Cognition

Aging Changes:
- Decline in brain weight.
- Reduction of cerebral blood flow to the brain.
- Cognitive function changes may go unnoticed due to slow progression.

Definition: A general term for impaired ability to remember, think, or make decisions, interfering with daily activities.
Characteristics:
- It is a progressive and irreversible impairment in cognitive function affecting memory, orientation, judgment, reasoning, language, and problem-solving.
- Dementia does not occur as part of normal aging.
Development: Can develop over a period of months or years.

Damage: Nerve cell damage can occur in various brain areas.
Subcategories of NCD:
- Delirium: Acute, reversible condition due to various causes.
- Mild NCD:
  - Defined by memory deficits that do not significantly impact daily living.
  - Symptoms can be minimal to mild and may be hardly noticeable.
  - Often involves perception issues, such as mistaking objects or people.

Definition: Transitional stage between normal cognitive aging and dementia, characterized by short-term memory impairment and challenges with complex cognitive functions.
Common Issues: Problems with executive function, such as problem-solving, planning, attention, and multitasking.

Overview: Nocturnal condition involving increased agitation and anxiety.
Management: Keep individuals active during the day.
Symptoms: Communication difficulties, mood changes, poor judgment, personality changes, and confusion with simple tasks.

Modifiable Risk Factors: Includes diabetes, hypertension, high cholesterol, obesity, smoking, lack of exercise, and sleep apnea.
Non-modifiable Risk Factors: Age (over 60), genetic components.

Importance: Assessment of cognition is crucial to determine baseline and identify issues.
Diagnostic Tools: Memory tests, attention assessments, problem-solving evaluations, physical exams, blood tests, and brain scans.
Incontinence Note: Incontinence does not equal dementia; bowel and bladder training can assist.

Potential Issues: Malnutrition, pneumonia, inability to perform Activities of Daily Living (ADLs), safety issues, loss of independence, and even death.
Dementia is an umbrella term, with Alzheimer's Disease being the most common subtype with classifications: mild, moderate, and severe.

Key Traits: Gradual, irreversible progression in cognitive function.
- Most common type of dementia characterized by plaques (beta-amyloid) and tangles.
- Genetic links: Early onset linked to APOE gene, particularly on chromosome 19, diagnosed in individuals aged 30-40.
- Neuritic plaques: Contribute to impairment in nerve cell function.

Agnosia: Inability to recognize familiar objects or stimuli.
Anomia: Inability to recall names of objects.
Aphasia: Loss of ability to express or comprehend language.
Apraxia: Difficulty carrying out movements when prompted.
Amnesia: Memory loss can occur while recalling childhood memories may still be possible.

Symptoms: Confusion that occurs at dusk; look for familiar or unfamiliar environments affecting sleep.
Management Strategies:
- Place familiar objects in the individual's room.
- Provide opportunities for physical activities in the afternoon.
- Frequent contact for reassurance and orientation, along with redirection techniques.

Vascular dementia, Frontotemporal dementia, Lewy body dementia, Creutzfeldt-Jakob disease, Wernicke's encephalopathy, Parkinson's disease, AIDS-related dementia, trauma-related dementia, and dementia due to toxins.

Definition: Acute change in mental status that may be a medical emergency.
Causes: Includes medications, dehydration, malnutrition, hyperthyroidism, infection, and surgical recovery.
Management: Early detection and treatment focused on the underlying cause, stabilizing glucose, correcting imbalances, and addressing polypharmacy.
Non-pharmacological Approaches: Always preferred first, such as music therapy, familiar activities, and writing.

Cholinesterase Inhibitors: Help prevent breakdown of acetylcholine; potential adverse effects include nausea and diarrhea.
Examples: Donepezil, Galantamine, Rivastigmine.
Memantine (Namenda): Used with cholinesterase inhibitors to balance glutamate levels; side effects include headache, constipation, and confusion.

Highlights comparison based on:
- Cause: Delirium often due to acute issues; dementia results from brain tissue damage.
- Onset: Delirium has a rapid onset; dementia is slow and progressive.
- Mental Status and Behavior: Delirium features disrupted thinking and short-term memory issues; dementia includes poor memory and personality changes.