The term “cognition” refers to the wide range of mental abilities. These abilities include memory, language, attention, perception, and reasoning. so any disorder that cause trouble to mental abilities are known as cognitive disorder.
Type of cognitive disorder:-
1) Delirium and 2) Dementia.
DELIRIUM
INFORMATION ON DELIRIUM
Delirium is a transient global disorder of cognition. Delirium is a condition of severe confusion and rapid changes in brain function that develops quickly (over hours or days) and involves changes in consciousness, attention, cognition (thinking and reasoning), perception, psychomotor behavior, emotion, and the sleep-wake cycle. Delirium represents a sudden and significant decline from the previous level of functioning. Delirium is usually temporary and reversible and does not reflect a persistent psychiatric disorder. The condition is a medical emergency associated with increased morbidity and mortality rates. The clinical key identifying features are decreased attention span and a waxing and waning type of confusion.
It may occur at any age but is most common after the age of 60 years. The delirious state is transient and of fluctuating intensity; most cases recover within 4 weeks or less. However, delirium may last up to 6 months with fluctuations especially when arising in the course of chronic liver disease, carcinoma, or subacute bacterial endocarditis. A delirious state may progress into dementia. Full recovery is common.
SYMPTOMS OF DELIRIUM
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1. Clouding of consciousness
2. Difficulty maintaining or shifting attention
3. Disorientation
4. Illusions
5. Hallucinations
6. Reversal of the sleep-wake cycle
7. Neurological symptoms
8. Dysphasia
9. Dysarthria
10. Tremor
The various clinical procedures available for diagnosis of delirium are:-
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1. CT scan.
2. Chest X-ray.
3. Urine test.
4. EMG.
5. ECG.
The main aim of treatment is to control or reverse the cause of the symptoms, and will vary with the specific condition causing delirium. The person should be in a pleasant, comfortable, non-threatening, physically safe environment for diagnosis and initial care. Hospitalization may be required for a short time.
Medications that may worsen confusion include anticholinergics, analgesics, cimetidine, central nervous system depressants, lidocaine, and other medications (including alcohol and illegal drugs).
Medications that may be considered for use include:
-thiamine
-sedating medications such as clonazepam or diazepam
-serotonin-affecting drugs (trazodone, buspirone)
-dopamine blockers (such as haloperidol, olanzapine, Risperdal, clozapine)
-fluoxetine, imipramine, Celexa (may help stabilize mood)
DEMENTIA
INFORMATION ON DEMENTIA
Dementia is a syndrome. It is a descriptive term for a collection of symptoms caused by a number of disorders affecting the brain.
Dementia, a progressive brain dysfunction, leads to a gradually increasing restriction of daily activities. It leads to significantly impaired intellectual functioning that interferes with normal activities and relationships. Affected people lose their ability to solve problems and maintain emotional control, like thinking and orientation and may experience personality changes, social act and behavioral problems, such as agitation, delusions, and hallucinations; lack of comprehension, calculation, learning capacity, language and judgment. Memory loss is a common symptom of dementia. There is also impairment of thinking and of reasoning capacity, and a reduction in the flow of ideas. The processing of incoming information is impaired, in that the individual finds it increasingly difficult to attend to more than one stimulus at a time, such as taking part in a conversation with several persons, and to shift the focus of attention from one topic to another.
CAUSES OF DEMENTIA
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1. Alzheimer’s disease or Huntington’s disease
2. Vascular dementia (or multi-infarct dementia), including Binswanger's disease
3. Dementia with Lewy bodies (DLB)
4. Frontotemporal lobar degeneration (FTLD), including Pick's disease
5. Frontotemporal dementia (or frontal variant FTLD)
6. Semantic dementia (or temporal variant FTLD)
7. Progressive non-fluent aphasia
8. It can also be a consequence of:
9. Creutzfeldt-Jakob disease
10. Huntington's disease
11. Parkinson's disease
12. HIV infection (leading to AIDS dementia complex)
13. Head trauma
14. Down's syndrome
15. Hypothyroidism
Important early indications of Dementia:
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1. Forgetfulness with effects at work
2. Difficulties with familiar activities (including absent mindedness)
3. Language problems (Difficulty understanding and using misappropriate fillers)
4. Problems with spatial and temporal orientation
5. Impaired capacity of judgment
6. Problems with abstract thinking
7. Leaving things behind
8. Mood swings and behavioral changes (sudden)
9. Personality changes (unexpected anger, jealous or timid)
10. Loss of initiative (loss of interest and zest)
11. Delusions - Monothematic Delusions, like mirrored self-misidentification
TREATMENT OF DEMENTIA
As with numerous other diseases there is no cure for the illness but medication can improve disease symptoms. There are a number of drugs available today for improving brain function. Typically antidementia or psychotropic drugs are prescribed. Although these drugs do not halt the disease or reverse existing brain damage, they improve symptoms and slow the progression of the disease. This may improve an individual’s quality of life, ease the burden on caregivers, or delay admission to a nursing home..
