1. Cognitive Disorders Delirium, Dementia, Amnestic Disorders

2. DELIRIUM Disturbance of consciousness and change in cognition developing over short period Decreased awareness Inability to focus Inattentiveness Disorientation Memory loss Language disturbance Perceptual alterations

3. CLINICAL SIGNS/SYMPTOMS Rapid onset Fluctuating course Intermittent memory loss Reduced LOC Globally reduced attention span Poorly organized thoughts Incoherent speech Psychomotor activity change Tremors Appetite and sleep disturbances

4. CAUSES Medical conditions Medications Substance toxicity Toxin exposure Combination of factors **Older adults at greater risk (multiple diagnoses and polypharmacy, decreased metabolism and excretion of drugs)

5. TREATMENT Most cases are reversible with TX Must determine cause – TX depends on reason Nursing DX: –Risk for injury –Altered thought processes –Self-care deficit –Sensory-perceptual alteration –Fear –Sleep pattern disturbance –Nutrition: altered (less) –Knowledge deficit

6. DEMENTIA Irreversible, progressive cognitive decline including loss of awareness, judgment, ability to reason…severe enough to interfere with daily functioning and communication with others –Alzheimer’s Disease –Vascular Dementia

7. ALZHEIMER’S DISEASE (AD) Primarily affects: –Cerebral cortex (conscious thought and language) –Production of acetylcholine (memory and learning) –Hippocampus (memory storage) –Neurons degenerate and lose synaptic connections to other neurons

8. LOSSES Ability to do purposeful movement (Apraxia) Encoding information for recall or connection between meaning of words spoken to them Early stages – may be aware of memory deficit (Amnesia) and use confabulation Inability to acquire and process new information Recent memory – lost first Remote memory – more marked as disease progresses

9. LANGUAGE PROBLEMS Anomia – inability to find the right word Agnosia – inability to identify an object Aphasia – impairment in the significance or meaning of language (inability to understand what is heard, follow instructions, communicate needs)

10. LANGUAGE PROBLEMS (Cont.) Language deterioration –Conversational speech to sentence fragments –Echolalia (repeat words/phrases) –Paralalia (repeat one word) –Logoconia (repeat one syllable) –Unintelligible, repetitive babbling –Mutism

11. Other Symptoms Catastrophic events – verbal or physical agitation in response to frustration and perceived threat/fear of environment Resistance to care Perceptual alterations Hide things – suspicious of others Restlessness, pacing, wandering Interruption of sleep-wake cycle Sundowning

12. DEPRESSION & DEMENTIA Non-progressive May accompany early stages of dementia Changes in appetite, sleep patterns Fatigue Withdrawal, self-neglect, helplessness Will not attempt to answer questions **Responds to treatment – improvement in cognitive ability

13. NURSING PROCESS Assessment Nursing Diagnoses Expected Outcome Nursing Interventions **Catastrophic Events: 1. Redirect and distract 2. Demented person is unable to control behavior – intervene and prevent injury to client or others 3. Who – What – When – Where - Why Evaluation