Unit 4C Cognition

-reduced ability to differentiate sensory information from hallucinations, dreams, illusions, imagery
-fragmented & disorganized thinking - unable to reason, judge, abstract, solve problems
- unable to form memories or store & retrieve info

-difficulty with: alertness, selectiveness, directiveness
-wakefulness reduced during day, leading to naps & drowsiness
-sleeplessness, agitation at night

-alternates between hyperactive & hypoactive
-slurred & disjointed sleep, aimless vocalizations & repetitions
-groping/picking at bedclothes, sudden movements

-fear, anxiety, irritability, anger, euphoria, apathy

-acute, over hours or a few days
-especially common in children & after age 60

-fluctuates
-symptoms usually worse at night

may resolve in a few hours - few weeks

recovery if underlying disease is corrected or self-limiting

-systemic infections
-metabolic disorders (hypoxia, hepatic or renal disease, hypoglycemia)
-postoperative states
-substance intoxication& withdrawal
-head trauma

-dysphoric mood ranging from mild, transient feelings of sadness to a severe sense of helplessness & hopelessness
-loss of interest in usual activities
-appetite & sleep disturbances
-difficulty concentrating/thinking
-decreased energy
-feelings of anxiety, irritability, fear, brooding

-able to date with some precision
-variable; symptoms usually develop over period of days to weeks but may be sudden

-often not recognized or misdiagnosed in older adults
-can be masked by symptoms of dementia (disorientation, memory loss, apathy, inattentiveness)

-self limiting
-median time period is 8 months; may last up to 2 years

-can be successfully treated
-spontaneous recovery is expected
-severe may end in suicide

-situational: bereavement, loss of health, major catastrophic event, trauma

-memory impairment
-aphasia,apraxia,agnosia
-decline in occupational/social functioning
-spatial disorientation, poor judgment
-violence, suicidal behavior
-slurred speech, anxiety, mood & sleep disturbances
-delusions, hallucinations

-depends on underlying etiology
-may be sudden (head trauma) or slow
-progress is relentless over several years

-depends on underlying etiology

-may progress to death over several years
-may be slowed

-generally irreversible

loss of language ability

-loss of sensory ability to recognize objects
-initially, can't recognize everyday objects. in later stages, can't recognize loved ones or body parts

-loss of purposeful movement without loss of muscle power
-ability to conceptualize/perform motor tasks deteriorates

right now

>18

12-18

<12

-lewy bodies are abnormal concentrations of protein that develop inside nerve cells

-parkinsonian features
-persistent or recurrent visual hallucinations
-fluctuating cognition

-rapid onset
-one-sided weakness, emotional outbursts, stepwise rather than progressive decline in intellectual functioning
-history of HTN, diabetes, cardio disease

-affects initiation, voluntary movements, sleep disturbances, labial emotions

-genetic, progressive
-dementia
-chorea: quick, jerky, purposeless, involuntary movements
-dysphagia
-explosive speech

-viral infection, transmissible
-causes cell destruction in cerebral cortex
-rapid onset, involuntary movements

-reversible cognitive impairments seen in depression
-suspected when onset is abrupt, clinical course rapid, and client complains of cognitive failures

-treat DAT symptoms
-delaying destruction of ACh by acetylcholinesterase
-slows onset of decline, but will not alter the course

cholinesterase inhibitors

-indicated for advanced DAT & has been shown to slow pace of deterioration
-blocks excess amts of glutamate that can damage nerve cells
-may help maintain patient function for a few months longer

N-methyl -D-aspartate

-may be measured for diagnosing dementia
-decrease of sBPP in CSF supports diagnosis because amyloid tends to deposit in brain and is not circulating CSF

CBC, serum electrolytes, BUN, glucose, Vitamin B12, folate, thyroid & liver function,test for syphilis, toxicity screening (heavy metal), alcohol screening

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