The document discusses cognitive disorders including delirium, dementia, and amnestic disorders, outlining their symptoms, causes, assessments, and treatment approaches. Several types of dementia are described such as Alzheimer's disease, vascular dementia, and Parkinson's disease. Nursing interventions focus on promoting safety, adequate nutrition and hygiene, emotional support, and structured routines.

1. COGNITIVE DISORDERS
Eric F.
Pazziuagan, RN, MAN

2. COGNITION
 The brain’s ability to
process, retain, and use
information.
 Include:
reasoning, judgment, perc
eption, attention, compreh
ension, and memory.

3. COGNITIVE DISORDER
 Is a disruption or impairment in the
higher- level functions of the brain.
 Devastating effects on the ability to
function in daily life.
 Can cause people to forget the
names of the family members, to
be unable to perform daily
tasks, and to neglect personal
hygiene.

4. PRIMARY CATEGORIES
DELIRIUM
DEMENTIA
AMNESTIC
DISORDERS

5. 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.
 Clients have difficulty paying attention, are
easily distracted and disoriented, and may
have sensory disturbances such as
illusions, misinterpretations, or
hallucinations.

6.  10%- 15% people in the hospital with
general medical conditions are delirious at
any given time.
 30%- 50% of acutely ill older adult clients
at some time during their hospital stay.
 Risk factors: increased severity of physical
illness, older age, and baseline cognitive
impairment such as that seen in dementia.
 Children may be more susceptible (febrile
and medications)

7. ETIOLOGY
 Physiologic disturbances
 Metabolic disturbances
 Cerebral disturbances
 Drug intoxication or
withdrawal

8. SYMPTOMS
 Difficulty with attention
 Easily distractable
 Disoriented
 May have sensory disturbances such as
illusions, misinterpretations, or
hallucinations
 Can have sleep- wake cycle disturbances
 Changes in psychomotor activity
 May experience
anxiety, fear, irritability, euphoria, or apathy

9. TREATMENT
 Primary treatment: identify
and any causal or
contributing medical
conditions.

10. Psychopharmacology
 Need no specific medication aside
from that indicated to the specific
condition.
 Antipsychotics: Haloperidol
(Haldol), 0.5- 1 mg. To decrease
agitation.
 Adequate food and fluid intake
 IV fluids or TPN

11. NURSING MANAGEMENT
 Client’s safety is a priority.
 Meet their physiologic and
psychologic needs.
 Behavior, mood, and level of
consciousness of these clients
can fluctuate rapidly throughout
the day.

12. DEMENTIA
 A mental disorder that involves multiple
cognitive deficits, primarily memory
impairment, and at least one of the
following disturbances:
 Aphasia: deterioration of language function.
 Apraxia: inability to execute motor functions
despite intact memory abilities.
 Agnosia: inability to recognize or name
objects despite intact sensory abilities.

13.  Disturbance in executive functioning, which is
the ability to think abstractly and to
plan, initiate, sequence, monitor, and stop
complex behavior.
 Cognitive deficits must be sufficiently
severe to impair social or occupational
functioning and must represent a decline
from previous functioning.
 MEMORY IMPAIRMENT: the prominent
early sign.
 Recent memory first before remote memory

14. Aphasia
 Usually begins with the inability to name
familiar objects or people and then
progresses to speech that becomes vague
or empty with excessive use of terms such
as “it” or “thing.”
 May exhibit:
 Echolalia: echoing what is heard
 Palilalia: repeating words or sounds over and
over

15.  Apraxia: May cause clients to lose
the ability to perform routine self-care
activities such as dressing or
cooking.
 Agnosia: may be frustrating for
clients.
 Disturbances in executive
functioning: evident due to inability to
learn new material, solve
problems, or carry out daily activities.

16. DSM-IV-TR DIAGNOSTIC CRITERIA
 Loss of memory (initial stages, recent
memory loss; later stages, remote memory
loss).
 Deterioration of language function
(forgetting names of common objects such
as chair or table, palilalia, and echolalia)
 Loss of ability to think abstractly and to
plan, initiate, sequence, monitor or stop
complex behaviors (loss of executive
function).

17. Onset and Clinical Course
 Mild: forgetfulness (hallmark of
beginning, mild, dementia). It exceeds
the normal, occasional forgetfulness
as part of the aging process.
 Difficulty finding words, frequently loses
objects, and feels anxious about these
losses
 Occupational and social settings are less
enjoyable, may avoid them

18.  Moderate: confusion is
apparent, along with progressive
memory loss.
 Can no longer perform complex tasks
but remains oriented to person and
place.
 Still recognizes familiar people.
 Toward the end of the stage, the person
loses the ability to live independently
and requires assistance because of
disorientation to time and loss of
information such as address and

19.  Severe: personality and
emotional changes.
 May be delusional, wander at
night, forget the name of his
spouse and children, and
require assistance in ADLs.
 Usually lives in nursing facilities
when they reach this stage.

20. Etiology
 Causes vary, although the clinical picture
is similar for more dementias.
 Often, no definitive diagnosis can be made
until completion of postmortem
examination.
 Metabolic activity is decreased in the
brain.
 Genetic component for some forms:
Huntington
 Infections: HIV, Creutzfeldt-Jacob disease

21. Most common types of
dementia:

22. Alzheimer’s disease
 Progressive brain disorder that has a
gradual onset but causes an increasing
decline of functioning, including loss of
speech, loss of motor function, and
profound personality and behavioral
changes such as
paranoia, delusions, hallucinations, inatten
tion to hygiene, and belligerence.
 Evidenced by: atrophy of cerebral
neurons, senile plaque deposits, and
enlargement of the third and fourth

23.  Risk increases with age; average duration
from onset of symptoms to death is 8- 10
years.
 Dementia of Alzheimer’s type, especially
with late onset (after 65 years of age), may
have a genetic component.
 Shown links to chromosomes 21, 14, and
19.

24. Vascular dementia
 Symptoms similar to AD, but onset is
typically abrupt, followed by rapid changes
in functioning; a plateu, or levelling-off
period; more abrupt changes; more abrupt
changes; another levelling-off period; and
so on.
 CT or MRI usually shows multiple vascular
lesions of the cerebral cortex and
subcortical structures resulting from the
decreased blood supply to the brain.

25. Pick’s disease
 Degenerative brain disease that
particularly affects the frontal and temporal
lobes and results in a clinical picture
similar to that of AD.
 Early signs: personality changes, loss of
social skills and inhibitions, emotional
blunting and language abnormalities.
 Onset: 50- 60 years old; death: 2-5 years

26. Creutzfeldt- Jakob Disease
 CNS disorder that typically develops in
adults 40-60 years old.
 Involves altered vision, loss of
coordination or abnormal movements, and
dementia that usually progresses (a few
months).
 Cause: infectious particle resistant to
boiling, UV radiation, and some
disinfectants.

27. HIV infection
 Can lead to dementia and other neurologic
problems.
 May result directly from an invasion of
nervous tissue by HIV or from other
acquired immuno-deficiency illnesses such
as taxoplasmosis and cytomegalovirus.
 May result in a wide variety of symptoms
ranging from mild sensory impairment to
gross memory and cognitive deficits to
severe muscle dysfunction.

28. Parkinson’s disease
 Slowly, more progressive
condition chracterized by
tremor, rigidity, bradykinesia, and
postural instability.
 Results from loss of neurons of
the basal ganglia.
 20%-60% has dementia

29. Huntington’s Disease
 An inherited, dominant gene disease that
primarily involves cerebral
atrophy, demyelination, and enlargement
of brain ventricles.
 Initially, there are choreiform movements
that are continuous during waking hours
and involve facial contortions, twisting, and
turning, and tongue movements.

30.  Personality changes are the initial
psychosocial manifestations, followed by
memory loss, decreased intellectual
functioning, and other signs of dementia.
 Begins in the late 30s or 40s and may last
10-20 years or more before death.

31. Head Trauma
 Dementia can be a direct pathophysiologic
consequence.
 Degree and type of cognitive impairment
and behavioral disturbance depend on the
location and extent of the brain injury.
 When it occurs as a single injury, the
dementia is usually stable rather than
progressive. Repeated head injury may
lead to progressive dementia.

32. Treatment and Prognosis
 Underlying cause is identified so that
treatment can be instituted.
 Improvement of blood flow may arrest the
progress of vascular dementia in some
people.
 Degenerative dementias: no treatment
have been found to reverse or retard the
fundamental physiologic processes.

33.  Replenishment Therapy
(modest therapeutic effects;
temporarily slow the progress
of dementia)
 Donepezil (Aricept)
 Rivastigmine (Exelon)
 Galantamine (Reminyl)
 Memantine (Namenda)

34. Assessment
 Mental Status Exam
 History: family, friends, or care givers
 General appearance and motor behavior:
 Aphasia: cannot name familiar objects or
names
 Apraxia loss of ability to perform tasks
 Uninhibited behavior: inappropriate
jokes, neglecting personal hygiene, showing
undue familiarity with strangers, disregarding
social conventions for acceptable behavior.

35.  Mood and affect:
 Anxiety and fear: initial
 Labile mood
 Anger and hostility
 Aggression
 Wandering at night
 Agitation
 withdrawal
 Thought processes and Content:
 Initial: abstract thinking is impaired
 Delusions of persecution

36.  Sensorium and Intellectual process
 Memory deficits
 Confabulation: make up answers to fill up
gaps
 Agnosia
 Confusion
 Hallucination
 Judgement and insight
 Poor judgment
 Insight is limited

37.  Self- concept
 Angry and frustrated: initially
 sadness
 Roles and relationships
 Work performance suffers
 Roles deteriorate
 Limits in relationship
 Psychologic and self-care considerations
 Disturbed sleep-wake cycles
 Incontinence
 Neglect bathing and grooming

38. Data Analysis
 Risk for injury
 Disturbed sleep pattern
 Risk for deficient fluid volume
 Risk for imbalance nutrition: less than body
requirements
 Chronic confusion
 Impaired environmental interpretation syndrome
 Impaired memory
 Impaired social interaction
 Impaired verbal communication
 Impaired role performance

39. Nursing Interventions
 Promoting patient’s safety and
protecting from injury.
 Offer unobtrusive assistance with or
supervision of cooking, bathing, or
self-care activities.
 Identify environmental triggers to
help client avoid them.

40.  Promoting adequate sleep, proper nutrition
and hygiene and activity.
 Prepare desirable foods and foods client can
self- feed; sit with client while eating.
 Monitor bowel elimination patterns; interfere
with fluids and fiber or prompts.
 Remind client to urinate; provide pads or
diapers as needed, checking and changing
them frequently to avoid infection, skin
irritation, unpleasant odors.
 Encourage mild activity such as walking.

41.  Providing emotional support.
 Be kind, respectful, calm and
reassuring; pay attention to client.
 Structuring environment and routine.
 Encourage clients to follow regular
routine and habits of bathing and
dressing rather than imposing on new
ones.
 Monitor amount of environmental
stimulation, and adjust when needed.

42.  Promoting interaction and
involvement
 Plan activities geared towards client’s
interests and activities
 Reminisce with client about the past
 If client is nonverbal, remain alert to
nonverbal behavior.
 Employ techniques of distraction, time
away, going along, or reframing to calm
clients who are agitated, suspicious, or
confused.