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What is cognitive impairment?

Cognitive impairment is when a person has trouble remembering, learning new things, concentrating, or making decisions that affect their everyday life. Cognitive impairment ranges from mild to severe. With mild impairment, people may begin to notice changes in cognitive functions, but still be able to do their everyday activities. Severe levels of impairment can lead to losing the ability to understand the meaning or importance of something and the ability to talk or write, resulting in the inability to live independently. The Center for Disease Control defines cognitive impairment among 8-year-old children by a score of 70 or below on an test of intellectual capability, more commonly known as an IQ test. Levels of cognitive impairment severity are defined by specific IQ ranges. Mild Cognitive Impairment IQ of 50 to 70 Moderate Cognitive Impairment IQ of 35 to 55 Severe Cognitive Impairment IQ 20 to 40 Profound Cognitive Impairment Below 20
Cognitively impaired persons are defined as having either a psychiatric disorder (e.g., psychosis, neurosis, personality or behavior disorders), an organic impairment (e.g., dementia), or a developmental disorder (e.g., mental retardation) that affects cognitive or emotional functions to the extent that capacity for judgment and reasoning is significantly diminished. Types of Cognitive Impairment

The concept of cognitive disabilities is extremely broad, and not always well-defined. In loose terms, a person with a cognitive disability has greater difficulty with one or more types of mental tasks than the "average" person. There are too many types of cognitive disabilities to list here, but we will cover some of the major categories. Most cognitive disabilities have some sort of basis in the biology or physiology of the individual. The connection between a person's biology and mental processes is most obvious in the case of traumatic brain injury and genetic diseases, but even the more subtle cognitive disabilities often have a basis in the structure or chemistry of the brain. A person with profound cognitive disabilities will need assistance with nearly every aspect of daily living. Someone with a minor learning disorder may be able to function adequately despite the disorder, perhaps even to the extent that the disorder is never discovered or diagnosed. Admittedly, the wide variance among the mental capabilities of those with cognitive disabilities complicates matters somewhat. In fact, one may reasonably argue that a great deal of Web content cannot be made accessible to individuals with profound cognitive disabilities, no matter how hard the developer tries. Some content will always be too complex for certain audiences. This is unavoidable. Nevertheless, there are still some things that designers can do to increase the accessibility of Web content to people with less severe cognitive disabilities.

Learning Disabilities Learning disabilities affect a person's ability to process information. In some cases, the individual has difficulties interpreting what is seen or heard. In other cases, the individual can interpret the information but has difficulties making mental connections--or links--between different pieces of information. Dyslexia "Dyslexia is one of several distinct learning disabilities. It is a specific language-based disorder of

constitutional origin characterized by difficulties in single word decoding, usually reflecting insufficient phonological processing abilities. These difficulties in single word decoding are often unexpected in relation to age and other cognitive and academic abilities; they are not the result of generalized developmental disability or sensory impairment. Attention Deficit Hyperactivity Disorder (ADHD) Some people mistakenly think of ADHD as a learning disability. It is true that some people with ADHD have difficulties learning, but oftentimes this is due to their distractibility, rather than to any kind of inability to process information. People with ADHD can be impulsive, easily distracted, and inattentive. Brain Injury Some causes of brain injury include traumatic head injury, stroke, and illness (such as meningitis or brain tumors). Every brain injury is different, and there is no reliable way to predict how a person's brain will be affected. After a person receives an injury to the head, medical professionals perform a series of neurological and psychological examinations to determine what areas of the brain were damaged. Genetic Diseases Genetic sources of cognitive disabilities include Down's syndrome, autism, and dementia, in order of least to most severe. Some individuals with Down's syndrome are able to function at a high level, while others are more limited in the cognitive capacity. Causes Cognitive Impairment The causes of cognitive disabilities are generally divided into prenatal, perinatal, and postnatal factors. Prenatal causes (those that occur before birth) may include genetic abnormalities, infections, exposures to substances that cause birth defects, and central nervous system malformations Down syndrome and fragile X syndrome are among the most common genetic causes of intellectual disability. Perinatal causes (those occurring around the time of birth) may include fetal malnutrition, prematurity, and decreased oxygen to the brain. Postnatal or acquired causes (those after the newborn period) may include trauma (accidental and nonaccidental), suffocation, infections, toxic ingestions, brain damage, central nervous system tumors or cancer, degenerative disorders, and environmental influences (psychosocial deprivation, severe malnutrition). Classifications Delirium Delirium is a disorder that makes situational awareness and processing new information very difficult for those diagnosed. It usually has a high rate of onset ranging from minutes to hours and sometimes days, but it does not last for very long, only a few hours to weeks. Delirium can also be accompanied by a shift in attention, mood swings, violent or unordinary behaviors, and hallucinations. It can be caused by a preexisting medical condition. Delirium during a hospital stay can result in a longer stay and more risk of complications and long terms stays. Dementia Dementia is known as a genetic or trauma induced disorder that erases part or all of the patients memory. It is usually associated with but not restricted to the elderly. It is also usually accompanied by another cognitive dysfunction. For non-reversible causes of dementia such as age, the slow decline of memory

and cognition is lifelong. It can be diagnosed by screening tests such as the Mini Mental State Examination (MMSE). Amnesia Amnesia patients have trouble retaining long term memories. Difficulty creating recent term lost of memories is called anterograde amnesia and is caused by damage to the hippocampus part of the brain which is a major part of the memory process.Retrograde amnesia is also caused by damage to the hippocampus but the memories that were encoded or in the process of being encoded in long term memory are erased

Potential Complications of Cognitive Impairment Because cognitive impairment can be due to serious diseases, failure to seek treatment can result in serious complications and permanent damage. Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your health care professional design specifically for you to reduce the risk of potential complications including: Developmental delays and failure to thrive Learning disability Paralysis or inability to move a body part Permanent cognitive impairment Permanent loss of sensation Personality changes Physical disability The Stages Cognitive impairment ranges from mild to severe. Most doctors identify three main stages of Alzheimers disease mild, moderate, and severe. Because each stage of dementia can last for several years or more, it can also be helpful to understand whether your loved one seems to be in the early, middle, or late part of each stage. Signs and Symptoms Signs of cognitive impairment can be recognized as early as 2 years of age.These symptoms will occur at varying levels depending on the severity of the disorder. Delays in reaching early childhood developmental milestones Difficulty retaining information and learning simple routines Confusion and behavior problems in new situations or places Short attention span Lack of curiosity Difficulty understanding social rules Sustained infantile behavior into toddlerhood or preschool years Difficulty understanding consequences of actions Limited and/or inconsistent communication skills Lack of age-appropriate self-help and self-care skills Memory loss. Frequently asking the same question or repeating the same story over and over. Not recognizing familiar people and places.

Having trouble exercising judgment, such as knowing what to do in an emergency. Changes in mood or behavior. Vision problems. Difficulty planning and carrying out tasks, such as following a recipe or keeping track of monthly bills.

Treatments for Cognitive Impairment Cognitive Remediation Therapy

For patients with milder cognitive deficits, different forms of psychotherapy may be useful in teaching the patient ways to work around their related problems. For example, cognitive remediation therapy is a treatment that emphasizes teaching the patient ways to compensate for their memory or thinking problems. In this treatment, the clinician uses information from neuropsychological testing to identify cognitive strengths that can be used to help overcome other areas of thinking that are not as strong. While widely used in the treatment of cognitive problems resulting from brain injury or stroke, there has been less use of this technique in patients with AD or PD. This treatment does not reverse or cure the cognitive disorder, but rather, the patient is taught strategies that can help with memory skills, such as organizing day-to-day tasks. Depending on the severity of cognitive impairment, many patients can use these skills independently In instances where the patient is more impaired, caregivers or family members can help apply these strategies. This type of therapy is an important treatment option, as it gives the patient concrete strategies to help cope with their cognitive problems. It also provides a supportive environment to express concerns and frustrations over changes in mental functioning. Cognitive remediation therapy is usually conducted by a neuropsychologist or speech-language pathologist, who is specially trained in these techniques. The major drawback of this treatment is that it works best with milder forms of cognitive deficits, as it requires insight into the patients own memory and thinking problems.

Behavioral Management

In this type of treatment, changes in the environment can be made to help minimize memory, visual-perceptual, or orientation difficulties. For example, simplifying the dcor of the living area to reduce excessive stimuli may help with distractibility or confusion. Use of a nightlight or low-level lighting to reduce visual misperceptions and confusion at nighttime may also be beneficial. Behavioral strategies can also help deal with other problems such as impulsivity, wandering, poor initiation, and problems with communication. Many patients benefit from a regular routine in their day-to-day activities and feel more comfortable with a clear, structured schedule.

Mental health and cognitive impairment It is well established that mental health disorders can significantly affect an individuals cognitive functioning. For many people who experience a mental health disorder, changes in cognitive functions such as memory and reasoning can often be some of the most distressing symptoms. Cognitive impairment can limit all aspects of a person's life, and exacerbate feelings of loss of control and mastery associated with many mental health problems. The table below outlines some of the cognitive changes that people with mental health issues can experience.


Can't keep track when reading a book or following a conversation Can't concentrate on anything, and get easily distracted Can only do one thing at a time Forget what they are doing in the middle of doing it Forget appointments, phone numbers and conversations Dependent on others to help remember things Can't learn new skills (e.g., computer) Can't see anything through to the end, for example, start to build something but get muddled half way through Can't cook a meal - difficulty sequencing and coordinating tasks Difficulty filling in forms Difficulties with planning and initiating activities of daily living Difficulties with maintaining motivation and drive




Mental health problems While cognitive impairment will predominantly affect a persons concentration, memory and communication, people with mental health problems are likely to have difficulty with their emotions, behavior and generally with coping in a challenging environment. One in four individuals will experience mental health problems at some point in their lives. A great deal of stigma and prejudice is still attached to mental illness, and there is much emphasis now on enabling people with mental health problems to reintegrate into society rather than being shut away from it. Independent mobility is not only a vital part of the rehabilitation process, helping people to rebuild confidence in social interaction, it is also an essential means for people to reach treatment and support networks. Cognitive dysfunction in mental illness Mental illness affects many people, but what most do not realize is that it does not just cause emotional problems it causes cognitive problems too. The person with mental illness may find it difficult to think clearly, pay attention and remember. For some, the cognitive problems are only evident during the episodes of illness. For others, the cognitive problems are more persistent. If mental illness is managed well, the person can lead a more productive life and have longer periods of stability. To better manage an illness it is important to understand the many ways it affects functioning. When people know what the cognitive symptoms of mental illness are, they can better manage the illness and function better.