cognitive disorders delirium dementia amnestic disoders
TRANSCRIPT
CharacteristicsCharacteristics•These disorders are not developmental
•Delirium and dementia often appear together
•One may be imposed upon the other
•Symptoms are consistent with one of the recognized syndromes of cognitive impairment
•Search for an underlying physiological cause for the symptoms
•Assess using a team-based approach
Diagnostic ProcessDiagnostic Process
Symptoms consistent with recognized cognitive impairment
Search for underlying physiological cause
Team based assessment
Recording ProceduresRecording Procedures
Axis I – presence of cognitive problem due to general medical condition
Axis III – underlying medical problem with ICD number
Provisional diagnosis – if unclear what cognitive deficits due to
With dementia: Note if there is a behavioral disturbance
SuperimposedSuperimposed
If in progression of existing dementia– delirium develops
•subtype is noted
An example– Dementia, Alzheimer’s type, late
onset, with Delirium•Dementia diagnosed 1st, the delirium
arrived
DifferencesDifferences
Delirium– Disturbance in consciousness accompanied
by widespread brain dysfunctionDementia
– Distinguished by impairment in memory• sort or long term• recent & remote
– Also impairment of 1 other brain functionBoth:
Exhibit signs & symbols of global brain dysfunction
DementiaDementia
Can be referred to as senility, gradual deterioration of intellectual abilities to where it impairs social and occupational functioning
Multiple cognitive deficits which are skill oriented, indicate global brain dysfunction
Easier to diagnose than delirium
Clients may present with cognitive disturbances
Dementia Dementia
May be caused by:– nonpsychiatric medical condition– a substance or – mixture
Terms– Aphasia – inability to understand or
produce language– Apraxia – loss of motor skill– Agnosia – problems with visual &
spatial
Causes of DementiaCauses of Dementia Over 70 possible causes Alzheimer's
– diagnosed only by ruling other things out Primary dementias
– produced directly by brain impairment Secondary dementias
– caused by diseases not attacking brain directly• Depression• Hormonal imbalances• Drugs• Arteriosclerosis• Pneumonia• HIV• etc
What Does Dementia Look Like?What Does Dementia Look Like? Early progression
– Client may be aware of deficits Numerous Attempts to hide
– Rigid patterns for daily life– Avoid departure from routine
Denial – including family
No typical case– Signs/symptoms vary greatly– Depends on cause, course, severity of underlying disease or problem– Region of brain affected looks different– Personality before dementia
MSE focus– Memory loss– Difficulty with problem solving– Language– Vision-spatial coordination– Numbers
Differential Diagnosis - DementiaDifferential Diagnosis - Dementia
Consider: – Normal aging– Delirium– Schizophrenia– Major depressive disorder (depressive
pseudodementia)– Factitious disorder with psychological symptoms
Females are most misdiagnosed Important to look at dementia vs. depression
Dementia versus DepressionDementia versus DepressionBoth may have poor judgment, somatic complaints, & psychotic Both may have poor judgment, somatic complaints, & psychotic behaviorsbehaviors
In Dementia– Memory deficits– Perseveration – Affect is
“suggestible” – Affect is
inconsistent
In Depression– Difficulty in
concentration– Difficulty learning
new information– Affect is not
influenced by others
– No cognitive disturbances
Dementia: Treatment PossibilitiesDementia: Treatment Possibilities
Depends on type of dementia diagnosed
No treatment for biological componentFind cause and attempt to treat it firstFocus on client management and
environmentSome types of medication may helpCounseling for client and support
group
DeliriumDelirium Disturbance of consciousness & change
in cognition Decline from higher functioning Impairment in occupational or social
functioning Difficulties with assessment
– Need medical tests– Accurate MSE – Accurate history– Primary cause may no longer be present– Children more susceptible to delirium from
meds Often misdiagnosed
Causes of DeliriumCauses of Delirium
General medical– Fever– Hypoxia (lack of oxygen)
– Ischemi (lack of blood flow to brain)
– brain infections such as meningitis Persisting effects of substance
– Many medications & drugs can cause delirium during or after use
Seizure or traumatic brain injury Multiple etiologies
What does delirium look like?What does delirium look like? Cannot concentrate
– Difficulty maintaining or shifting attention Manifest disorganized thinking Misinterpretations of environment
– Easily distracted Perceptual disturbance (illusions, hallucinations…) Inability to remember immediate info Disorientation to time & place Change in speech Onset rapid Severity may fluctuate over course of day Mostly short duration but sometimes follows illness to death Sleep disturbance Change in psychomotor activity possible Anger, irritability, fear (often of hallucinations)
FOR MORE INFO...
http://www.mentalhealth
Associated FeaturesAssociated Features
Emotional disturbances Neurological signs
– Dysgraphia• Difficulty writing
– Constructional apraxia• Difficulty drawing
– Dysnomia• Difficulty naming objects
Tremor Symmetrical increase or decrease in reflexes Autonomic hyperactivity
PredisposingPredisposing Differential Differential FactorsFactors DiagnosisDiagnosis Advanced age
(over 60) Drug dependence Preexisting Brain
injury
Schizophrenia Dementia Psychotic
disorders Factitious disorder
with psychological symptoms
Therapeutic Interventions & Therapeutic Interventions & TreatmentTreatment
Identify and treat causative factorsRecognize emergency situationsTreat behavioral or psychiatric
symptomsEnvironmental treatmentsEducation of support system
Amestic DisordersAmestic Disorders
Memory impairment– absence of other significant cognitive
impairments
Disturbance in memory– due to direct physiological effects of GMC– persisting effects of substance
• can be abuse
– medication– toxin exposure
Amnesic DisordersAmnesic Disorders
Rare to last more than few months Amnesia
– cannot learn new material – Cannot recall recent events although maybe remote
past– Know self & name but not where at or what
Some confabulation to fill gaps Unaware of memory deficits/denial May acknowledge but appear unconcerned Age & onset varies Common to head injury Evidence memory disturbance – consequence of
medical condition or substance use
CausesCauses
Not part of delirium or dementia or intoxication or withdrawal
Chronic heavy alcohol use Stroke Brain tumors Repeated or severe hypoglycemia
– in poorly controlled diabetes Current or recent use of substance Damage to certain brain structures
– caused by surgery, insufficient oxygen, cutoff of blood flow
Infection