Cognition

COGNITION

• Definition: The mental action or process of acquiring knowledge and understanding through thought, experience, and the senses.

SCOPE OF COGNITION

• Continuum of cognitive functioning:

  • Basic cognitive functioning to higher-order cognitive functioning.

• Impairments:

  • Categories: Intact, Normal for age and culture, Impaired.

  • Cognitive disturbances can be observable or measurable.

  • Severity can range from mild to severe.

  • Changes in cognition can be:

  • Temporary

  • Long-term

  • Permanent

OUTCOMES

• Explain the definition and scope of cognition.

• Review human anatomy and physiology related to brain and brainstem.

• Apply pathophysiology related to alterations in cognition.

• List risk factors affecting cognition.

• Explain findings of health history and neurological assessment across the lifespan.

• Correlate impaired cognition with clinical manifestations.

• Recognize age-related differences impacting care for individuals with cognitive alterations.

• Describe collaborative interventions for cognitive impairments.

• Outline relationships between cognition and concepts such as:

  • Acid-base balance

  • Development

  • Fluid and electrolytes

  • Glucose and hormonal regulation

  • Intracranial regulation

  • Mobility

  • Nutrition

  • Oxygenation/gas exchange

  • Perfusion

TERMS TO KNOW

• Accommodation: The process of adjusting one's understanding to new information.

• Aphasia: A language disorder affecting communication.

• Assimilation: Integrating new experiences into existing schemas.

• Development: The process of growth and change in physical and cognitive abilities.

• Growth: Physical increase in size or mass.

• Polypharmacy: The concurrent use of multiple medications by a patient.

RISK FACTORS FOR COGNITION

• Assessment should consider:

  • Stage of development (may differ from chronological age)

  • Infants and children: Routine observation, history, level of consciousness.

  • History of intracranial disease or trauma.

  • Medication/substance use or abuse.

  • Environmental exposure.

  • Presence of abnormal symptoms.

  • Mental status, intellectual function, thought, and language.

PIAGET’S STAGES OF DEVELOPMENT

• Sensorimotor Stage (birth to 2 years): Learning through sensory experiences and manipulating objects.

• Preoperational Stage (2-7 years): Learning through pretend play.

• Concrete Operational Stage (7-10 years): Beginning logical thinking, struggles with abstract concepts.

• Formal Operational Stage (10-18 years): Ability to think abstractly, deductive reasoning.

  • Early (10-13 years)

  • Middle (14-17 years)

  • Late (17-20 years)

GLASGOW COMA SCALE

Assessment Measures:

• Eye Opening:

  • To sound

  • Spontaneous (5)

  • To speech (4)

  • To pressure (3)

  • None (1)

• Verbal Response:

  • Oriented (5)

  • Confused (4)

  • Inappropriate words (3)

  • Incomprehensible sounds (2)

  • None (1)

• Motor Response:

  • Obeys commands (6)

  • Localizes pain (5)

  • Normal (4), Abnormal flexion (3), Extension (2), None (1)

Glasgow Coma Scale Score:

• Total Score breakdown:

  • Mild: 13-15

  • Moderate: 9-12

  • Severe: 3-8

PEDIATRIC COMA SCALE

• Eye Opening: 4 (spontaneous) to 1 (none)

• Best Verbal Response: 5 (oriented) to 1 (none)

• Best Motor Response: 6 (obeys commands) to 1 (none)

ALTERED COGNITION

• Causes:

  • Result of multiple pathophysiologic phenomena:

  • Neurologic

  • Toxicologic

  • Infection

  • Metabolic

  • Perfusion

  • Oxygenation

• Symptoms include:

  • Anxiety and restlessness

  • Difficulty concentrating

  • Sluggish pupils

  • Fixed pupils

  • Comatose state with no response to painful stimuli.

GERONTOLOGIC CONSIDERATIONS

• Age-related cognitive impairments:

  • Decreased nerve conduction

  • Altered temperature regulation

  • Decreased perception of pain

  • Decreased senses

  • Increased likelihood of confusion with illness before other manifestations.

CLINICAL MANAGEMENT

Levels of Prevention:

• Primary Prevention: Preventive measures before disease onset.

• Secondary Prevention: Quick identification and intervention.

• Tertiary Prevention: Collaborative care and treatment.

Clinical Management for Nurses:

• Safety first - fall precautions while allowing ambulation.

• Protect airway; no oral fluids or medications if altered LOC.

• Check gag and swallow reflex.

• Reduce polypharmacy.

• Reorient patients to person, place, and time.

• Allow patient decision-making.

• Provide consistent routines.

• Try to assign the same nurse for continuity of care.

OTHER CAUSES OF IMPAIRED COGNITION

• Various conditions can lead to impaired cognition:

  • Infection

  • Hypoglycemia

  • Dehydration

  • Medication/substance overdose

  • Seizures

  • Changes in daily medication, especially in older adults

  • Hypoxia

RECAP AND QUESTIONS

• What is the scope and definition of cognition?

• What are assessment findings in individuals with good vs. impaired cognition?

• What complications arise from impaired cognition?

• Identify modifiable vs. non-modifiable risk factors.

• Compare and contrast children’s cognition relative to adults.

• Discuss gerontological considerations in cognitive care.

• Describe examples of primary, secondary, and tertiary prevention measures regarding cognition.