Cognitive Disorders

Cognition

the brain's ability to process information, store (retain) information, and use information

reasoning

judgment

perception

attention

comprehension

memory

Cognitive Abilities

Cognitive Disorder

an impairment in higher brain functions, affecting thinking and functioning. Severely affects daily life

Delirium

a sudden disturbance in consciousness and cognition characterized by reduced awareness of the environment, impaired attention, and changes in thinking and perception. Usually caused by an underlying medical condition or substance-related issue. usually temporary (reversible). improves once the cause is treated

acute onset (hours to days)

fluctuating course (worse at certain times of the day, often at night)

Onset and Course of Delirium

1. Disturbance in attention

2. Disorientation

3. Perceptual disturbances (Illusions, Misinterpretations, and Hallucinations)

4. Cognitive changes

5. Sleep-wake disturbance

6. Psychomotor changes

7. Emotional changes

Core Symptoms of Delirium

hypoxia (low oxygen)

electrolyte imbalance

kidney or liver failure

abnormal blood sugar (hypo/hyperglycemia)

dehydration

sleep deprivation

vitamin deficiencies (B12, thiamine)

brain injury or tumor

toxin exposure

Physiological / Metabolic causes of Delirium

sepsis

urinary tract infection

pneumonia

Systemic infections that causes delirium

meningitis

encephalitis

HIV

syphilis

Brain infections that causes delirium

anticholinergics

lithium

alcohol

sedatives

Drug intoxications that causes delirium

alcohol

sedatives

hypnotics

Drug withdrawals that causes delirium

Haloperidol

First-line medication for delirium

Benzodiazepines

NOT routinely recommended. May worsen delirium, especially in elderly. Used mainly for alcohol withdrawal delirium

altered and fluctuating LOC

hallmark sign of delirium

Hyperactive type: restlessness, agitation, picking at bedclothes, attempting to get out of bed

Hypoactive type: lethargy, sluggishness, decreased movement

Psychomotor changes in Delirium

incoherent or difficult to understand

rambling or disorganized

perseveration (repeating same topic)

pressured speech (rapid, loud)

may call out or scream (often at night)

Speech changes in Delirium

Dementia (Major Neurocognitive Disorder)

a progressive cognitive decline characterized by impairment in multiple cognitive domains and no disturbance in level of consciousness (unlike delirium). Deficits must impair social or occupational functioning or represent a decline from previous level. associated with decreased brain metabolic activity

memory impairment (early and prominent sign)

Core feature of Dementia

Aphasia, Apraxia, Agnosia, Executive Dysfunction

Additional Cognitive Deficits in Dementia

Aphasia

deterioration of language ability, difficulty naming objects or people, speech becomes vague or empty

Apraxia

inability to perform motor activities, despite intact motor function

Agnosia

inability to recognize or name objects, despite intact sensory function

Executive Dysfunction

impaired ability to plan, organize, initiate tasks, sequence actions, and problem-solve

Mild Neurocognitive Disorder

Mild cognitive decline. Independent living still possible, may need assistance or adjustments

impaired recent memory. Forgets names, objects, and tasks

Memory deficit in early stage dementia

impaired remote memory. Forgets family members, personal history, and own identity

Memory deficit in late stage dementia

difficulty naming objects (anomia)

vague speech (e.g., "thing")

echolalia - repeating what is heard

palilalia - repeating own words

Speech and Language changes in dementia

Huntington Disease

Alzheimer's Disease (linked to abnormal APOE gene)

dementias that have a strong genetic link

HIV infection

Creutzfeldt-Jakob Disease

infections affecting the brain can lead to dementia:

Alzheimer's Disease

Lewy Body Dementia

Vascular Dementia

Frontotemporal Lobar Degeneration

Prion Diseases

HIV-Related Dementia

Parkinson Disease

Huntington Disease

Traumatic Brain Injury (TBI)

Common Types of Dementia

Alzheimer's Disease

most common type. Gradual onset, progressive decline. neuron atrophy, senile plaques, and enlarged ventricles in the brain. Manifests as memory loss, speech and motor decline, and personality changes

Lewy Body Dementia

a progressive brain disorder caused by abnormal protein clumps (alpha-synuclein) that destroy nerve cells. cognitive + motor + psychiatric symptoms. visual hallucinations and delusions common. early functional impairment

Vascular Dementia

a decline in thinking skills caused by conditions that block or reduce blood flow to the brain, depriving it of oxygen and nutrients. Symptoms often appear suddenly—unlike Alzheimer's—and can include confusion, disorientation, difficulty with planning and reasoning, and mood changes. Risk factors include high blood pressure, diabetes, high cholesterol, and smoking

Frontotemporal Lobar Degeneration

a progressive neurodegenerative disease involving nerve cell loss in the brain's frontal and temporal lobes, representing a major cause of early-onset dementia (usually under 65). It causes significant behavioral, personality, and language changes, often characterized by atrophy in these specific areas. Strong Hereditary component

Prion Diseases (Creutzfeldt-Jakob Disease)

rare, fatal, and rapidly progressive neurodegenerative disorders caused by the misfolding of normal brain proteins into abnormal, destructive, and contagious prion proteins, which create sponge-like holes in the brain. Early symptoms include rapid memory loss, behavioral changes, poor coordination, and visual disturbances. It is almost always fatal, typically within one year of diagnosis. No cure or effective treatment exists to slow the disease, so management focuses on relieving symptoms

HIV-Related Dementia

a severe neurocognitive disorder caused by HIV infection entering the brain, commonly affecting individuals with advanced, untreated HIV. It causes progressive cognitive, motor, and behavioral decline, including memory loss, slowed thinking, and poor coordination

Parkinson's Disease Dementia

a decline in thinking and memory that typically develops at least a year after a Parkinson's diagnosis. It affects up to 70% of people with Parkinson's, causing symptoms like memory loss, impaired attention, executive function difficulties, and visual hallucinations. While no cure exists, medications like cholinesterase inhibitors can help manage symptoms

Huntington Disease

a fatal, inherited neurodegenerative disorder that causes the progressive breakdown of nerve cells in the brain, typically surfacing between ages 30 and 50. It causes involuntary movements (chorea), cognitive decline, and psychiatric issues. There is no cure, with death usually occurring 15-20 years after symptoms begin

Alzheimer's Disease → most common (60%)

Vascular Dementia → second most common

Most common types of NCD

Alzheimer's → more common in women

vascular dementia → more common in men

Gender trends of NCD

Cholinesterase Inhibitors

NMDA Receptor Antagonist

Combination Therapy

Pharmacological Treatment of NCD

Cholinesterase Inhibitors

Donepezil, Rivastigmine, Galantamine. Used to slow progression (temporarily). Causes modest improvement. does NOT cure or stop disease

Memantine

NMDA receptor antagonist for moderate to severe Alzheimer's. Slows progression

Namzaric (memantine + donepezil)

a once-daily, extended-release, fixed-dose combination medication used to treat moderate-to-severe dementia of the Alzheimer's type

1. Supportive Touch

2. Reminiscence Therapy

Non-Pharmacologic Interventions