Understanding Cognitive
Disorders
Developed by DATA of Rhode Island through a special
grant from the RI Department of Human Services
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
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
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
Screening for Cognitive Disorders
Mental Status : brief interview used to
assess cognitive disorders

5 major components:
1.
2.
3.
4.
5.
Appearance and behavior
Mood and affect
Thought
Perception
Sensorium and Intellect
•
Sensorium = consciousness and awareness of
surroundings
Cognitive Disorders
There are multiple types of cognitive disorders.
These include:
Delirium, dementia including traumatic brain injury
and development disabilities
Delirium
1. 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)
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)
Course (cont.)
Tends to occur more in certain people:




Elderly
Medically ill (e.g., cancer; AIDS)
Dementia
Substance Abusers
Delirium (cont.)
3. 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)
Delirium (cont.)
4. 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
Dementia
1. 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
Dementia (cont.)
2. 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:
75-84:
85+:
1.29%
3.83%
10.14%
Statistics
Incidence is the same for males and
females
Onset varies by type of dementia

e.g., Alzheimer’s vs. vascular dementia
People over age 75 at increased risk for
dementia
Dementia (cont.)
3. Example: Alzheimer’s Disease (most
common)
A.
Development of multiple cognitive deficits
manifested by both:
1) Memory impairment
2) One (or more) of the following:
a)
b)
c)
d)
Aphasia
Apraxia
Agnosia
Disturbance in executive functioning
Criteria (cont.)
B. Significant impairment and decline
C. Gradual onset and continuing decline
- Rule out other dementias and mental
disorders (depression)
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:
1.
2.
3.
Gross atrophy of the brain
Neurofibrillary tangles
Senile plaques
Dementia (cont.)
4. 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)
Causes (cont.)
Vascular dementia can be influenced by
diet as well as genetic factors (link to heart
disease)
Psychosocial factors


Higher education level is associated with
lower dementia risk
Social resources and family support can
improve life for patients with dementia
Dementia (cont.)
5. 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
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
Developmental Disability
A condition that begins before the age of 21 and
is likely to continue indefinitly.
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
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
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
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
Impact of Cognitive Impairment
Neuropsychological deficits contribute to
the inattention, distractibility and apparent
lack of motivation early in services.
Understanding the cognitive weaknesses
and strengths is useful for making and in
providing realistic with realistic
expectations about service goals and
expectations.
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.
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
Listening Skills (LISTEN CAREFULLY)
 Look at the person to whom you are speaking
 Interest yourself in the conversation
 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
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
Model
Concent.
Impairmnt
Memory
Impairmnt
Executive
Impairmnt
Motivatiional Summarize:
Verbal Cues,
Nonverbal
Cues
Familiarization, notes,
audio tape,
rehearsal,
homework
Behavioral
Provide Verbatim
written materials
Memory books
Homework
Role rever.
Paper/pen
problem
solving
Coaching
Coaching
Role Plays
Repeat info
Use
Nonverbal &
verbal
cueing
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
QUESTIONS