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

2. 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

3. 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

4. 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)

5. 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

6. 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)

7. 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

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

9. 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

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