3.1: Cognition

Cognitive Disorders

Definitions

Cognitive Impairment:

Decreased ability to mentally process information

General characteristics of cognitive impairment:

• Confusion
• Impulsiveness
• Delusions
• Limited attention
• Reduced alertness
• Poor judgment
• Problem solving deficits
• Inappropriate social interactions

Dementia:

Loss of intellectual and cognitive functioning interfering with social and/or occupational functioning. May or may not be progressive.

• Pre-senile dementia – before age 65
• Senile dementia – after age 65
• Primary degenerative dementia – progressive

Memory Impairment:

• Immediate – minutes, hours
• Recent – days, weeks
• Remote – years

	CVA-Depression-UTI Reversible/false/direct	Alzheimer Irreversible/true/indirect
Goal is to return to prior level?	Yes.	No.
Treatment focus?	To improve function with therapy and RNA.	To maintain function, minimize further deterioration. Emphasis is on decreasing agitation and improving orientation, functional communication, memory recall and overall emotional health.
Aware of their deficits?	Usually – and very concerned.	Usually not – no concern.
Memory?	Inconsistent but not worse at night.	Recent memory is worse than remote memory, with immediate memory remaining intact – worse at night.
Onset?	Usually specific and can be pinpointed to day or week.	Onset is difficult to pinpoint and vague.

Some residents have mixed characteristics/deficits and benefit from both direct and indirect treatment techniques.

Etiology

Diagnosis and Medical Conditions	False dementia Reversible cognitive deficits	True dementia Irreversible cognitive deficits
Parkinson disease		X
Huntington chorea		X
Alzheimer disease		X
Pick disease		X
Multi-infarct dementia		X
Amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease)		X
Cerebrovascular accident (CVA)	X
Traumatic brain injury (TBI)	X
Urinary tract infection (UTI)	X
Thyroid disorder	X
Metabolic imbalance	X
Medication use and interaction	X
Anesthesia effects (post surgical)	X
Low blood sugar	X
Depression	X
Brain tumor	X	X
Subdural hematoma	X	X
Anoxia	X	X
Hydrocephalus	X	X
Alcohol abuse history	X	X

Specific Characteristics

of Parkinson disease, Huntington chorea, Alzheimer disease, Pick disease, etc.

	Parkinson disease, Huntington chorea, for example	Alzheimer disease, Pick disease, for example
Onset of cognitive deficit	Gradual medical deficits first, then cognitive deficits	Initial problem is intellectual functioning and then medical
Language	Normal	Aphasia
Speech	Dysarthric	Normal
Memory	Retrieval problems	Unable to learn
Cognition	Slowed	Poor judgment
Affect	Depressed	Unconcerned
Posture	Stooped	Normal
Tone	Increased	Normal
Movement	Tremor	Normal
Gait	Abnormal	Normal

Communication Approaches

Reversible (false dementia/direct)	Irreversible (true dementia/indirect)
What is today’s date?	Today is June 22. Look at your book.
Who is the president?	The president is George W. Bush.
What did you have for breakfast?	Your journal says you had pancakes for breakfast.
No, this is not a restaurant.	Yes, this is a great restaurant, isn’t it?
Don’t give up. Try again. Lots of practice.	You’re right, we should rest.
Why do you need to lock you wheelchair brakes?	Let me lock your brakes for you.
Who visited you yesterday?	Look in your book. See where your son signed.
Could you suggest a better time for your nap?	Time to nap so you’re rested for the dance tonight.
No, there is no money. Your son has it at home.	You’re right. You have lots of money. It is safe.