Cognitive Disorders DELIRIUM A syndrome that involves a disturbance of consciousness accompanied by a change in cognition.

Usually develops over a short period, sometimes a matter of hours, and fluctuates, or changes, throughout the course of the day. Common in older acutely ill clients.


Prolonged disorder can lead to dementia.

Etiology • Results from an identifiable physiologic, metabolic ,or cerebral disturbance or disease or from drug intoxication or withdrawal Common causes • Physiologic or metabolic • Infection • Drug related • Hypoxemia, electrolyte imbalances, renal or hepatic failure, hyper/hypogly, B12, vit C, niacin or CHON deficiency, brain tumor, head injury, paint solvents, insecticides and related substances,cardiovascular shock • Systemic: sepsis, UTI, pneumonia • Cerebral: meningitis, encephalitis, HIV, syphilis • Intoxication: anticholinergics,lithium, OH, sedatives and hypnotics • Withdrawal: OH, sedatives, hypnotics • Rxn to anes, Rx meds or illicit drugs Signs and symptoms • Fluctuating levels of consciousness  Sundowning: disoriented and severely confused at night and early morning hours • Impaired ability to reason and carry out goal-directed behavior. • Alternating patterns of hyperactivity-hypoactivity • Impaired attention span • Alterations in sleep-wake patterns • Fear and high levels of anxiety • Cognitive changes  Memory impairment  Disoriented  Language disturbance: incoherent  Perceptual disturbance: hallucinations and illusions Hyperactive Behavior  Hypervigilance  Restlessness

dietary supplements and herbal preparations. • Get adequate sleep. • • • Manage client’s confusion Control env’t toreduce sensory overload Promote sleep and proper nutrition. or rapid speech Anger Distractibility Nightmares Persistent abnormal thoughts(delusions) Hypoactive Behavior  Lethargy  Speaks or moves little or slowly  Has spells of staring  Reduced alertness  Generalized loss of awareness of the environment Pharmacologic and Non-pharmacologic Treatment Primary tx: identify and treatany causal or contributing medical condition DRUGS • Sedatives: to prevent inadvertent self-injury • Antipsychotics (Haldol): to decrease agitation • Benzodiazepines: ONLY for delirium induced by OH withdrawal ***NOTE: Sedatives and benzodiazepines are avoided because they may worsen delirium Health Teachings: • Monitor chronic health conditions carefully • Visit physician regularly • Tell physicians and health care providers the meds taken. inc over-the-counter meds. loud. Nursing Interventions • Promote client’s safety. insecticides and similar products.     Incoherent. DEMENTIA . • Check with physician before taking any non Rx meds • Avoid OH and recreational drugs • Maintain a nutritious diet. • Use safety prec when working with paint solvents.

Signs and Symptoms • Memory impairment usually short-term at first. loss of motor function and profound personality and behavior changes (paranoia. and impaired sleep • • Common Types • Alzheimer’s dementia • Vascular dementia (multi-infarcts) • HIV dse • Head trauma • Parkinson’s dse • Huntington’s dse • Pick’s dses • Creutzfeldt-jakob dse • General medical condition (brain tumors. delusions. it can be of a primary nature and is NOT reversible. Usually slow and insidious process progressing from months-years. senile plaque deposits and enlargement of the 3rd and 4th ventricles of the brain • Risk of the dse increases with age. delusion. subdural hematoma) • Substance use Alzheimer’s Dementia • Progressive brain disorderthat has gradual onset but causes and increasing decline in functioning: speech. and ability to solve problems and new skills. memory.hallucintation. Unlike delirium. hallucinations. poor judgment Mood disturbances: anxiety. Judgment and moral and ethical behaviors decline as personality is altered.- Marked by progressive deterioration in intellectual function. inattention to hygiene) • Evidenced by atrophy of cerebral neurons. and average duration from noset of Sx to death is 8-10years Vascular dementia • CT scan/ MRI result: multiple vascular lesions of the cerebral cortex and subcortal structures resulting to decrease blood supply to the brain HIV diseases . • – – – Cognitive impairment: Aphasia: language disturbance Apraxia: inability to carry out motor activities despite intact motor fxns Agnosia: loss of sensory ability Significant decline in previous level of functioning.

loss of coordinationand dementia that usually progresses rapidly Basic Workup for Dementia • Chest and radiograph studies • EEG • U/A .gross memory and cognitive deficits-severe muscledys function Parkinson’s Disease • Slowly progressive neurologic condition characterized by hand tremor. bradikinesia and postural instability. some disinfectants and ultraviolet radiation. The dse begins late 30’s. emotional blunting and language abnormalities. It involves altered vision. Huntington’s Disease • An inherited dominant gene disease that primarily involves cerebral atrophy. twisting.• • These may result directly from the invasion of nervous tissue by HIV or other AIDS-related illnesses such as toxoplasmosis and cytomegalovirus. • • Onset: 50-60 years of age. impaired memory and impaired executive functioning. demyelination and enlargement of the brain ventricles. Sx: from mild sensory impairment. rigidity. death occurs in 2-5 years Early signs: personality changes. turning and tongue mov’ts during waking hours Pick’s Disease • Degenerative brain dse that particularly affects frontal and temporal lobes resulting to Alzheimer’s dse manifestations. • death. • • Results from loss of neurons in the basal ganglia Cognitive and motor slowing.early 40’s and may last for 10-20 years or more before • Involves facial contortions. lossof social skills and inhibitions. Creutzfeldt-jakob Disease • CNS disorder that typically develops in 40-60 years • • Encephalopathy due to infectious particle to resistant to boiling.

proper nutrition and hygiene and activity Structure env’t and routine Provideemotional support Promote interaction and involvement in Delirium vs Dementia Onset: acute impairment of orientation. diarrhea and insomia Test stools for GI bleediing Monitor for nausea. fluctuating levels of consciousness and cognitive impairment Cause: secondary to many underlying d/o that cause temporary.HIV Serum creatinine assay Electrolyte assessment Vitamin B12 levels Vision and hearing evaluation Neuroimaging (whendiagnostic isuues not clear) Pharmacologic Treatment Drug Name  Tacrine (Cognex)  Donepezil (Aricept) c. Galantamine (Reminyl) Nursing Considerations Monitor for hapatotoxic effect Monitor for flu-like Sx - Monitor for nausea. abdominal pain and loss of appetite. intellectual fxn. judgment and affect Essential Feature: Disturbance in consciousness. Rovastigmine (Exelon) d. vomiting. vomiting. abdominal pain and loss of appetite Monitor for nausea. dizziness andsyncope Nursing Interventions • Promote client’s safety andprotect from injury • • • • Promote adequate sleep.• • • • • • • • Thyroid fxn test Folate levels VDRL. memory. diffuse disturbances of brain fxn .

Sx do not fluctuate • • Either primary in etiology or secondary to dse state or condition Progresses over months-years. depressed. calculation and judgment. orientation. irreversible Speech: maybe slurred. anxiety and irritability most prominent EEG: pronounced diffuse slowing or fast cycle • Gen normal in early stages. withdrawn. progressive aphasia • Short-term then long-term memory destroyed • Hallucinations not prominent • • Labile. illusions Mood: fear. OC Normal or mildly low . disorganized thinking Memory: impaired short-term memory Perception: visual or tactile hallucinations. paranoid.Course: usually brief (hours-days) prolonged may lead to dementia • Slow insidious dedterioration in cognitive fxning • Progressive deterioration inmemory.

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