Definition of cognitive disorder

Cognitive Disorder Symptoms, & Treatment | Cognitive Impairment Examples

Cognitive disorders often begin subtly but progress until they significantly impede the affected individual’s quality of life. It is important to understand the various cognitive disorders, their symptoms and relevant treatment options.

What Are the Types of Cognitive Disorders?

Cognitive disorders are a part of the neurocognitive disorder classification in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Cognitive disorders are defined as any disorder that significantly impairs the cognitive function of an individual to the point where normal functioning in society is impossible without treatment. Some common cognitive disorders include:

Dementia
Developmental disorders
Motor skill disorders
Amnesia
Substance-induced cognitive impairment

Alzheimer’s disease, one of the most common cognitive disorders, affects approximately 5. 1 million Americans.

What Causes a Cognitive Disorder?

Like most mental disorders, cognitive disorders are caused by a variety of factors. Some are due to hormonal imbalances in the womb, others to genetic predisposition and still others to environmental factors. Common environmental causes of cognitive disorders include a lack of proper nutrients and interaction during vulnerable stages of cognitive development, particularly during infancy.

Other common causes of cognitive disorder include substance abuse and physical injury. When an area of the brain that determines cognitive function is damaged, either by the excessive use of drugs, by alcohol or from physical trauma, those neurophysiological changes can result in cognitive dysfunction.

What Are the Signs of Cognitive Disorder?

Cognitive disorder signs vary according to the particular disorder, but some common signs and symptoms overlap in most disorders. Some of the most common signs of cognitive disorder include:

Confusion
Poor motor coordination
Loss of short-term or long-term memory
Identity confusion
Impaired judgment

Some cognitive disorders develop in stages and symptoms increase in severity the further the disease progresses. Alzheimer’s disease, for example, begins with the patient showing very minor signs of forgetfulness. Sufferers may forget names they know well, or they may have trouble remembering what they did recently. The initial symptoms of early-onset Alzheimer’s disease are often indistinguishable from normal memory errors. However, as the disease progresses, the affected person’s memory becomes persistently impaired. They may have rare moments of clarity, but life is generally lived in a state of confusion.

If you or a loved one is experiencing any of these symptoms, call our toll-free hotline today at . We are available 24/7 to take your call and to help you find the information you need.

Emotional Symptoms of Cognitive Problems

Cognitive problems manifest in a variety of ways, with emotional imbalance being one of the most common symptoms. Cognitive impairment is frustrating, and those suffering from it often react with emotional outbursts, making it difficult for friends and family to help. Others may push people away in an attempt to isolate themselves, only making the problem worse. Other cognitive disorders have the opposite effect, causing the person to have dulled or nonexistent emotions.

Physical Symptoms of Cognitive Problems

Cognition problems often manifest in the form of visible outward symptoms. The affected person may appear dazed and confused, and their eyes may have a glazed appearance. Motor coordination is often affected in both neurological and psychological cognitive disorders, and the person may have unusual mannerisms or simply a lack of balance and normal posture.

Short-Term and Long-Term Effects of Cognitive Instability

Cognitive instability comes with both short- and long-term effects. Some common short-term effects include memory loss, a state of confusion and a lack of coordination. Long-term effects include the increasing loss of declarative memory, such as forgetting names and significant faces, and a general lack of emotional stability and control over one’s actions.

Is There a Test or Self-Assessment I Can Do?

Various memory and cognitive function tests are available online, but it is important to understand that these tests can only give you a general idea concerning some of the symptoms that a person with a cognitive disorder may experience. A full medical exam is necessary to impart an official diagnosis, and you should consult a doctor before you begin any form of treatment plan.

Medication: Drug Options for Cognitive Issues

Fortunately, various options are available when it comes to drugs for cognitive issues. While most cognitive disorders cannot be cured permanently, the symptoms that make life difficult can be treated and managed to improve your quality of life. From supplements and drugs engineered to reduce memory loss and improve cognitive function to those that help with the depression and anxiety that can often result from cognitive impairment, the drug options for cognitive issues are many.

Cognitive Drugs: Possible Options

The most widely used drugs for cognitive disorders are antidepressants and drugs that prevent the further decay of memory. Such drugs can make it possible to extend the awareness of a person affected by cognitive issues by many years. To determine which drugs would be most effective for a given situation, you need to undergo a full medical assessment.

Medication Side Effects

All medicines come with their own set of side effects, and cognitive disorder treatments are no different. Many of these drugs are powerful, and it can result in drowsiness, insomnia and upset stomach, to name but a few of the common side effects. To determine whether a particular drug is worth taking in exchange for its side effects, you should work closely with a medical professional.

Drug Addiction, Dependence and Withdrawal

Cognitive dysfunction can make a person feel hopeless, and they may turn to unfortunate sources in an effort to regain some control over their mental state. Commonly abused substances include alcohol, illegal narcotics and prescription drugs. Stimulants are a commonly abused drug for those who are dealing with cognitive issues that impair the sharpness of their mental processes. It is also possible to become addicted to legitimately prescribed medication that was initially aimed at treating a cognitive disorder. Individuals with cognitive impairment may become dependent on their medications and suffer withdrawal if they attempt to get off them without proper medical supervision.

If you or a loved one is addicted to medication for a cognitive disorder, help is available. Call our 24/7 hotline at for information on how you can get free of your addiction while managing the symptoms of your cognitive disorder.

Medication Overdose

Medication overdose is a serious issue that often results from dependence on a prescribed medication, including those for cognitive disorders. When a medication stops being effective, many individuals increase their dosage without consulting their doctor in an attempt to make the drug work again. Taking more than the prescribed amount of medication can easily result in drug overdose and have life-threatening consequences.

Depression and Cognitive Problems

Cognitive disorders and depression are heavily linked, and many depression-related illnesses result in at least mild cognitive dysfunction. Not being able to think clearly or remember fully can naturally lead to depression if the affected person feels like they have lost something they will never be able to get back. In cases where depression and cognitive problems are linked and the depression lasts longer than a few months, doctors may prescribe an antidepressant or other lifestyle changes to combat the effects of depression.

Dual Diagnosis: Addiction and Cognitive Disorders

Addiction and cognitive disorders have a high comorbidity rate. In fact, many researchers believe that addiction is a form of cognitive impairment and may be the result of atypical neural activity. Cognitive impairment also comes as a result of substance abuse, and research shows that adults with alcoholism are 10 times more likely than the general population to have ADHD.

Getting Help for a Cognitive Issue

If you need help finding information on cognitive issues, whether for yourself or for a loved one, we can help. Call our 24/7 hotline at for more information on cognitive disorders, comorbidity with substance abuse and the various treatment options available to you. It is never too late to seek help, and our friendly representatives would love to help you begin on your path to mental and physical wellness.

Cognitive Deficits - StatPearls - NCBI Bookshelf

Continuing Education Activity

Cognition is the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses. It encompasses various aspects of high-level intellectual functions and processes such as attention, memory, knowledge, decision making, planning, reasoning, judgment, perception, comprehension, language, and visuospatial function, among others. "cognitive deficit" is an inclusive term used to describe the impairment of different domains of cognition. This activity reviews the evaluation and management of cognitive deficits and highlights the role of the interprofessional team in evaluating and improving care for patients with this condition.

Objectives:

Summarize the risk factors for developing cognitive deficits.
Outline the typical presentation of a patient with cognitive deficits.
Review the management options available for cognitive deficits.
Describe the importance of coordination and communication among the interprofessional team in the evaluation and management of patients with cognitive deficits.

Access free multiple choice questions on this topic.

Introduction

"Cognitive deficit" is an inclusive term used to describe the impairment of different domains of cognition. Cognitive deficit is not limited to any particular disease or condition but may be one of the manifestations of someone's underlying condition. It is also used interchangeably with "cognitive impairment." It might be a short-term condition or a progressive and permanent entity.

On the other hand, cognitive disorders are a bigger entity, which is a part of neurocognitive disorders (DSM-5). Cognitive disorders are defined as any disorder that significantly impairs the cognitive functions of an individual to the point where normal functioning in society is impossible without treatment. Alzheimer disease is the most well-known condition associated with cognitive impairment.

Etiology

Cognitive deficits may be from birth or caused later by environmental factors such as brain injury, mental illness, neurological disorders. Not every elderly will have a cognitive deficit, but the cognitive deficit is more common in the elderly.

Some of the early causes of cognitive deficit include chromosome abnormalities/genetic syndromes, prenatal drug exposure, malnutrition, poisoning due to lead or other heavy metals, neonatal jaundice, hypoglycemia, hypothyroidism, prematurity, hypoxia, trauma, or child abuse.

In childhood or adolescence, Cognitive deficit may develop as a result of many conditions. Some examples include side effects of cancer therapy, heavy metal poisoning, malnutrition, metabolic conditions, autism, and immune conditions like systemic lupus erythematosus.

With increasing age, conditions such as stroke, delirium, dementia, depression, schizophrenia, chronic alcohol use, substance abuse, brain tumors, vitamin deficiencies, hormonal imbalances, and some chronic diseases may cause a cognitive deficit. Brain pathologies like Alzheimer disease, Parkinson disease, Lewy body dementia, Huntington disease, HIV dementia, prion disease manifest with cognitive deficits. Drugs like sedatives, tranquilizers, anticholinergic, glucocorticoids are also associated with cognitive deficits. Head injury and infection of the brain or meninges can cause cognitive deficits at any age.[1][2]

Epidemiology

The frequency of cognitive deficit due to various causes is difficult to predict and is not well established. However, increasing age is the most important factor for cognitive impairment. Alzheimer disease is the most well-known condition associated with cognitive impairment. Approximately 5.5 million people are affected by Alzheimer disease in the US, and the worldwide prevalence is estimated to be more than 24 million.

The prevalence and incidence of Alzheimer among African American populations were approximate twice those among European Americans. The incidence of dementia is predicted to double every 10 years after 60 years of age. Age-specific incidence of Alzheimer disease increases significantly from less than 1% per year before the age of 65 years to 6% per year after the age of 85 years. [3][4]

Pathophysiology

The general pathology of cognitive decline/deficits is damage to neuronal tissue. This includes damage to the grey matter, which comprises the cortex and the thalamus and basal ganglia, and the white matter, which comprises the coverings of the axons of the connections between grey matter areas. The damage to certain areas is responsible for certain deficits. For instance, damage to the parietal lobe can cause the inability to dress or visuospatial function. Damage to the frontal lobe systems can cause deficits in planning, and abstract understanding and damage to the temporal lobes cause deficits in language and memory.

The causes of this damage are due to toxicity to neurons from metabolic disorders or heavy metals or other toxins such as toluene or infection or due to ischemic damage due to stroke or hemorrhage or direct injuries such as head injury or cancer or surgery. Damage can also be caused by neurodegenerative processes such as Alzheimer, Parkinson, multiple sclerosis, or Huntington disease. These illnesses appear to directly damage neuronal tissue through immunologic interaction with abnormal proteins.

Histopathology

Most of the dementias are confirmed by finding abnormal proteins in brain sectioning. Alzheimer is defined by amyloid and Tau inclusions in the brain tissue, Parkinson and Lewy body dementia are supported by Lewy bodies and frontal dementias by Tau inclusions. Parkinson-like illness is also associated with Synleuclin inclusions. Prion diseases have abnormally folded proteins called prions in the brain tissue.

History and Physical

Cognitive deficit is not an illness in itself but a manifestation of an underlying condition. The patient may notice these changes themselves, or most of the time, it is noticed by the caretakers and friends of the patient. The patients usually have the following:

Trouble remembering things (frequently asking the same question or repeating the same story again and again )
Difficulty in learning new things and concentrating
Vision problems and trouble speaking
Difficulty recognizing people and places. They often find new places or situations overwhelming.
Confusion or agitation.
Mood changes
Change in their behavior, speech,
Difficulty even with their usual daily tasks

Cognitive impairment can come and go or wax and wane. Cognitive impairment can be mild, or severe, or anything in between. With mild impairment, there are changes in cognitive functions, but the individual can still do his/her everyday activities. Severe levels of impairment (dementia) can lead to a point where the individual is incapable of living independently because of the inability to plan and carry out regular tasks (Activities of daily living/instrumental activities of daily living) and apply judgment.

Cognitive impairment may accompany different other symptoms, depending on the underlying disorder or condition. Sometimes they may present as emergency cases and may require acute life-saving interventions.

Infective causes may present with fever, rashes, headache, nausea, vomiting, neck stiffness, malaise, seizures, and others.

It may accompany metabolic disorders and present with abdominal pain, nausea, vomiting, tachycardia, bradycardia, fatigue, muscle weakness, shortness of breath, excess thirst, urinary problems, and even loss of consciousness.

Cognitive deficits may accompany symptoms of other problems, such as head injury, stroke, or dementia. The patient might present with behavioral or personality changes, loss of consciousness, vision changes, imbalance, severe headaches, seizures, sleep pattern changes, numbness, weakness, and paralysis.

Cognitive disorder includes delirium and mild and major neurocognitive disorder, which may present as follows:

Delirium develops very rapidly and over a short period of time. It is mainly characterized by disturbances in cognition. Other manifestations are confusion, disorientation, excitement, and also a change in consciousness. Hallucinations and illusions may be common. It also makes processing new information and situational awareness very difficult. Its onset ranges from minutes to hours and sometimes days. However, it only lasts a few hours to weeks. It can also be accompanied by inattention, mood swings, or abnormal behaviors. There is usually an underlying medical or surgical condition causing it. Delirium during a hospital stay can result in complications and long terms stay.
Mild and major neurocognitive disorders are commonly associated with the elderly. These disorders develop slowly and are mainly characterized by memory loss in addition to cognitive impairments. There may also be psychosis, agitation, and mood changes. The difference between mild and major neurocognitive disorders is mainly based on the severity of the symptoms. Major neurocognitive disorder(previously known as dementia) is characterized by significant cognitive decline and the development of dependence. The mild neurocognitive disorder is characterized by moderate cognitive decline, and the patient is still independent. To be diagnosed, delirium and other mental disorder should be ruled out. For causes of dementia such as age, which is irreversible, the decline of cognition and memory is lifelong.[5][6][7][8]

Evaluation

The evaluation consists of detailed history from patient and family members (including the onset, duration, symptoms, impact, impact on activities of daily living, and changes from the patient's previous level of execution and functioning) and clinical assessment of the patient that encompasses a wide range of information collected from physical, neurological, and mental status examinations.

The history gathered from the patient and the accompanying family/friend should be focused on:

Changes in cognitive functions (onset, course, and examples)
Change in functional status-Selfcare (cooking,testing,hygiene,finances)
Physical symptoms (nausea, vomiting, vision, hearing, speech, balance, gait, balance, sensation, and motor functions)
Psychiatric symptoms (mood changes, behavioral and personality changes)
Current medication, if any

There are various screening tools used by patients, families, and physicians to assess the patient's cognitive abilities. Screening is to identify those patients who deserve a complete diagnostic assessment. Physicians often assess the patient's mental status with a brief test, such as the mini-mental state examination (MMSE). However, the experts have identified several new and improved instruments suited for use in primary care settings. Popular tools used by primary care physicians are:

General practitioner assessment of cognition (GPCOG)
Memory impairment screen (MIS)
Montreal cognitive assessment (MoCA)
Mini-Cog
Memory and executive screening (MES) e.t.c.

Short Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Dementia Severity Rating Scale (DSRS), AD-8, and General Practitioner Assessment of Cognition (GPCOG) can be used to gather information from caretaker/ family members. Individuals who fail these tests need further diagnostic evaluation or a referral to a specialist. In addition, more detailed neuropsychological testing may help determine the type and degree of impairment and what mental skills are impaired.

Different tools have different applications according to the presenting case. For example, Montreal Cognitive Assessment (MOCA) is mostly used for general screening because of its coverage of a broad array of cognitive functions. Mini-mental state examination (MMSE) is used for the evaluation of patients with Alzheimer disease because of its main focus on testing memory.

As part of the physical exam, the physician should perform a detailed neurological examination to determine the involvement of the brain and nervous system. These tests can help detect neurological signs of different brain pathologies like stroke, Parkinson disease, brain tumors, or other medical conditions. The neurological exam includes the basement of mental status, cranial nerves, motor and sensory functions, reflexes, coordination, balance, and gait.

Other tests depend upon the accompanying physical signs and symptoms. It may include complete blood count, thyroid tests, vitamin B12 levels, basic metabolic panel, urine analysis, liver function tests, renal function tests, which may help find out different Infectious causes and metabolic disorders. Also, brain imaging like CT-scan and MRI may be useful to delineate brain pathologies like a brain tumor, bleeding, or stroke.[5][6][9][10]

Treatment / Management

Treatment of cognitive deficits depends on what actually is causing impairment. If it is caused by an illness or a condition, then it is likely to recover after the treatment. Infections and metabolic syndromes, depression, thyroid disorders, Medication effects are some curable causes of cognitive decline. For cognitive disorders, a detailed assessment and management are required, and the interventions focus mainly on the improvement of quality of life and the limitation of residual defects.

There is no pharmacological treatment for mild cognitive impairment. The management is focused on promoting functional status. Counseling is a very important component of patient management. These individuals are at increased risk for trouble with mobility and recurrent falls. Problems with vision and hearing need to be addressed and corrected. People with sleep apnea may be benefited from continuous positive airway pressure (CPAP). There is no established evidence to conclude that the treatment of depression improves cognitive impairment. There are negative impacts of the use of anticholinergic medications on cognitive function in the elderly. The treatment with antidepressants should be avoided, especially the ones with amitriptyline, nortriptyline, and paroxetine (ones with significant anticholinergic properties). A trial of withdrawing, managing, and simplifying medications in older adults may lead to an effective improvement in cognitive function.

For the treatment of delirium, the cause must be established first. Medication such as antipsychotics or benzodiazepines (BZDs) can help reduce the symptoms in some cases. For alcohol abuse or malnourished cases, vitamin B supplements are recommended. Some extreme cases also require life support. Ginkgo biloba is a popular herbal supplement that is thought to improve cognition and memory. However, it has failed to prevent cognitive decline in those with mild cognitive impairment or normal cognition in randomized control trials.[11][12][10]

Physical activity, cognitive training and exercises, proper sleep, and relaxation techniques can help cognitive health. Mediterranean diet may help people with cognitive impairment. Occupational therapy focuses on teaching different patient strategies to minimize the effect of cognitive impairment on daily life. Environmental approaches, such as reducing noise around the patient, help the patient focus on tasks, and reduce distraction, confusion, and frustration. They are making sure that the patient is around familiar objects and surrounding helps. Psychotherapy and psychosocial support for patients and families have evidence of better outcomes in clear understanding and proper management of the disorder and therefore maintaining a better quality of life for everyone involved.

Alzheimer disease has no cure, but available medications slow the worsening of dementia symptoms and help improve cognition and behavioral problems that appear during the disease course. The standard medical treatment for Alzheimer disease includes cholinesterase inhibitors and a partial N -methyl-d-aspartate antagonist. Behavioral symptoms are common and can exacerbate cognitive and functional impairment in the patients. Secondary symptoms of Alzheimer disease-like depression, delusion, agitation, aggression, sleep disorders, hallucinations, also need treatment. Psychotropic medications like antidepressants, anxiolytics, neuroleptics, beta-blockers, antiparkinsonian agents, antiepileptic drugs (for their effects on behavior) are regularly used. Cognitive decline in normal aging usually mild and require behavioral and supportive interventions only.[6][8][10][13][14]

Differential Diagnosis

Cognitive deficit is not an illness in itself but a manifestation of an underlying condition. Some disease conditions associated with cognitive deficits are:

Delerium
Alzheimer disease
Huntington disease
Stroke
Developmental disorders (Down syndrome)
Head injury
Multiple sclerosis
Parkinson disease
Lewy body dementia
Meningitis
Acquired immune deficiency syndrome
Alcohol, drugs, toxins
Wernicke Korsakoff syndrome

Prognosis

The prognosis of cognitive deficits depends upon the underlying cause. There are many causes like medication, depression, thyroid disorders, infections, which are correctable. Whereas conditions like Alzheimer disease cannot be reversed, and only the progression can be slowed. Many causes of cognitive deficits are acute life-threatening conditions, and without proper medical or surgical management can result in a great deal of morbidity and mortality. For patients diagnosed with Alzheimer disease, the average life expectancy for a person age 65 years or older is about 4 to 8 years. Some individuals with Alzheimer disease even may live up to 20 years after the first signs of disease.

In some instances, cognitive deficits may be a symptom of an underlying serious or life-threatening condition that can be life-threatening. These include:

Brain tumor
Stroke
Encephalitis
Meningitis
Traumatic head injury
Heatstroke or profound dehydration
Kidney failure
Sepsis
Spinal cord injury or tumor

So the prognosis depends on various factors. [15]

Complications

A cognitive deficit can be coexisting with a variety of serious diseases and conditions. Therefore the failure to timely seek treatment can result in serious complications and even permanent damage. Once the underlying condition is diagnosed, it is important to follow a proper treatment plan to reduce the risk of potential complications, which may include:

Developmental delays and failure to thrive
Learning disabilities
Speech and hearing defects
Paresis/paralysis
Permanent cognitive impairment
Permanent sensory loss
Physical disabilities
Personality changes
Permanent loss of memory
Loss of independence
Falls/injuries
Coma

Deterrence and Patient Education

Age is the primary cause of cognitive impairment. Other risk factors include family history, physical inactivity, and disease/conditions such as Parkinson’s disease, heart disease, stroke, brain injury, brain cancers, drugs, toxins, and diabetes. Individuals may reduce the risk of cognitive impairment by keeping physically active, eating a healthy diet, and maintaining healthy blood pressure, blood sugar, and cholesterol levels. Some causes of cognitive impairment are treatable, like infections, medication side effects, depression, and vitamin B12 deficiency. It is important to identify people who are showing signs of cognitive impairment to ensure that they are evaluated by a health care professional and receive appropriate care or treatment.

Apart from increasing age, hypertension, diabetes, hypercholesterolemia, smoking, and obesity are thought to be responsible for the clearance of amyloid (protein) from the brain, which in turn increases the risk of developing Alzheimer disease. A higher risk of Alzheimer disease, in particular, is associated with the presence of a number of these risk factors, at the same time, and while the person is in his or her 50s. So it is essential to maintain healthy blood pressure, blood sugar, and blood cholesterol.

Environmental and behavioral interventions are beneficial, especially in managing behavioral problems. Simple approaches such as noise cancellations and redirecting attention, maintaining a familiar environment, providing security objects, monitoring personal comfort, and avoiding confrontation can help in managing behavioral issues. Regular aerobic exercise and the Medeterinian diet have been shown to slow the progression of Alzheimer disease.

There are various memory, and cognitive function tests available online. It is important to understand that these tests only give you a general idea about cognitive deficits in someone. However, consultation with a physician and a full medical checkup is always necessary before coming to any diagnosis and starting management options. Alzheimer disease and dementia can create havoc not only in the patient but also in the family, friends, and the community. So the management encompasses the role of the physicians, patients themselves, family and friends, and also policymakers. Healthcare policymakers must explore policy changes and initiatives that will increase support, expand research, and, ultimately, improve the quality of life for people living with cognitive impairment and also their families.

Enhancing Healthcare Team Outcomes

Cognitive deficits may be a manifestation of a variety of systemic conditions. So it requires an interprofessional team to act via a comprehensive and coordinated approach to carefully come to a particular diagnosis and start necessary interventions. Many healthcare professionals, including primary care physicians and nurses, psychiatrists, physiotherapists, dieticians, caregivers, and also social workers, work together to ensure that the patient with cognitive deficits remains safe and leads a proper quality of life. [Level-5]

Because these patients suffer from sensory and sensory processing deficits, the team can be helpful in directing the patient and family on how to overcome these issues. For instance, an Alzheimer patient will often have dressing apraxia, and so clothing with velcro or lacking sleeves is easier for the patient to don those buttons and things that tie.

Patients with dementia often cannot chew and have a coordinated swallow and so dietary and speech consults can be useful in helping the patient enjoy eating and drinking without the risk for aspiration pneumonia.

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References

1.: Belanoff JK, Gross K, Yager A, Schatzberg AF. Corticosteroids and cognition. J Psychiatr Res. 2001 May-Jun;35(3):127-45. [PubMed: 11461709]
2.: Kalachnik JE, Hanzel TE, Sevenich R, Harder SR. Benzodiazepine behavioral side effects: review and implications for individuals with mental retardation. Am J Ment Retard. 2002 Sep;107(5):376-410. [PubMed: 12186578]
3.: Mayeux R, Stern Y. Epidemiology of Alzheimer disease. Cold Spring Harb Perspect Med. 2012 Aug 01;2(8) [PMC free article: PMC3405821] [PubMed: 22908189]
4.: Rajan KB, Weuve J, Barnes LL, Wilson RS, Evans DA. Prevalence and incidence of clinically diagnosed Alzheimer's disease dementia from 1994 to 2012 in a population study. Alzheimers Dement. 2019 Jan;15(1):1-7. [PMC free article: PMC6531287] [PubMed: 30195482]
5.: Morley JE, Morris JC, Berg-Weger M, Borson S, Carpenter BD, Del Campo N, Dubois B, Fargo K, Fitten LJ, Flaherty JH, Ganguli M, Grossberg GT, Malmstrom TK, Petersen RD, Rodriguez C, Saykin AJ, Scheltens P, Tangalos EG, Verghese J, Wilcock G, Winblad B, Woo J, Vellas B. Brain health: the importance of recognizing cognitive impairment: an IAGG consensus conference. J Am Med Dir Assoc. 2015 Sep 01;16(9):731-9. [PMC free article: PMC4822500] [PubMed: 26315321]
6.: Lopez OL. Mild cognitive impairment. Continuum (Minneap Minn). 2013 Apr;19(2 Dementia):411-24. [PMC free article: PMC3915547] [PubMed: 23558486]
7.: Trivedi JK. Cognitive deficits in psychiatric disorders: Current status. Indian J Psychiatry. 2006 Jan;48(1):10-20. [PMC free article: PMC2913637] [PubMed: 20703409]
8.: Torpy JM, Burke AE, Glass RM. JAMA patient page. Delirium. JAMA. 2008 Dec 24;300(24):2936. [PubMed: 19109124]
9.: Zhuang L, Yang Y, Gao J. Cognitive assessment tools for mild cognitive impairment screening. J Neurol. 2021 May;268(5):1615-1622. [PubMed: 31414193]
10.: Langa KM, Levine DA. The diagnosis and management of mild cognitive impairment: a clinical review. JAMA. 2014 Dec 17;312(23):2551-61. [PMC free article: PMC4269302] [PubMed: 25514304]
11.: Mendiola-Precoma J, Berumen LC, Padilla K, Garcia-Alcocer G. Therapies for Prevention and Treatment of Alzheimer's Disease. Biomed Res Int. 2016;2016:2589276. [PMC free article: PMC4980501] [PubMed: 27547756]
12.: Yiannopoulou KG, Papageorgiou SG. Current and future treatments for Alzheimer's disease. Ther Adv Neurol Disord. 2013 Jan;6(1):19-33. [PMC free article: PMC3526946] [PubMed: 23277790]
13.: Snitz BE, O'Meara ES, Carlson MC, Arnold AM, Ives DG, Rapp SR, Saxton J, Lopez OL, Dunn LO, Sink KM, DeKosky ST., Ginkgo Evaluation of Memory (GEM) Study Investigators. Ginkgo biloba for preventing cognitive decline in older adults: a randomized trial. JAMA. 2009 Dec 23;302(24):2663-70. [PMC free article: PMC2832285] [PubMed: 20040554]
14.: Féart C, Samieri C, Rondeau V, Amieva H, Portet F, Dartigues JF, Scarmeas N, Barberger-Gateau P. Adherence to a Mediterranean diet, cognitive decline, and risk of dementia. JAMA. 2009 Aug 12;302(6):638-48. [PMC free article: PMC2850376] [PubMed: 19671905]
15.: Barnes J, Bartlett JW, Wolk DA, van der Flier WM, Frost C. Disease Course Varies According to Age and Symptom Length in Alzheimer's Disease. J Alzheimers Dis. 2018;64(2):631-642. [PMC free article: PMC6207933] [PubMed: 29914016]

Cognitive disorders in elderly patients

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12.07.2021

Cognitive disorders is one of the most common syndromes in the practice of a neurologist, which, unfortunately, is diagnosed most often at an advanced stage, when the possibilities of therapy are significantly limited.

Let's start in order.

What are cognitive functions - these are the most complex functions of the brain, with the help of which the process of rational knowledge of the world is carried out and purposeful interaction with it is ensured. nine0018 These include:

Attention - the ability to maintain the level of mental activity required for mental work and focus mental activity on the actual task.
Memory - the ability to capture, store and repeatedly reproduce the information received during life.
Speech - the ability to verbal communication in oral and written form, including the understanding of addressed speech and the construction of one's own statement. nine0027
Perception (gnosis) - the ability to perceive and recognize information coming from the senses.
Praxis - the ability to acquire, maintain or use various motor skills.

Control (regulatory) functions is the ability to control one's cognitive activity and behavior, including planning and monitoring the implementation of actions taken. nine0003

It is worth highlighting two degrees of cognitive impairment - moderate cognitive impairment and dementia .

Moderate cognitive impairment is a transitional condition in which there is a decrease in cognitive function, but does not lead to social maladaptation. For example: the patient is able to fully take care of himself in everyday life, but the patient spends much more time and effort, which leads to complaints of memory loss, absent-mindedness, irritability, general weakness, etc.

Dementia - neuropsychiatric syndrome, in which the structure of which is an acquired long-term (more than 6 months) clinically significant cognitive decline in the form of severe cognitive impairment, causing social and professional maladjustment and loss of habitual functioning of varying severity.

Main causes of cognitive disorders: nine0003

Neurodegenerative diseases such as Alzheimer's disease.
Cerebrovascular diseases - chronic and acute cerebrovascular accident (DEP, stroke)
Metabolic disorders causing "brain damage" - chronic lack of oxygen, diseases of the liver, kidneys, carbohydrate metabolism disorders, thyroid diseases, deficiency of vitamins B1, B12, folic acid, proteins, poisoning with toxic substances or drugs
Traumatic brain injury
Brain tumors
CSF metabolism disorder (hydrocephalus)
Autoimmune diseases (multiple sclerosis, rheumatoid arthritis)
Infectious diseases (meningitis, encephalitis, viral diseases)

How to suspect a cognitive impairment?

Pay attention to yourself, and even more so to your loved ones over the age of 65, if a person has begun to avoid communication, walking, has difficulties in communication, domestic services, or orientation in the area has been disturbed, then it is advisable to consult a neurologist and neuropsychologist. nine0003

What diagnostics should be carried out first of all in case of cognitive decline?*

Examination by a neurologist, neuropsychologist, psychotherapist
MRI of the brain / with limitations CT of the brain
CBC, OAM, ECG, biochemical blood test, coagulogram, blood test for the concentration of vitamin B1, B12 and folic acid

Further, after examining a neurologist and receiving the results of the research, an in-depth study, diagnosis and selection of treatment with a rehabilitation program will be carried out.

With early identification of the cause of cognitive impairment, there is a high probability of effective recovery or a significant improvement in the quality of life!

_____________________________________________________________________________________

*Lyadov clinics have all the necessary range of equipment and specialists for comprehensive diagnostics, treatment and rehabilitation of patients with cognitive impairments of any severity. nine0003

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Cognitive disorders | SKKSPB No. 1

WHO recognizes dementia as a public health priority. The forecasts given by experts are alarming. Thus, according to the World Health Organization, in 2030 the total number of people with dementia in the world will be about 82 million, and by 2050 there may be about 152 million.

Dementia has become “younger” and today it appears not only in the very elderly, but in 9% of cases it occurs in people under the age of 65 years. There are many misconceptions associated with this disease. Not everyone knows that the cause of cognitive disorders can be not only heredity, but also the conduct of an unhealthy lifestyle, bad habits, and excess weight. It used to be that the decline in cognitive functions with age is a normal process: a person ages, and therefore becomes forgetful, irritable, and confused. But today, experts have come to a different opinion: the aging process of the brain, which is irreversible, can be slowed down and help a loved one live longer in a clear mind. nine0003

Anastasia Vasilenko, a psychiatrist at the Stavropol Regional Psychiatric Hospital No. 1, spoke in detail about the causes and mechanisms of the appearance of cognitive disorders.

– What are cognitive disorders?

– Cognition is knowledge. Cognitive means everything related to cognitive processes - perception, thinking, memory, attention, the ability to make plans and evaluate the consequences of one's actions. Simply put, it is something that relates to the mind and intellect. nine0003

– What age groups are at risk?

- If we talk about age dynamics, it is clear that we are always different. Every year we are different from who we were before. There is so-called healthy aging, and there are disorders and diseases. With healthy aging, a person does not have gross memory impairments, and he does not do any absurdities. When these disorders appear, we say that senile dementia or some other kind of dementia begins to develop. Unfortunately, such cognitive impairments do not only occur in old age. In general, today, intellectual spectrum disorders can begin as early as after 40 years. nine0003

- Dementia or dementia: what is it and why does it start to progress?

- Dementia - the loss of the ability to think correctly, remember and remember. When a person begins to have intellectual spectrum disorders, the first thing that becomes noticeable is memory impairment. He becomes forgetful. Sometimes such violations occur very early. In my practice, I met the development of dementia at the age of 36 and at 27. If you notice that there are problems with memory, you should consult a doctor. nine0003

– Why does the brain start to work differently?

- There are two main forms of dementia. The first is due to genetic prerequisites. These are Alzheimer's disease, Parkinson's disease and some others. And there is dementia that develops without such a genetic predisposition, but as a result of the fact that the brain suffers for other reasons. It never happens “suddenly”, it never starts suddenly. The development of dementia can be facilitated by lifestyle, the presence of diseases and negative environmental factors in which a person lives. Here it is appropriate to use such a thing as brain hygiene. At 17-20 years old, if there are no diseases, the brain is in excellent condition. And if a young person does not drink alcohol, does not smoke, does not use drugs, goes in for sports, does not have excess weight, takes care of his health, his brain will remain in good shape for a long time. And there is a high probability of living to 70, 80, 90 years with a clear mind.

Anastasia Vasilenko said that chronic alcoholism, neglected endocrinological diseases, hypertension, smoking, a sedentary lifestyle, overweight, craniocerebral injuries can be the cause of dementia before the age of 30-40. For these reasons, the blood supply to the brain is disrupted, and it gradually begins to die. If you do not start treatment, dementia will develop catastrophically quickly.

The psychiatrist also reminded that against the background of a severe infection or some other disease, a temporary memory disorder and loss of attention may appear. But this is due to the fact that the body is weakened. It is worth recovering, getting enough sleep, resting, and intellectual abilities will be restored. nine0003

– The appearance of what symptoms should alert and make you go to the doctor?

– Even from a sedentary lifestyle, the brain suffers. The first symptoms to look out for are headaches, dizziness, and nausea. When they appear, you need to contact a neurologist. In this case, there are still no violations of memory, attention, cognitive functions, but the person feels heaviness in the head, quickly gets tired, has poor thinking at the end of the working day, and actively responds to weather changes. This indicates insufficient blood supply to the brain. nine0003

Anorexia, illiterate vegetarianism, diabetes mellitus, and any endocrinological diseases can also lead to malnutrition of the nervous tissue. Important! If you are physically healthy, if you lead an active lifestyle and go to the doctor on time, and not just thoughtlessly take pills, then your brain will be healthy. But this does not apply to Alzheimer's and Parkinson's disease.

– How to notice the first symptoms of Alzheimer's disease?

- Memory disorders and intellect disorders are growing very quickly, which are more pronounced in Alzheimer's disease than in senile dementia. A person suddenly becomes confused, cannot understand what is happening, because he does not remember current events well. Literally, if he turns away from you and turns again, he will think that he saw you for the first time. Such patients always have a surprised, confused look. There are also violations of speech and the usual order of actions. Patients confuse words and cannot, for example, perform a simple test: disassemble and assemble a ballpoint pen. nine0003

As Anastasia Olegovna noted, up to a certain point a person can understand for himself that he is developing dementia. He complains of a short-term memory disorder and forgets what happened a day or an hour ago. Whether treatment will be prescribed on time, how the disorder will proceed - it all depends on the patient's environment. It is relatives who should sound the alarm in time and not ignore the symptoms.

- Dementia can be with psychotic disorders: with delusions, hallucinations, aggression, vivid behavioral disorders and without them. It is clear that if a person suddenly expresses crazy ideas (for example, “you want to kill me and take my apartment”) and behaves aggressively, then relatives turn to a psychiatrist. But when there are no such vivid violations, and memory and intellect fade away gradually, unfortunately, people turn for help very late. And often relatives say that everything was fine “literally until yesterday”. But when you start asking questions, it turns out that five years ago the patient had forgetfulness, and two years ago she got lost on the street, and for the last year she has been afraid to leave the house because she is not sure that she will find her way back. Then it becomes clear that the symptoms appeared a long time ago. Patients with dementia often remember events of the distant past to the smallest detail, and the current ones are not fixed in memory. Many say: yes, my grandmother has such a memory, no one in the family has such a memory, she reads “Eugene Onegin” by heart. But in fact, this is a formidable symptom that current events are already being erased from memory. nine0003

– These disorders cannot be cured, but is it possible to somehow prolong mental clarity?

– Relatives, doctors, and patients themselves understand that the process is irreversible. And this sometimes makes them refuse treatment, which is wrong. The more attention is paid to the disease, the better the doctor's prescriptions are carried out, the longer the patient will remain independent in simple everyday situations.

Medications exist, their action is effective, but they do not reverse development, because the dead nerve tissue is not restored. Medicines help neurons to start working more actively: they get tired less, and a person maintains a high level of functioning longer. Medical treatment is necessary, but it alone is not enough. Supportive social activities are needed. A person suffering from dementia should know well where they live. To do this, it is necessary to maintain order in his room (every thing has its own place), place a clock and a calendar on the walls. It is important to keep the tablets in the pill box and monitor how the patient takes them. And most importantly - to train the skills that are needed constantly: go to the store for bread, dress yourself, brush your teeth.

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