Unit 10.

Cognitive Disorders
 Overview

• Cognition
– Brain’s ability to process, retain, use information
– Processes: reasoning, judgment, perception,
attention, comprehension, memory
• Cognitive disorders:
– disruption or impairment in higher-level brain functions

• Categories:
– Delirium, and Dementia
 Delirium
• Syndrome involving disturbance of consciousness with change
in cognition
• Etiology: usually from identifiable physiologic, metabolic,
cerebral disturbance or disease or from drug intoxication or
withdrawal
• Treatment and prognosis: transient; clearing with treatment
of underlying cause

– Psychopharmacology: sedation

– Other medical treatments

 Delirium and Nursing Process
Application
• Assessment

– History: medical history; medications

– General appearance, motor behavior: disturbed

psychomotor behavior; possible speech problems

– Mood, affect: rapid, unpredictable shifts

– Thought processes, content

 Delirium and Nursing Process Application
(cont.)
• Assessment (cont.)
– Sensorium, intellectual processes: altered LOC that
fluctuates; attention deficits
– Judgment, insight: impaired
– Roles, relationships: inability to fulfill roles
– Self-concept: fear, feelings of being threatened
– Physiologic, self-care: sleep problems, failure to
perceive internal body cues
 Delirium and Nursing Process
Application (cont.)
• Data analysis/nursing diagnoses

– Risk for injury

– Acute confusion

• Outcome identification

– Freedom from injury

– Increased orientation, reality contact
 Delirium and Nursing Process
Application (cont.)
• Intervention
– Promoting patient safety

– Managing patient’s confusion: orienting cues;

speaking in low, clear voice; avoiding sensory
overload

– Promoting sleep, proper nutrition

• Evaluation
 Delirium and Community-Based Care

• Referrals for continued cognitive problems

– Home health-care/visiting nurses

– Rehabilitation program
– Adult day care
– Residential care
– Support groups
 Dementia
• Multiple cognitive deficits; primarily
memory plus any of the following:
– Aphasia (echolalia, palilalia)
– Apraxia
– Agnosia
– Disturbance in executive function
 Dementia (cont.)

• Types of dementia:

– Alzheimer’s disease
– Vascular dementia
– Pick’s disease
– Creutzfeldt-Jakob disease
– Parkinson’s disease
– Huntington’s disease
– Dementia due to head trauma
 Dementia (cont.)
• Treatment and prognosis
– Underlying cause
– Usually progressive
– Medications for degenerative dementias:
cholinesterase inhibitors
– Symptomatic treatment for behaviors
• Antidepressants
• Antipsychotics
• Mood stabilizers
 Dementia and Nursing Process Application

• Assessment
– Mental status exam
– History
– General appearance, motor behavior: apraxia,
uninhibited behavior
– Mood, affect: increasing labile mood; rapid shifting
– Thought processes, content: impaired abstract
thinking, delusions of persecution
 Dementia and Nursing Process Application (con

• Assessment (cont.)
– Sensorium, intellectual processes: loss of
intellectual function; memory deficits; confabulation
– Judgment, insight: poor, limited
– Self-concept
– Roles, relationships
– Physiologic, self-care: disturbed sleeping;
incontinence, hygiene deficits
 Dementia and Nursing Process Application (con

• Data analysis/nursing diagnoses

– Risk for injury
– Chronic confusion

• Outcome identification
– Freedom from injury
– Involvement in surroundings, others in
environment
 Dementia and Nursing Process Application (con

• Intervention
– Safety
– Sleep, proper nutrition, hygiene, activity
– Environmental, routine structure
– Emotional support (supportive touch)
– Interaction, involvement (reminiscence
therapy, distraction, time away, going along)

• Evaluation