COGNITIVE DISORDERS o dementia

 Revolves around learning and memory

 Brain imaging shows- enlarged lateral and
 Divided into reversible and irreversible
third ventricles
NON-DEMENTIA  Impaired return of cerebrospinal fluid to the
subarachnoid space and to the venous system
1. Mild Cognitive Impairment  Tx- neurosurgery- ventricular shunt is placed
o is a regression in cognition that is not a in one of the lateral ventricles in the brain
result of normal aging
o It results in confusion, changes in the 2. Vit. B 12 Deficiency
persons way of knowing and  demyelinination of the cerebrum occurred
understanding  peripheral neuropathy is the common
o No treatment but they can have a physical symptom
variety of activities:  delirium, depression and psychosis
o Improve sleep habits  Tx: Vit. B 12 replacement
o Treat underlying psychiatric disorder
o Eat well, reduce alcohol
o Increase socialization and do IRREVERSIBLE DEMENTIAS
stimulating activities DSM IV-TR Criteria for Dementia
o Challenge the brain with mental The development of multiple cognitive deficits
exercise manifested by both:
o Compare and contrast things
1. Memory impairment ( impaired ability to learn
2. Delirium new information or to recall previously learned
o refers to dramatic behavioral changes information)
that a person may experience 2. One or more of the following cognitive
disturbances
HALLMARK SIGNS: a. Aphasia
b. Apraxia
 Fluctuating level of consciousness
c. Agnosis
 Slurred speech
d. Disturbance of executive functioning
 Day-night sleep reversal
 Hallucinations (visual, tactile) B. The cognitive deficits in criteria A1 and A2 each cause
significant impairement in social and occupational
3. Pseudodementia functioning and represent a significant decline from
o cognitive deficits or depression but not previous level of functioning.
enough symptoms to make a dementia C. The course is characterized by a gradual onset and
diagnosis continuing cognitive decline.
o If depressed treat with medications,
psychotherapy, occupational and
1. Alzheimer’s Disease
exercise therapy
 Alois Alzheimer- 1907
DSM IV-TR CRITERIA FOR DELIRIUM
 Hallmark sign- neurofibrillary tangle
1. disturbances of consciousness( reduced clarity  Protein plaques ( Beta amyloid)
of awareness of the environment) with reduced
ability to focus, sustain or shift attention.
STAGES OF ALZHEIMER’S
2. changes in cognition ( memory deficit,
Mild (MMSE Duration – 2-3 Changes
disorientation, language disturbance,
score 20-30) years
perceptual disturbance) Decreased short
3. Develops over a short period of time ( usually term memory
hours to days) and with a tendency to fluctuate Word name
during the course of the day finding difficulty
Decision making,
DEMENTIA
concentration,
 A progressively deteriorating course that reasoning and
ultimately affects cognition, perception, judgment
language, behavior and motor abilities. problems
Moderate 3-4 years Apraxia, agnosia,
(MMSE score aphasia with
POTENTIALLY REVERSIBLE DEMENTIAS 10-19 poor
comprehension,
1. Normal Pressure Hydrocephalus disorientation,
o triad symptoms Blunting of
o unsteady gait or apraxia affect,
o urinary urgency or incontinence misidentification,
sleep
 disturbance,  Memory loss
delusions,  Word finding difficulty
Needs assistance  Difficulty concentrating
in activities of  Misinterpreting the environment
daily living
 Delusions
 Illusions
Redirectable,
extreme  Somatic preoccupations
emotional  Misidentification
lability, self-  sundowning
absorption,
supervision with 4 A’S OF ALZHEIMERS AND ADAPTIVE ACTIONS
meals,  Agnosia- impaired ability to recognize or
wandering, identify familiar objects and people in the
urinary absence of visual and hearing impairment
incontinence  Assess and adapt to visual impairment
Severe (MMSE 5-10 years Gait disturbance,
 Do not expect patient to remember you,
score 0-9) unable to fed
introduce yourself
self, double
incontinence,  Cover mirrors or pictures
bowel impaction,  Name objects and demonstrate their use
bed bound,  Keep area free of ingestible hazards
difficulty
swallowing, fetal  APHASIA- language disturbances are exhibited
position in both expressing and understanding spoken
Requires 24 hrs words.
supervision,  EXPRESSIVE APHASIA- inability to express
close thoughts in words
observation  RECEPTIVE APHASIA- inability to understand
what is said
STAGES ACCCORDING TO COGNITIVE DECLINE
(REISBERG SCALE)  Assess and adapt for hearing loss
 Observe and use gestures, tone and facial
 Stage 1- No Cognitive decline, experiences no expression
problem in daily living  Provide help for word finding
 Stage 2 – Very Mild Cognitive decline, forgets  Restate your understanding of behaviors and
name and location of objects, may have trouble word fragments
finding words  Acknowledge feelings expressed verbally and
 Stage 3 – Mild Cognitive decline, has difficulty nonverbally
travelling to new locations, has difficulty  Use simple words and phrases for concise and
handling problems at work organized
 Stage 4 – Moderate Cognitive decline, has  Allow time to responses
difficulty with complex task  Use pictures, symbols and signs
 Stage 5 – Moderately Severe Cognitive decline,
needs help to choose clothing, needs prompting
to bathe AMNESIA
 Stage 6 – Severe Cognitive decline, needs help  inability to learn new information or to recall
in putting on clothing, requires assistance in previously learned information
bathing, may have a fear of bathing, has  Do not expect patient to remember you,
difficulty to use toilet, or is incontinent introduce yourself
 Stage 7 – Very Severe Cognitive decline  Do not test patients memory unnecessarily
Vocabulary becomes limited, eventually  Operate on the here and now
declining in single words, loses ability to walk  Provide orientation cues
and sit, becomes unable to smile  Remember you must adopt when the patient
CAUSES cannot change
 Compensate for the patients lost judgment or
 Neural Loss reasoning
 Beta amyloid Plaques
 Brain atrophy  Apraxia- inability to carry out motor activities
 Genetics despite intact motor function
 Hormones o Assess and adopt for motor weakness
and swallowing difficulties
o Simplify task, give step by step
instructions and time for response
CLASSIC BEHAVIORS OF ALZHEIMER’S
 o Initiate motion for patient with gentle
guidance or touch

2.Vascular Dementia

 2nd most prevalent dementia

 Brain has multiple vascular lesions in the cortex
and subcortical areas
 Maintain ability to speak with word finding
difficulty
 Dementia is related to location of lesion

RISK FACTORS

 Hypertension
 Diabetes mellitus
 Cardiac arrhythmias
 Previous stroke
 Tobacco use
 Alcohol use and substance abuse

TREATMENT

 Treat the medical problem and health issues

 Improve physical health

PSYCHOTHERAPEUTIC MANAGEMENT FOR DEMENTIA

 Communication strategies- be pleasant, kind

and use good eye contact
 Scheduling strategies- develop a schedule that
provides structure
 develop singular activities
 provide group experience with one subject at a
time

Nutritional strategies

 serve smaller meals several times a day

 finger foods

Toileting Strategies

 provide attention to personal hygiene &

toileting needs
 take the patient to the bathroom every 2 hrs