Yard. Doç.Dr. N. Berfu AKBAŞ COGNITIVE AND MENTAL DISORDERS DUE TO A GENERAL MEDICAL CONDITION (DGMC ) Yard. Doç.Dr. N. Berfu AKBAŞ

COGNITIVE DISORDERS DGMC “Clinically significant deficit in cognition and memory that represents a significant change from a previous level of functioning” DELIRIUM DEMENTIA AMNESTIC DISORDER COGNITIVE DISORDERS DGMC

DELIRIUM Disturbance of consciousness and a change in cognition with sudden onset. Abnormalities of mood, perception, behaviour, tremor, nystagmus, incoordination, urinary incontinance Fluctuates during day, worse at night “It’s a syndrome, not a disease!” Other names: acute confusional state, acute brain syndrome, metabolic encephalopathy, toxic psychosis, acute brain failure

Important to recognize; %90 postcardiotomy %40-50 after hip fracture surgery %30 AIDS %20 after severe burns %15-20 in general medical wards Advanced age ( >65-%30-40) 1 year mortality %50 ( poor prognostic sign)

Etiology: CNS disease ( epilepsy, brain trauma, infections, neoplasms, vascular disorders) Systemic Diseases ( arrhytmias, hypoglycemia, hypoxia, hepatic-uremic encephalopathies, endocrine dysfunction, fever, sepsis) Post-operative states Drugs and poisons Electrolyte imbalance of any cause

Major neurotransmitter: Acetylcholine Neuroanatomical area: Reticular Formation ( attention and arousal ) EEG: diffuse slowing of background activity TX: treat the underlying cause!! Psychotic features: haloperidol Insomnia: benzodiazepines( lorazepam)

DEMENTIA Multiple cognitive defects ( impairment in memory, general intelligence,learning, language,problem solving, orientation, perception, attention, judgement ) without impairment in consciousness. >65, %5 have severe, %15 mild dementia. Time of death after onset of symptoms: 5-9 years %60- Alzheimer type, after that vascular dementia most common

Psychiatric and Neurological Changes Personality Hallucinations and delusions Mood Cognitive changes( aphasia, apraxia, agnosia, seizures, primitive reflexes

AMNESTIC DISORDERS Retrograde Amnesia: inability to recall previously learned information Anterograde Amnesia: impairment in the ability to learn new information Usually short-term, recent memory impaired İmmediate and remote memory intact. The specific cause determines the course and prognosis

Thiamine Deficiency ( Korsakoff’s Syndrome) Hypoglycemia Seizures Head trauma Cerebral Tumors SVA Herpes Simplex Encephalitis Hypoxia ECT Multiple Sclerosis Alcohol Benzodiazepins