2.9 dementia and delerium

what is cognition

collection of mental processes and activities used in percieving, remebering, thinking and understanding, as well as the act of using these proceesses

• perceptual motor function

• language domain

• learning and memory

• social cognition

• complex attention

• executive function

what is cognitive impairment

is when a person has difficulty;

• remebering things

• concentrating

• learning new tasks

• solving problems

• planning and organising things

• making decisions

causes of cognitive impairment

• brain injury (stroke, MS, dementia)

• congenital brain impairment (cerebal palsy)

• drug-related

• psychiatric

• environment or experiential (ptsd)

risk factors for cognitive impairment

non-modifiable

• age

• gender

• genetic predisposition

• congenital disorders

• neurodevelopmental disorders

modifiable

• smoking

• alcohol consumption

• physical health

• diet

• sleep disorders

• scoial engagement

• cardiovascular health

• environment

what is mild cognitive impairment (MCI)

a mild neurocognitive disorder

• impairment in cognitive abilities greater than expected age

• does not intefere with activities of daily living

• increased forgetfulness and reliance on compensatory stratergies

• not severe enough to fit the criteria of dementia

• may not always progress to dementia

types of MCI

• amnestic MCI affecting memory

• non-amnestic MCI affecting cognitive abilities such as language, attention, processing speed and judgment

dementia (major neurocognitive disorder)

umbrella term for several conditions affecting memory, cogntive function and behaviour

sub-types of dementia

• alzhiemers disease

• vasucular dementia

• dementia with lewy bodies

• fronto-temporal dementia

• other neurognentitive

sensory impairments relating to demnentia

• olfactory dysfunction

• visual impairment

• hearing impairment

motor impairments in relation to dementia

• gait changes

  • reduced velocity

  • high variability

  • difficulty multi-tasking when walking

what is delirium

an acute disorder of attention and cognition of fluctuating course and associated with an underlying cause

• underrecognised

• can mimic BPSD

• potentially life threatening

delirium risk factors

• visual impairment

• cognitive impairment

• severe illness

• altered urea:creatinine ration

delirium precipitating factors

• surgery

• polypharmacy

• restraints

• malnutrition

• dehydration

• catheterisation

types of delirium

• hyperactive “confused”

  • agitation

  • restlessness

  • psychosis

  • emotional lability

  • refusal to participate

• hypoactive “not themselves” - higher mortality and is often unrecognised

  • drowsy or lethargy

  • withdrawal

  • inattentive / flat affect

  • poor oral intake

  • decreased responsiveness

• mixed - both at same time

depression

characterised by a low mood or loss of pleasure or interest in activities for a long period of time

• often misdiagnosed or undiagnosed in older adults