Delirium, Dementia & Amnestic Cognitive Disorders

Scott Rower 9/20/06

Cognitive Disorders In General
 

Brain dysfunction  cognitive deficits Cognitive Functions

Memory, attention, perception & thinking

Develop later in life

Delirium – What Is It?

A syndrome of disturbances in consciousness accompanied by symptomatic manifestations of early brain dysfunction

(which can not be better explained by dementia)

Delirium – Main Symptoms
  

Confusion Disorientation Cognitive Changes

Memory dysfunction, perceptual dysfunction

Types of Delirium
 

 

Delirium Due to a Medical Condition Delirium Due to Substance Intoxication Delirium Due to Substance Withdrawal Delirium Due to Multiple Etiologies Delirium Not Otherwise Specified

What are other possible effects?
   

Emotional disturbances Tremors Autonomic hyperactivity Reversal of night-day sleep-wake cycle Extreme shifts in psycho-motor activity

Who is at risk?

What Is The Course?
 

Begins abruptly Fast recovery

Dependant on i.d. & attention

Complete recovery is common

Differential Diagnosis
   

Dementia Substance intoxication & withdrawal Schizophrenia, Schizophreniform Malingering & Factitious Disorder

But Scott, Are There Other Causes?

  

Severe medical illness Severe mental illness Fever Poisoning Brain Injury

 

Severe lack of food or water Sleep deprivation Excess stress

Key Diagnostic Point
 

Disturbance of consciousness Change in cognition

Dementia – What Is It?

A gradual deterioration of the brain functioning that affects judgment, memory, language & other advanced cognitive processes

Dementia – Main Symptoms

 

All cognitive function becomes affected Memory impairment Cognitive disturbance(s)

Agnosia, Aphasia, Apraxia, Executive Functioning

Types of Dementia
  

 

Dementia of the Alzheimer’s Type Vascular Dementia Dementia Due to Other General Medical Conditions Substance-Induced Persisting Dementia Dementia Due to Multiple Etiologies Dementia Not Otherwise Specified

Cortical Vs. Subcortical Dementia
Language Memory

Aphasia Recall & recognition impaired Impaired Less severe depression & anxiety Normal until late in progression

No aphasia Impaired recall; normal or less impaired recognition Impaired More severe depression & anxiety Impaired

Visuospatial Skills Mood Coordination

What Are Other Possible Side Effects?

Emotional changes

Irrational beliefs, depression, agitation, aggression, apathy

Who Is At Risk?

Big surprise – the elderly
  

Ages 75 – 79  2.3% 80 – 84  4.6% 85 & Older  8.5%

What Is The Course?
 

Continued cognitive deterioration Death Sad, I know

Differential Diagnosis
   

Delirium Schizophrenia MDD Age-Related Cognitive Decline

What Are The Causes of Dementia
    

Brain trauma Infectious disease Toxic substances Diseases Multiple genes

The Alzheimer’s Brain

What Is The Treatment?
 

Biological treatment Psychosocial treatment

  

Estrogen replacement therapy Treatment of hypertension? Nonsteroidal anti-inflammatory drugs?

Key Diagnostic Point
 

Memory impairment At least one major cognitive disturbance

Amnestic Disorder – What Is It?

Loss of memory w/o loss of high-level cognitive functions

Inability to transfer information into long term memory

What Are The Main Symptoms?

Inability to learn new info or recall previously learned info Issues with social and occupational functioning

What is the course?

  

Acute onset Subtle onset Due to head trauma is largely variable

Greatest after injury, improvement until about 2 years

What Are The Types of Amnestic Disorder?

Based on etiology

Amnestic disorder due to general medical condition Substance-induced persisting amnestic disorder Amnestic disorder not otherwise specified

Differential Diagnosis

Repetition of sequential string of info a good test
 

Unimpaired  amnestic disorder Impaired  delirium

 

Any cognitive impairment? Direct effect of a medical condition or substance abuse?

Key Diagnostic Point

Distinguishing feature is memory impairment without other cognitive deficits

Amnestic Disorder In The Media

Oliver Sacks’ – The Man Who Mistook His Wife for a Hat Dory from Finding Nemo Memento

Making A Diagnosis

2 tiered process

1 – recognition that symptoms are consistent w/ a DSM disorder 2 – Search for underlying physiological asuse

Making A Diagnosis

To delineate which cognitive disorder

Does the patient have disturbances of consciousness? Does the patient have an impairment of cognition? What is the temporal basis of the patient’s disturbance?

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