COGNITIVE

DISORDERS
P.TEMBO
MENTAL HEALTH
1. Dementia
2.Derilium
 Affect memory, orientation, judgment, and attention.
DEMENTIA

 An impairment in cognitive functioning with global

deficits. Level of consciousness is stable. Prevalence is
highest in those > 85 years of age. The course is
persistent and progressive. The most common causes
are
 Alzheimer’s disease (50%) and multi-infarct dementia
(25%). Other causes are outlined in the mnemonic
DEMENTIAS.
CAUSES

 Degenerative diseases(Parkinson’s,Huntington’s)
 Endocrine (thyroid, parathyroid, pituitary, adrenal
 Metabolic (alcohol, electrolytes, vitamin B12
deficiency,)
 Exogenous (heavy metals, carbon monoxide, drugs)
CONT

 Neoplasia
 Trauma (subdural hematoma)
 Infection (meningitis, encephalitis, endocarditis,
syphilis)
 Affective disorders (pseudodementia)
CONT

 Stroke/Structure (vascular dementia,ischemia,

vasculitis, normal pressure hydrocephalus)
HISTORY/PE

 Diagnostic criteria include memory

impairment and one or more of the
following:
 Aphasia: Language impairment.
 Apraxia: Inability to perform motor
activities.
 Agnosia: Inability to recognize previously
known objects.
 Impaired executive function (problems
with planning, organizing, and
abstracting) in the presence of a clear
sensorium.
 Personality, mood, and behavior changes are common
(e.g., wandering and aggression).
DIAGNOSIS

 A careful history and physical is critical. Serial mini-

mental status exams should be performed.
 Rule out treatable causes of dementia; obtain CBC,
RPR, TFTs, HIV, B12/folate, ESR, and a head CT or MRI.
TREATMENT

 Provide environmental cues and a

rigid structure for the patient’s
dailylife.
 Cholinesterase inhibitors are used to
treat. In dementia due to Alzheimer’s
disease, cholinesterase inhibitors may
delay the progression of dementia and
 perhaps lead to a slight improvement.
 Low-dose antipsychotics may be used for agitation.
Avoid benzodiazepines, which may worsen disinhibition
and confusion.
 Family, caregiver, and patient education and support
are imperative
The 4 A’s of dementia

 Amnesia
 Apraxia
 Aphasia
 Agnosia
Delirium
 An acute disturbance of consciousness with altered cognition that
develops over a short period of time (usually hours to days). Children, the
elderly, and hospitalized patients (e.g., ICU psychosis) are particularly
susceptible.
 Major causes are outlined in the mnemonic I WATCH DEATH.
 Symptoms are potentially reversible if the underlying cause can be
treated.
Major causes of
delirium—I WATCH DEATH
 Infection
 Withdrawal
 Acute metabolic/substance Abuse
 Trauma
 CNS pathology
 Hypoxia
 Deficiencies
 Endocrine
 Acute vascular/MI
 Toxins/drugs
 Heavy metals
HISTORY/PE

 Presents with acute onset of waxing and waning

consciousness with lucid intervals and perceptual
disturbances (hallucinations, illusions, delusions).
 Patients may be combative, anxious, paranoid, or
stuporous.
 Also characterized by a ↓ attention span and short-term
memory; a reversed sleep-wake cycle; and ↑ symptoms
at night (sundowning).
DIAGNOSIS

 . Check vitals, and glucose; perform physical and

neurologic exams.
 Note recent medications (insulin,anticholinergics,
steroids, narcotics, or benzodiazepines), substance use,
prior episodes, medical problems, signs of organ failure
(kidney, liver), and infection (occult UTI is common in
the elderly).
 Order lab and radiologic studies to identify a possible
underlying cause.
TREATMENT
 Treat underlying causes (delirium is often reversible).
 Normalize fluids and electrolytes.
 Optimize the sensory environment.
 Use low-dose antipsychotics (e.g., haloperidol) for agitation and
psychotic symptoms.
 Conservative use of physical restraints may be necessary to prevent harm
to the patient or others