CCC1 - Cognition, Delirium, Dementia

Cognition definition

The mental process of acquiring knowledge through thought, experience, and the senses

What are the two general states of cognition?

Intact and impaired

What must be assessed about cognitive impairment?

Degree, temporary vs chronic, and stability if chronic

What are the domains of cognitive function?

Executive function, language, social cognition/emotions, concentration, visuospatial/motor function, learning and memory

What is executive function?

Decision-making, planning, and problem solving

What does the language domain include?

Speaking and understanding communication

What is social cognition?

Ability to process emotions and social interactions

What are risk factors for cognitive impairment?

Environmental exposures, aging, substance use, traumatic brain injury, and disease-specific conditions

What environmental exposures affect cognition?

Herbicides, pesticides, pollution, and lead

What diseases are linked to cognitive impairment?

Huntington's disease and Parkinson's disease

What is assessed in level of consciousness?

Alertness and wakefulness

What are the four components of orientation?

Person, place, time, situation

What is included in pupil assessment?

Size and reaction to light

What subjective data is collected in cognition assessment?

Reasoning, understanding, speech, ability to follow commands, and gait

What diagnostic tests are used for cognition?

CT, MRI, labs, ECG, and urine tests

What does the Mini-Mental State Exam assess?

Orientation, memory, recognition, and drawing ability

What does the Mini-Cog assess?

Short-term memory and clock drawing

What is the priority when analyzing cognitive cues?

Safety

What are interventions for cognitive impairment?

Therapy, support groups, pharmacological interventions, and supportive care

What should be evaluated in cognitive patients?

Improvement, decline, or stability and safety status

What is delirium?

An acute, rapid-onset state of confusion with altered perception

Is delirium reversible?

Yes, if the underlying cause is treated

What is the main cause of delirium?

Lack of oxygen to the brain

What are common causes of delirium?

Brain injury, substance use or withdrawal, electrolyte imbalance, medications, hospitalization, infection, sleep deprivation, surgery, serious illness

Who is most at risk for delirium?

Very young and older adults

What is the pathophysiology of delirium?

Decreased oxygen leads to impaired brain function and neuronal changes

What brain changes occur with aging?

Decreased dendrites, axons, and synapses leading to slower processing

What does RASS assess?

Level of alertness and agitation

What does CAM-ICU assess?

Acute change, thinking, and altered level of consciousness

What is the easiest delirium screening tool?

Nursing Delirium Screening Scale

What are nursing priorities for delirium?

Identify cause, ensure safety, reorient patient, and monitor LOC

What is dementia?

A chronic, progressive decline in cognition affecting one or more domains

What is another term for dementia?

Major neurocognitive disorder

Is dementia reversible?

No

What happens in mild dementia?

Patient is mostly independent but needs help with complex tasks

What happens in moderate dementia?

Memory and language decline, difficulty with tasks, sundowning, and trouble recognizing loved ones

What happens in severe dementia?

Severe mental and physical decline, possible bedbound state

What is sundowning?

Increased confusion at night or in the dark

What medications are used for mild to moderate dementia?

Cholinesterase inhibitors such as donepezil and galantamine

What medications are used for moderate to severe dementia?

Donepezil, rivastigmine, memantine, and suvorexant

What medications should be used cautiously in dementia?

Psychotropic medications

What is the impact of untreated delirium?

Can lead to long-term disability

How does dementia impact caregivers?

Causes increased burden and emotional stress

How does awareness vary in dementia?

It can fluctuate depending on disease progression

What is the difference in onset between delirium and dementia?

Delirium is sudden, dementia is gradual

What is the difference in duration between delirium and dementia?

Delirium is short-term, dementia is long-term

What is the difference in reversibility between delirium and dementia?

Delirium is reversible, dementia is not

What happens to LOC in delirium vs dementia?

Delirium fluctuates, dementia is usually stable until late