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Psychiatric / Mental Health Nursing
Cognitive Disorders
West Coast University
NURS 204
What are cognitive disorders?
 Delirium
 Dementia
 Amnestic disorders
Etiology
 Delirium
 An underlying systemic illness, including infection,
and endocrine disorder, trauma, and drug/alcohol
abuse
 Dementia
 Classified as to the cause or area of brain damage
 Amnestic disorders
 Head trauma, hypoxia, encephalitis, thiamine
deficiency, and substance abuse
Theories
 Genetics
 Dementia of Alzheimer’s type
 Dementia from Huntington’s disease
 Dementia from Pick’s disease
Theories - continued
 Infection
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Delirium
Dementia from Creutzfeldt–Jakob disease
Parkinson’s disease
Amnestic disorders
 Vascular insufficiency
 Brain tissue destroyed
 Symptoms absent until 100–200 cc of brain tissue
destroyed
 Underlying systemic illness or injury
 Delirium
 Amnestic disorders
Differentiating Types of Cognitive
Disorders
 Delirium
 Acute confusional state characterized by
disruptions in thinking, perception, & memory
 Dementia
 Chronic state characterized by declines in
multiple cognitive areas, including memory
 Amnestic disorders
 Uncommon cognitive disorder characterized
by amnesia
Amnestic Disorder
 Characterized by short-and long-term
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memory deficits
Inability to recall previously learned
information or past events
Inability to learn new materials
Cofabulation, apathy, bland affect
Amnestic disorder NOS: not enough
supporting evidence to link a cause to the
amnesia (medical or substance)
Delirium and Dementia
Differences
 Delirium
 Fluctuating consciousness
 Varying attentiveness
 Acute
 Rapid onset
 Cause is identifiable
 Generally reversible
Delirium and Dementia
Differences - continued
Dementia
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Stable levels of consciousness
Steady attentiveness
Chronic
Slow insidious onset
Undetermined cause
Generally irreversible
Depression
 Depression can be masked by symptoms
suggestive of dementia
 The term pseudodementia is used to
describe the reversible cognitive
impairments seen in depression
 Pseudodementia is characterized by an
abrupt onset, rapid clinical course, and
client complaints about cognitive failures
Assessment
Delirium
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Fluctuating levels of consciousness
Disorientation and sundowning
Impaired reasoning
Poor attention span
 Altered sleep–wake cycle
 Alternating patterns of motor behavior
Assessment - continued
Dementia
 Memory impairment
 Cognitive impairment
 Aphasia
 Apraxia
 Agnosia
 Poor judgment
 Decline in previous abilities
Interventions for Delirium
 Introduce self and call client by name at
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each contact
Maintain face-to-face contact
Use short, concrete phrases
Keep room well lit
Keep environmental noise low
Set limits on behavior
1:1 staffing as needed
Interventions for Dementia
 Gently orient the client
 Educate family about home safety
 Maintain optimal nutrition
 Bowel and bladder training
 Utilize nonverbal forms of communication
 Structure the environment to support
cognitive functions
Supporting Optimal Memory
Functioning
 Environmental reminders
 Reminiscence activities
 Triggers for semantic memory
 Support cognitive strengths
 Assist to cope with cognitive deficits
Common Medications for Cognitive Disorders
 Dementia of the Alzheimer’s Type (DAT)
 Donepezil (Aricept)
 Galantamine (Reminyl)
 Rivastignime (Exelon)
Slows the rate of cognitive decline
Potent acetylcholinesterase inhibitors
Common Medications for Cognitive Disorders
 Dementia with Lewy Bodies
 Escitalopram (Lexapro)
Reduce symptoms of depression when present
 Pick’s Disease
 Valproic Acid (Depakote)
Reduce problematic mood swings and agitated
behavior
 Vascular Dementia with psychosis
 Quetiapine (Seroquel)
Reduce or eliminate delusions and hallucination
Caregiver Difficulties
 Wandering behaviors
 Sundowning disorientation
 ADLs
 Medication management
 Burnout and fatigue
Caregiver Resources
 Family meetings
 Alzheimer’s Disease and Related
Disorders Association (ADRDA)
 Caregiver support groups
 Identify community resources
 ID bracelet for the client
Self-Awareness
 Caring for clients with cognitive disorders
can be difficult and frustrating at times.
 Self-awareness inventory in your text
 The responses are designed to help you to
become more successful in working with
cognitively impaired clients and their
families.
Review Question
 Delirium is thought to be caused primarily
by:
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A. Genetics.
B. Underlying systemic illness.
C. Brain injury.
D. Vascular insufficiency.
Review Question
 A key characteristic of an amnestic
disorder is:
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A. Short-term and long-term memory loss.
B. Hallucinations.
C. Long-term memory loss.
D. Short-term memory loss.
Review Question
 A caregiver for a client diagnosed with dementia of
the Alzheimer’s type is unable to effectively
communicate with the client. Which of the following
techniques would be most appropriate to teach the
caregiver?
 A. Setting strict time limits and rephrasing misunderstood
questions
 B. Using multiple memory cues and giving several
directions at once
 C. Correcting errors by the client, and speaking in a loud
clear voiced.
 D. Encouraging verbal and nonverbal communication,
while maintaining a calm demeanor
Review Question
 The home health nurse is instructing a family
who cares for a patient with dementia
alzheimer’s type about safety measure would
include:
 A. Putting locks on the outside of doors so the patient
can not leave the room or house
 B. Purchasing a MedicAlert bracelet that identifies the
client as having DAT
 C. Chemically restraining the patient to prevent
agitation and confusion
 D. Restraining the patient in a chair or bed to prevent
falls
Review Question
 The actual cause of dementia associated
with dementia of the Alzheimer’s Type is:
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A. Diabetes
B. Infection
C. Unknown
D. Head trauma
E. Drug intoxication
Review Question
 One of the difference between delirium
and dementia is that clients with delirium:
 A. Are very attentive
 B. Experience a slow, insidious onset of
symptoms
 C. Have fluctuating consciousness
 D. Respond to questions appropriately and
correctly