Delirium, Dementia & Amnestic Cognitive Disorders

Scott Rower9/20/06

Cognitive Disorders In General

Brain dysfunction cognitive deficits Cognitive Functions

Memory, attention, perception & thinking Develop later in life

Delirium – What Is It?

A syndrome of disturbances in consciousness accompanied by symptomatic manifestations of early brain dysfunction (which can not be better explained by dementia)

Delirium – Main Symptoms Confusion Disorientation Cognitive Changes

Memory dysfunction, perceptual dysfunction

Types of Delirium

Delirium Due to a Medical Condition Delirium Due to Substance

Intoxication Delirium Due to Substance

Withdrawal Delirium Due to Multiple Etiologies Delirium Not Otherwise Specified

What are other possible effects?

Emotional disturbances Tremors Autonomic hyperactivity Reversal of night-day sleep-wake

cycle Extreme shifts in psycho-motor

activity

Who is at risk?

What Is The Course?

Begins abruptly Fast recovery

Dependant on i.d. & attention Complete recovery is common

Differential Diagnosis

Dementia Substance intoxication & withdrawal Schizophrenia, Schizophreniform Malingering & Factitious Disorder

But Scott, Are There Other Causes?

Severe medical illness

Severe mental illness

Fever Poisoning Brain Injury

Severe lack of food or water

Sleep deprivation Excess stress

Key Diagnostic Point

Disturbance of consciousness Change in cognition

Dementia – What Is It?

A gradual deterioration of the brain functioning that affects judgment, memory, language & other advanced cognitive processes

Dementia – Main Symptoms

All cognitive function becomes affected

Memory impairment Cognitive disturbance(s)

Agnosia, Aphasia, Apraxia, Executive Functioning

Types of Dementia

Dementia of the Alzheimer’s Type Vascular Dementia Dementia Due to Other General

Medical Conditions Substance-Induced Persisting

Dementia Dementia Due to Multiple Etiologies Dementia Not Otherwise Specified

Cortical Vs. Subcortical Dementia

Characteristic Cortical Subcortical

LanguageAphasia No aphasia

MemoryRecall & recognition impaired

Impaired recall; normal or less impaired

recognition

Visuospatial SkillsImpaired Impaired

Mood Less severe depression & anxiety

More severe depression & anxiety

Coordination Normal until late in progression

Impaired

What Are Other Possible Side Effects?

Emotional changes Irrational beliefs, depression, agitation,

aggression, apathy

Who Is At Risk?

Big surprise – the elderly Ages 75 – 79 2.3% 80 – 84 4.6% 85 & Older 8.5%

What Is The Course?

Continued cognitive deterioration Death

Sad, I know

Differential Diagnosis

Delirium Schizophrenia MDD Age-Related Cognitive Decline

What Are The Causes of Dementia

Brain trauma Infectious disease Toxic substances Diseases Multiple genes

The Alzheimer’s Brain

What Is The Treatment?

Biological treatment Psychosocial treatment

Prevention

Estrogen replacement therapy Treatment of hypertension? Nonsteroidal anti-inflammatory

drugs?

Key Diagnostic Point

Memory impairment At least one major cognitive

disturbance

Amnestic Disorder – What Is It?

Loss of memory w/o loss of high-level cognitive functions Inability to transfer information into long

term memory

What Are The Main Symptoms?

Inability to learn new info or recall previously learned info

Issues with social and occupational functioning

What is the course?

Variable Acute onset Subtle onset Due to head trauma is largely variable

Greatest after injury, improvement until about 2 years

What Are The Types of Amnestic Disorder?

Based on etiology Amnestic disorder due to general

medical condition Substance-induced persisting amnestic

disorder Amnestic disorder not otherwise

specified

Differential Diagnosis

Repetition of sequential string of info a good test Unimpaired amnestic disorder Impaired delirium

Any cognitive impairment? Direct effect of a medical condition or

substance abuse?

Key Diagnostic Point

Distinguishing feature is memory impairment without other cognitive deficits

Amnestic Disorder In The Media Oliver Sacks’ –

The Man Who Mistook His Wife for a Hat

Dory from Finding Nemo

Memento

Making A Diagnosis

2 tiered process 1 – recognition that symptoms are

consistent w/ a DSM disorder 2 – Search for underlying physiological

asuse

Making A Diagnosis

To delineate which cognitive disorder Does the patient have disturbances of

consciousness? Does the patient have an impairment of

cognition? What is the temporal basis of the

patient’s disturbance?