Alterations in Sensory Processes/Cognitive Function

Cognition

• The systematic way in which a person thinks, reasons, and uses language AND/OR:

• The mental process of knowing, including aspects such as awareness, perception, reasoning, and judgment

Sensory Compensation

When one sense is lost, other senses often become heightened:

• Example: patient is blind, but has great hearing

• When patient is ill, they are sometimes unable to compensate

Sensory Reception

Process of receiving data of external and internal environment via the sense

Kinethetic

Awareness of body position and movement

Stereognosis

Sense that perceives solidity of objects and their size, shape, and texture; perceive and identify objects

Functional Sensory Input

Reception — Perception — Reaction

• Register that something is hot — perceiving the pain — react by moving hand away from the burner

Reticular Activating System (RAS)

Organizer of incoming stimuli:

• Poorly defined network — extends from hypothalamus to medulla

• Mediates sensoristasis

• Monitors and regulates incoming sensory stimuli

RAS Filtering

Muffling out unimportant/irrelevant stimuli to maintain focus;

• determines what you should and should not be focusing on

• React to same stimuli differently based on environment

  • Example: baby crying in public = sympathy, aww cute

  • VERSUS: baby crying at 3am = annoyed

Sensoristasis

Optimal arousal state that is regulated by RAS

Somnolent

Extreme drowsiness, but will respond normally to stimuli

• Normal stimuli = knocking on the door, speaking to them, light touch — they will wake up

Stupor

(Unconscious) Can be aroused by extreme and/or repeated stimuli; unable to express how they are feeling and there could be airway obstruction/dysfunction

• Extreme stimuli = raised voice, shaking them, bed movement, etc.

• Sans stimuli = patient will return to state

• Narcotics/certain drugs = this is the response to overdose

Coma

(Unconscious) Cannot be aroused and does not respond to stimuli

• Stimuli = sternal rubbing, extreme stimuli to get ANY response

• Concerns: BREATHING

• Causes: medically induced, hypotension (poor circulation), extreme bodily trauma, electrolyte abnormalities

• Needs immediate intervention — should be top priority

Normal

Alert, aware, and responsive — interacting and conscious

Sensory Deprivation

Reduction in or absence of usual and accustomed stimuli

• Patients might develop this to normal hospital commotion and become anxious

• Sleep = harder to sleep in hospital (shared space, noise, illness, etc.), causing altered cognition

Sensory Deprivation INTERVENTIONS

• Help patient form a routine

• Keep mind going, maintain stimulation

• Frequent interactions during the day

• Medication (sleeping aids, etc.)

• If they were taking OTC drugs outside of hospital stay, try to replicate as best you can

• Encourage movement

• Family visitation/pet therapy

• Keep them comfortable (letting them wear their own pajama pants, etc.)

• Reorienting clocks

Sensory Overload

One or more of the senses are overloaded; overstimulation, overwhelmed, panicky

Signs/symptoms: agitation, racing thoughts, confusion

Causes: internal (pain, nausea, etc.) stimuli, external (roommate, hospital setting) stimuli, other (overuse of medical jargon)

Sensory Deficit

Impairment, or lack of senses

• Impaired vision, hearing, taste, smell, or tactile perception

• Can be reversible or permanent

  • Be sensitive to loss sense — ensure patient is able to understand you by taking proper interventions

  • Example: olfactory loss — unable to smell gas/smoke or when food has spoiled; taste can also be muffled

Sensory Processing Disorder

Difficulty in the way the brain receives sensory information, or the way the brain organizes and uses that sensory input

• Leads to challenges interacting in the environment

Factors Impacting Sensory Function

• Age = Gradual degradation

• Culture

• Personality and Lifestyle

• Stress and Illness

• Medication = side-effects can cause sense impairment or cognitive alteration

Presbyopia

Age-related vision degradation = a need for reading glasses

• 40 years and older

Cataracts

Clouding of the eye lens

• Seen in 50% of patients over 80 years old

Glaucoma

Increased intraocular pressure — irreversible optic nerve damage

Retinopathy

Non-inflammatory damage to retina — may be caused by uncontrolled diabetes

Macular Degeneration

Loss of visual field in the center of the eye — strong peripheral vision

Presbycusis

Age-related hearing loss — 80 years and older

• Could be due to cerumen buildup

Peripheral Neuropathy

Damage to peripheral nervous system — uncontrolled diabetes, shingles, and longterm alcohol usage/severe vitamin deficiencies (these two often go hand-in-hand)

• NOT REVERSABLE

CVA - Stroke

Sensation, longterm deficients

• Reversible OR permanent damage to the nerves

• Face, drooping, swallowing, movement, etc.

Consciousness

Awareness and responsiveness; requires intact RAS

Attention

Required to acquire and express information; allows you to focus on SOME stimuli and ignore others

Memory

Allows you to retain SOME information and forget others;

• Linked to the senses — more likely to remember if memory is connected to more senses

Learning

What we are attempting to learn, must be meaningful and linked to previous knowledge — build on concepts to gain more understanding, etc.

Communication

Verbal and non-verbal

Normal Cognition

Baseline is individual for each patient;

bCAM Assessment

Brief Confusion Assessment Method

Polypharmacy

May lead to drug interactions that cause cognitive alterations

Beers Criteria

List of medications that should not be used (or should be used with extreme caution) in adults over the age of 65

• Could cause cognitive changes and dangerous affects

Expressive Aphasia (Broca’s Aphasia)

Inability to express words one wants to say — verbal or written

• Limited speech; slow or takes great effort; reduced grammar, poor articulation

• Person knows what they want to say but can’t find the words

  • Frustrating to the patient

Receptive Aphasia (Wernicke’s Aphasia)

Difficulty understanding verbal or written words

• Impaired auditory comprehension and feedback

Dysarthria

Motor speech disorder related to stroke or brain injury

• Speech is slurred or garbled, slow, soft

Delirium

Acute confusional state; typically sudden onset

• REVERSABLE

• Caused by: infections, metabolic disorders, chemical imbalance, etc.

  • Hyperactive Delirium = patient is VERY confused and active

Dementia

Generalized impairment of intellectual functioning; interferes with social and occupational functioning

• Gradual onset that is progressive

• IRREVERSIBLE

• Alzheimer’s Disease, Diffuse Lewy Body Disease, Frontopemporal/Vascular, etc.

Anosognosia

Not aware of their illness or condition due to damage or changes to the brains frontal lobe (the part of the brain that is responsible for our self image)

Aphasia

Difficulty with or complete loss of all aspects of language caused by damage to the left side of the brain (the part of the brain responsible for language)

Agnosia Definition

Loss of recognition and inability to process sensory information

Apraxia Definition

The loss of purposeful or skilled physical movement even if you understand the instructions

Amnesia Definition

Loss of memory and/or the ability to form new memories

Altered Percpetion

Loss of visual perception and the inability to interpret sensory information

Apathy

Individual has a loss of interest or concern for everyday things, for example a lack of personal hygiene

7 A’s of Dementia

Progressive symptoms of dementia:

• Anosognosia

• Aphasia

• Agnosia

• Apraxia

• Amnesia

• Altered Perception

• Apathy

Agnosia Types

• Auditory: inability to recognize or differentiate between sounds, like you aren’t able to recognize familiar voices

• Tactile: inability to recognize or identify objects by touch

• Visual: inability to recognize objects or individuals when seeing them

Apraxia Types

• Buccofacial: unable to carry out facial movements on command

• Limb (kinetic): inability to make precise movements with an arm or leg

• Ideomotor: inability to make appropriate movements in response to verbal commands

• Ideational: inability to make multiple sequential movement, for example getting yourself dressed

• Verbal: difficulty coordinating mouth movements

• Constructional: inability to draw or construct simple figures

• Oculomotor: difficulty moving eyes on command

Amnesia Types

• Anterograde: inability to form new memories

• Retrograde: loss of previously made memories

• Transient global amnesia: fluctuating confusion or agitation over the course of several hours

Depression

Mental decline that is very rapid where individuals may struggle to do things for themselves and will often go into social isolation

• Reversible condition

• May be mistaken for dementia