Altered Cognition
- 3. At the end of this session students will be able to 1. Define cognition and cognitive disorder. 2. Define dementia. 3. Indentify the types of dementia. 4. Recognize the symptom of dementia. 5. Elaborates the causes of dementia.
- 4. 6. Define Delirium. 7. Enlist the symptom of delirium. 8. Recognize the causes of delirium. 9. Explain the diagnostic procedure for dementia and delirium. 10. Identify nursing care for dementia and delirium.
- 5. Mental process characterized by knowing, thinking, learning, and judgment. Cognitive disorders include delirium and dementia.
- 6. Cognitive disorder are those conditions in which the predominant disturbance is a clinically significant deficit in cognition or memory that represents a significant change from a previous level of functioning . (American psychiatric Association ,2000,p,135)
- 7. A loss of previous levels of cognitive, executive, and memory function in a state of full alertness; the progressive decline in cognitive function due to damage or disease in the brain beyond what might be expected from normal aging.
- 8. Primary dementia = dementia itself is the major sign of an organic brain disease not directly related to any other organic illness Alzheimer’s disease Secondary dementia = caused by or related to another disease or condition HIV Cerebral trauma
- 9. Amnesia--inability to learn new information or to recall previously learned information Agnosia--failure to recognize or identify objects despite intact sensory function Aphasia--language disturbance that manifest in both understanding & expressing the spoken word Apraxia--inability to carry out motor activities despite intact motor function
- 11. Impairment in abstract thinking, judgment, and impulse control Disregard of social conduct Uninhibited and inappropriate behavior Neglect of personal appearance and hygiene
- 12. May affect language ◦ difficulty naming objects ◦ vague, imprecise speech ◦ aphasia Personality changes Apraxia = inability to carry out motor activities despite intact motor function Irritability, mood instability, sudden outbursts
- 13. Unable to comprehend own limitations ◦ serious risk for accidents ◦ unable to work or care for personal needs independently Wandering away from home or health care setting
- 14. Dementia of the Alzheimer’s type Vascular dementia Dementia due to HIV Dementia due to head trauma Dementia due to disease processes Dementia due to other general medical conditions Persistent dementia due to substance use Dementia due to multiple etiologies
- 15. A mental state characterized by a disturbance of cognition, which is manifested by confusion, excitement, disorientation, and a clouding of consciousness; hallucinations and illusions are common. It is characterized by a disturbance of consciousness and a change in cognition that develops rapidly over a short period of time.
- 16. Difficulty with attention ◦ focusing ◦ sustaining ◦ shifting Extreme distractibility Disorganized thinking Rambling, irrelevant, pressured, incoherent speech Impairment in reasoning ability and goal-directed behavior
- 17. Disorientation to time and place Impairment of recent memory Misperceptions of the environment (hallucinations/illusions) Disturbance in the sleep-wake cycle State of awareness ranges from hyper vigilance to stupor/semi-coma Vivid dreams and nightmares Fluctuations of psychomotor activity ◦ restlessness, hyperactivity ◦ vegetative state (i.e. catatonic stupor)
- 18. Emotional instability ◦ anxiety, depression, irritability, anger ◦ murmuring, moaning, calling out for help ◦ attempts to flee or attack others Autonomic manifestations ◦ tachycardia ◦ sweating ◦ flushed face ◦ dilated pupils ◦ elevated blood pressure
- 19. General medical conditions Substances ◦ medications ◦ toxins Overdose of drugs or alcohol Withdrawal from alcohol, drugs, or medication Multiple etiologies ◦ more than one general medical condition ◦ combination of medical condition and substance use
- 20. 1 Dementia ◦ Chronic, slow progression ◦ Irreversible disorder ◦ Impaired memory ◦ Global cognitive deficits ◦ Most commonly caused by Alzheimer’s ◦ Does not require immediate treatment Delirium ◦ Rapid in onset (hours to days), fluctuating course ◦ May be reversed especially, if treated early ◦ Greatly impairs attention ◦ Focal cognitive deficits ◦ Most commonly caused by systemic disease, drug toxicity, or metabolic changes ◦ Requires immediate treatment
- 21. CT scan Mental Status Exam (MSE) CBC, Chemistry Panel, Basic Metabolic Profile (to determine underlying cause)
- 22. Brain Imaging/Lab Tests - CT or MRI, cerebrospinal fluid (all used to confirm a diagnosis or eliminate various possibilities) Blood tests - used to diagnosis neurosyphilis. Metabolic tests - determine treatable disorders such as a vitamin B12 deficiency EEG (electroencephalography) is used to diagnose Creutzfeldt-Jakob disease.
- 23. Recent reviews indicated that the GPCOG, MMSE and MIS are the most appropriate screening tools for primary care in that they are quick to use and have high sensitivity and specificity to diagnose cognitive impairment (>80%) Ref: Brodaty et al, 2002; Brodaty et al 2005; Borson et al, 2000; Borson et al 2005; Buschke et al 2006; Lorentz et al 2002; Milne et al 2008.
- 25. TEST RESULTS Psychological and social aspects Factors affecting test performance History Informant perspective Medical tests, scans etc Response to assessment Findings and recommendations Functional assessment; other measures Interpreting Results
- 26. Brief in duration ◦ 1 week to 1 month Diminishing of symptoms ◦ occurs upon recovery from underlying cause ◦ 3 days to 1 week common ◦ may take up to 2 weeks May transition into a more permanent cognitive disorder ◦ dementia Prognosis of Dementia Progressive and irreversible
- 28. Altered thought processes r/t severe dehydration as e/b hyper vigilance, distractibility, visual hallucinations, and disorientation to time, place, and person. Altered thought processes r/t barbiturate ingestion e/b altered sleep patterns, delusions, disorientation, and decreased ability to grasp ideas. Altered thought processes r/t brain disorder e/b inaccurate interpretation of environment, deficit in recent memory, impaired ability to reason, and confabulation.
- 29. Impaired verbal communication related to cognitive impairment as evidenced by recent memory loss . Impaired social interaction related to altered thought process, as evidenced by loss of conformity to social norms. Self care deficit related to cognitive impairment. Disturbed thought process related to cognitive impairment. Risk of injury related to fear and disorientation.
- 30. Care for physiological needs Respond to hallucinations Respond to wandering Decrease agitation Administer medications Reinforce coping mechanisms Communicate therapeutically Provide health education, involving family and community Remember that elderly people are very sensitive to medications. Administer with care, and monitor closely.
- 31. Highest priority is to maintain quality life and attend to physical needs ◦ Nutrition and fluid balance ◦ Ensure safety- May need restraint in acute care settings ◦ Sedatives may be needed for sleep deprivation Communicate with clear messages and simple instructions Maintain dignity Decrease anxiety with dementia. ◦ Keep lights on if pt fears dark or shadows ◦ Orientate to time, place and person
- 32. Person wears identification bracelet Install special locks, safety devices on doors, stove & other potentially dangerous objects Check frequently for burns, bruises, or abrasions Assess for signs of abuse Only use restraints after other methods are ineffective--need MD order Look directly at person when speaking Identify yourself prior to interaction Use simple short phrases Ask specific rather than general questions Distract if asking same question repeatedly Assist in word finding Reassure that you intend to help Avoid arguing Convey patience and understanding Promote Safety Communication
- 33. Establish regular & predictable routine Breakdown complex tasks into small simple steps Consistent care by regular staff Use large clock & calendar distraction & stimulation, avoid clutter & unnecessary objects Post lists of daily activities Person wear glasses & hearing aid Avoid medications if possible Check person frequently Decrease Confusion
- 34. Encourage regular exercise Ensure nutrition & hydration Assist with ADLs Assess frequently for physical pain, constipation, & discomfort Evaluate agitation and worsening behavior carefully Suggest day treatment for clients living at home Teach ways to manage uncooperative behavior Teach about causes and course of dementia Monitor & assess level of stress on the family Encourage use of social support to decrease caregiver stress Help families mourn the loss of their loved one Physical & Emotional Wellbeing Family Education Schober, Glod, Jones, 1998, p. 251
- 35. Stuart, G. & Laraia, M. (2005). Principles & practice of psychiatric nursing (8th Ed.). St. Louis: Elsevier Mosby Stuart, G. & Sundeen, S. (1995). Principles & practice of psychiatric nursing (5th Ed.). St. Louis: Mosby searchfiletype.com/Cognitive-Responses-Organic-Mental-Disorders- fs60. www.scribd.com/doc/22161869/Cognitive-Disorders www.powershow.com/.../Cognitive_Disorders_powerpoint_ppt_prese nta... faculty.mccneb.edu/awwinter/Unit7.ppt www.sjsu.edu/people/phyllis.../Nurs_127Ax_S_01x_Cognitivex_ECT. pp... healthvista.freehosting.net/.../Mental%20Health_Organic%20Disor ders.p... quizlet.com/15725973/ch-17-cognitive-disorders-ppt-flash-cards/