency disease or
Creuzfeldt Jakob disease
 Most common types of dementia
*Alzheimer’s disease
*Prion diseases (Creuzfeldt-Jakob)
*Lewy body dementia
*Parkinson’s disease
*Vascular dementia
*Huntington’s disease
*Frontotemporal lobar degeneration * HIV, TBI (traumatic brain injury
Alzheimer’s disease
 Progressive disorder
 Gradual onset with increasing decline in function
 May loose speech, motor function, have personality and behavior
changes like paranoia, delusions (altered reality), hallucinations
 Exhibits belligerence
 Neglects hygiene
 Risk for development increases with age
 Post mortem evaluation shows atrophy of cerebral neurons, plaque
deposits and 3rd/4th ventricle enlargement
Treatment & Prognosis of Dementia
 Dementia of the Alzheimer’s type is the most common type (60% of all
dementia’s) in North America
 More common in women
 Treatment starts with identifying the underlying cause in order to
differentiate which type of dementia (Alzheimer’s vs vascular etc.)
 Prognosis involves progressive deterioration od physical and mental abilities
until death
 Patients become totally dependent on caregivers
 Neurotransmitters are decreased in dementia: medications that “replenish”
acetylcholine, cholinergic agonists and cholinesterase inhibitors (Aricept,
Exelon, Reminyl, Razadyne, Cognex, Namenda) show modest therapeutic
effects
 Behaviors can be treated symptomatically: antidepressants, antipsychotics
Nursing Process for Dementia
 Assessment by the Nurse:
-Obtain a history from family if patient is unable to give information
-Appearance and Behavior
-Mood and Affect
-Thought Processes (first affects recent/immediate memory)
-Sensorium and Intellectual Processes
-Self (awareness) Concept
-Physiologic & Self Care issues
-Judgement/Insight
-Roles & Relationships
Nursing Interventions for Patients with
Dementia
 Promoting patient safety is a priority: protecting against
injury and managing risks
 Promoting adequate nutrition, hygiene, sleep and
activity
 Providing a structured environment and routine
 Providing emotional support and reassurance
 Promoting Involvement