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1. Psychiatric / Mental Health Nursing
Cognitive Disorders
West Coast University
NURS 204

2. What are cognitive disorders?
 Delirium
 Dementia
 Amnestic disorders

3. Etiology
 Delirium
 An underlying systemic illness, including infection,
and endocrine disorder, trauma, and drug/alcohol
abuse
 Dementia
 Classified as to the cause or area of brain damage
 Amnestic disorders
 Head trauma, hypoxia, encephalitis, thiamine
deficiency, and substance abuse

4. Theories
 Genetics
 Dementia of Alzheimer’s type
 Dementia from Huntington’s disease
 Dementia from Pick’s disease

5. Theories - continued
 Infection
 Delirium
 Dementia from Creutzfeldt–Jakob disease
 Parkinson’s disease
 Amnestic disorders
 Vascular insufficiency
 Brain tissue destroyed
 Symptoms absent until 100–200 cc of brain tissue
destroyed
 Underlying systemic illness or injury
 Delirium
 Amnestic disorders

6. Differentiating Types of Cognitive
Disorders
 Delirium
 Acute confusional state characterized by
disruptions in thinking, perception, & memory
 Dementia
 Chronic state characterized by declines in
multiple cognitive areas, including memory
 Amnestic disorders
 Uncommon cognitive disorder characterized
by amnesia

7. Amnestic Disorder
 Characterized by short-and long-term
memory deficits
 Inability to recall previously learned
information or past events
 Inability to learn new materials
 Cofabulation, apathy, bland affect
 Amnestic disorder NOS: not enough
supporting evidence to link a cause to the
amnesia (medical or substance)

8. Delirium and Dementia
Differences
 Delirium
 Fluctuating consciousness
 Varying attentiveness
 Acute
 Rapid onset
 Cause is identifiable
 Generally reversible

9. Delirium and Dementia
Differences - continued
Dementia
 Stable levels of consciousness
 Steady attentiveness
 Chronic
 Slow insidious onset
 Undetermined cause
 Generally irreversible

10. Depression
 Depression can be masked by symptoms
suggestive of dementia
 The term pseudodementia is used to
describe the reversible cognitive
impairments seen in depression
 Pseudodementia is characterized by an
abrupt onset, rapid clinical course, and
client complaints about cognitive failures

11. Assessment
Delirium
 Fluctuating levels of consciousness
 Disorientation and sundowning
 Impaired reasoning
 Poor attention span
 Altered sleep–wake cycle
 Alternating patterns of motor behavior

12. Assessment - continued
Dementia
 Memory impairment
 Cognitive impairment
 Aphasia
 Apraxia
 Agnosia
 Poor judgment
 Decline in previous abilities

13. Interventions for Delirium
 Introduce self and call client by name at
each contact
 Maintain face-to-face contact
 Use short, concrete phrases
 Keep room well lit
 Keep environmental noise low
 Set limits on behavior
 1:1 staffing as needed

14. Interventions for Dementia
 Gently orient the client
 Educate family about home safety
 Maintain optimal nutrition
 Bowel and bladder training
 Utilize nonverbal forms of communication
 Structure the environment to support
cognitive functions

15. Supporting Optimal Memory
Functioning
 Environmental reminders
 Reminiscence activities
 Triggers for semantic memory
 Support cognitive strengths
 Assist to cope with cognitive deficits

16. Common Medications for Cognitive Disorders
 Dementia of the Alzheimer’s Type (DAT)
 Donepezil (Aricept)
 Galantamine (Reminyl)
 Rivastignime (Exelon)
Slows the rate of cognitive decline
Potent acetylcholinesterase inhibitors

17. Common Medications for Cognitive Disorders
 Dementia with Lewy Bodies
 Escitalopram (Lexapro)
Reduce symptoms of depression when present
 Pick’s Disease
 Valproic Acid (Depakote)
Reduce problematic mood swings and agitated
behavior
 Vascular Dementia with psychosis
 Quetiapine (Seroquel)
Reduce or eliminate delusions and hallucination

18. Caregiver Difficulties
 Wandering behaviors
 Sundowning disorientation
 ADLs
 Medication management
 Burnout and fatigue

19. Caregiver Resources
 Family meetings
 Alzheimer’s Disease and Related
Disorders Association (ADRDA)
 Caregiver support groups
 Identify community resources
 ID bracelet for the client

20. Self-Awareness
 Caring for clients with cognitive disorders
can be difficult and frustrating at times.
 Self-awareness inventory in your text
 The responses are designed to help you to
become more successful in working with
cognitively impaired clients and their
families.

21. Review Question
 Delirium is thought to be caused primarily
by:
 A. Genetics.
 B. Underlying systemic illness.
 C. Brain injury.
 D. Vascular insufficiency.

22. Review Question
 A key characteristic of an amnestic
disorder is:
 A. Short-term and long-term memory loss.
 B. Hallucinations.
 C. Long-term memory loss.
 D. Short-term memory loss.

23. Review Question
 A caregiver for a client diagnosed with dementia of
the Alzheimer’s type is unable to effectively
communicate with the client. Which of the following
techniques would be most appropriate to teach the
caregiver?
 A. Setting strict time limits and rephrasing misunderstood
questions
 B. Using multiple memory cues and giving several
directions at once
 C. Correcting errors by the client, and speaking in a loud
clear voiced.
 D. Encouraging verbal and nonverbal communication,
while maintaining a calm demeanor

24. Review Question
 The home health nurse is instructing a family
who cares for a patient with dementia
alzheimer’s type about safety measure would
include:
 A. Putting locks on the outside of doors so the patient
can not leave the room or house
 B. Purchasing a MedicAlert bracelet that identifies the
client as having DAT
 C. Chemically restraining the patient to prevent
agitation and confusion
 D. Restraining the patient in a chair or bed to prevent
falls

25. Review Question
 The actual cause of dementia associated
with dementia of the Alzheimer’s Type is:
 A. Diabetes
 B. Infection
 C. Unknown
 D. Head trauma
 E. Drug intoxication

26. Review Question
 One of the difference between delirium
and dementia is that clients with delirium:
 A. Are very attentive
 B. Experience a slow, insidious onset of
symptoms
 C. Have fluctuating consciousness
 D. Respond to questions appropriately and
correctly