This document provides information about cognitive disorders such as dementia and delirium. It defines key terms, describes symptoms, causes, diagnostic procedures and nursing care approaches. The main points covered are: dementia involves progressive cognitive decline while delirium has rapid onset and fluctuating symptoms. Common types of dementia include Alzheimer's disease. Symptoms of delirium include impaired attention and cognition. Causes can be medical conditions, substances or multiple factors. Assessment involves tests of cognition, brain imaging and ruling out physical causes. Nursing care prioritizes safety, communication, reducing confusion and promoting well-being and family support.

1. Nursing Study Contents

3. At the end of this session students will be able to
1. Define cognition and cognitive disorder.
2. Define dementia.
3. Indentify the types of dementia.
4. Recognize the symptom of dementia.
5. Elaborates the causes of dementia.

4. 6. Define Delirium.
7. Enlist the symptom of delirium.
8. Recognize the causes of delirium.
9. Explain the diagnostic procedure for dementia and
delirium.
10. Identify nursing care for dementia and delirium.

5.  Mental process characterized
by knowing, thinking, learning,
and judgment.
 Cognitive disorders include
delirium and dementia.

6. Cognitive disorder are those conditions in which the
predominant disturbance is a clinically significant
deficit in cognition or memory that represents a
significant change from a previous level of
functioning .
(American psychiatric Association ,2000,p,135)

7. A loss of previous levels of cognitive, executive, and
memory function in a state of full alertness; the
progressive decline in cognitive function due to
damage or disease in the brain beyond what might be
expected from normal aging.

8. Primary dementia = dementia itself is the major sign of
an organic brain disease not directly related to any
other organic illness
 Alzheimer’s disease
Secondary dementia = caused by or related to another
disease or condition
 HIV
 Cerebral trauma

9.  Amnesia--inability to learn new information or to
recall previously learned information
 Agnosia--failure to recognize or identify objects
despite intact sensory function
 Aphasia--language disturbance that manifest in both
understanding & expressing the spoken word
 Apraxia--inability to carry out motor activities
despite intact motor function

11.  Impairment in abstract thinking, judgment, and impulse
control
 Disregard of social conduct
 Uninhibited and inappropriate behavior
 Neglect of personal appearance and hygiene

12.  May affect language
◦ difficulty naming objects
◦ vague, imprecise speech
◦ aphasia
 Personality changes
 Apraxia = inability to carry out motor activities despite
intact motor function
 Irritability, mood instability, sudden outbursts

13.  Unable to comprehend own limitations
◦ serious risk for accidents
◦ unable to work or care for personal needs independently
 Wandering away from home or health care setting

14.  Dementia of the Alzheimer’s type
 Vascular dementia
 Dementia due to HIV
 Dementia due to head trauma
 Dementia due to disease processes
 Dementia due to other general medical conditions
 Persistent dementia due to substance use
 Dementia due to multiple etiologies

15. A mental state characterized by a disturbance of
cognition, which is manifested by confusion,
excitement, disorientation, and a clouding of
consciousness; hallucinations and illusions are
common.
It is characterized by a disturbance of consciousness
and a change in cognition that develops rapidly over a
short period of time.

16.  Difficulty with attention
◦ focusing
◦ sustaining
◦ shifting
 Extreme distractibility
 Disorganized thinking
 Rambling, irrelevant, pressured, incoherent
speech
 Impairment in reasoning ability and goal-directed
behavior

17.  Disorientation to time and place
 Impairment of recent memory
 Misperceptions of the environment
(hallucinations/illusions)
 Disturbance in the sleep-wake cycle
 State of awareness ranges from hyper vigilance
to stupor/semi-coma
 Vivid dreams and nightmares
 Fluctuations of psychomotor activity
◦ restlessness, hyperactivity
◦ vegetative state (i.e. catatonic stupor)

18.  Emotional instability
◦ anxiety, depression, irritability, anger
◦ murmuring, moaning, calling out for help
◦ attempts to flee or attack others
 Autonomic manifestations
◦ tachycardia
◦ sweating
◦ flushed face
◦ dilated pupils
◦ elevated blood pressure

19.  General medical conditions
 Substances
◦ medications
◦ toxins
 Overdose of drugs or alcohol
 Withdrawal from alcohol, drugs, or medication
 Multiple etiologies
◦ more than one general medical condition
◦ combination of medical condition and substance use

20. 1
 Dementia
◦ Chronic, slow
progression
◦ Irreversible disorder
◦ Impaired memory
◦ Global cognitive deficits
◦ Most commonly caused
by Alzheimer’s
◦ Does not require
immediate treatment
 Delirium
◦ Rapid in onset (hours to
days), fluctuating course
◦ May be reversed
especially, if treated early
◦ Greatly impairs attention
◦ Focal cognitive deficits
◦ Most commonly caused
by systemic disease,
drug toxicity, or
metabolic changes
◦ Requires immediate
treatment

21.  CT scan
 Mental Status Exam (MSE)
 CBC, Chemistry Panel, Basic
Metabolic Profile (to
determine underlying cause)

22.  Brain Imaging/Lab Tests - CT or MRI,
cerebrospinal fluid (all used to confirm a
diagnosis or eliminate various possibilities)
 Blood tests - used to diagnosis neurosyphilis.
 Metabolic tests - determine treatable
disorders such as a vitamin B12 deficiency
 EEG (electroencephalography) is used to
diagnose Creutzfeldt-Jakob disease.

23. Recent reviews indicated that the
GPCOG, MMSE and MIS are the most
appropriate screening tools for primary
care in that they are quick to use and have
high sensitivity and specificity to
diagnose cognitive impairment (>80%)
Ref: Brodaty et al, 2002; Brodaty et al 2005; Borson et al, 2000; Borson et al 2005; Buschke et al
2006; Lorentz et al 2002; Milne et al 2008.

25. TEST
RESULTS
Psychological
and social aspects
Factors affecting
test performance
History
Informant
perspective
Medical tests,
scans etc
Response to
assessment
Findings and
recommendations
Functional
assessment;
other measures
Interpreting Results

26.  Brief in duration
◦ 1 week to 1 month
 Diminishing of
symptoms
◦ occurs upon recovery
from underlying cause
◦ 3 days to 1 week
common
◦ may take up to 2 weeks
 May transition into a
more permanent
cognitive disorder
◦ dementia
Prognosis of Dementia
 Progressive and
irreversible

28.  Altered thought processes r/t severe dehydration as e/b
hyper vigilance, distractibility, visual hallucinations,
and disorientation to time, place, and person.
 Altered thought processes r/t barbiturate ingestion e/b
altered sleep patterns, delusions, disorientation, and
decreased ability to grasp ideas.
 Altered thought processes r/t brain disorder e/b
inaccurate interpretation of environment, deficit in
recent memory, impaired ability to reason, and
confabulation.

29.  Impaired verbal communication related to cognitive
impairment as evidenced by recent memory loss .
 Impaired social interaction related to altered thought
process, as evidenced by loss of conformity to social
norms.
 Self care deficit related to cognitive impairment.
 Disturbed thought process related to cognitive
impairment.
 Risk of injury related to fear and disorientation.

30.  Care for physiological needs
 Respond to hallucinations
 Respond to wandering
 Decrease agitation
 Administer medications
 Reinforce coping mechanisms
 Communicate therapeutically
 Provide health education, involving
family and community
Remember that
elderly people
are very
sensitive
to medications.
Administer with
care, and
monitor
closely.

31.  Highest priority is to maintain quality life and attend to
physical needs
◦ Nutrition and fluid balance
◦ Ensure safety- May need restraint in acute care settings
◦ Sedatives may be needed for sleep deprivation
 Communicate with clear messages and simple instructions
 Maintain dignity
 Decrease anxiety with dementia.
◦ Keep lights on if pt fears dark or shadows
◦ Orientate to time, place and person

32.  Person wears identification
bracelet
 Install special locks, safety
devices on doors, stove &
other potentially dangerous
objects
 Check frequently for burns,
bruises, or abrasions
 Assess for signs of abuse
 Only use restraints after
other methods are
ineffective--need MD order
 Look directly at person when
speaking
 Identify yourself prior to
interaction
 Use simple short phrases
 Ask specific rather than general
questions
 Distract if asking same question
repeatedly
 Assist in word finding
 Reassure that you intend to help
 Avoid arguing
 Convey patience and
understanding
Promote Safety Communication

33.  Establish regular & predictable
routine
 Breakdown complex tasks into
small simple steps
 Consistent care by regular staff
 Use large clock & calendar
  distraction & stimulation, avoid
clutter & unnecessary objects
 Post lists of daily activities
 Person wear glasses & hearing
aid
 Avoid medications if possible
 Check person frequently
Decrease Confusion

34.  Encourage regular exercise
 Ensure nutrition &
hydration
 Assist with ADLs
 Assess frequently for
physical pain, constipation,
& discomfort
 Evaluate agitation and
worsening behavior
carefully
 Suggest day treatment for
clients living at home
 Teach ways to manage
uncooperative behavior
 Teach about causes and
course of dementia
 Monitor & assess level of
stress on the family
 Encourage use of social
support to decrease
caregiver stress
 Help families mourn the
loss of their loved one
Physical & Emotional Wellbeing Family Education
Schober, Glod, Jones,
1998, p. 251

35.  Stuart, G. & Laraia, M. (2005). Principles & practice of psychiatric
nursing (8th Ed.). St. Louis: Elsevier Mosby
 Stuart, G. & Sundeen, S. (1995). Principles & practice of psychiatric
nursing (5th Ed.). St. Louis: Mosby
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