Cognition
• Fundamental human feature
• Impacts all areas of our life
• Helps our brain put things together
• Relates to intellectual and perceptual process but also emotional and spiritual

Cognitive Disorder- A problem in several areas that include judgment, memory, orientation, problem solving, language, relationships and doing things

Factors that affect cognitive function:
• Previous injury
• Medication, drugs, alcohol
• Fluid and electrolyte imbalance

Normal aging:
• Cognitive changes occur
• Process of aging is unique
• Memory (severe loss is not normal)
• Learning
• Changes are not progressive
• Information retrieval
• Perception
• Intellectual ability

Mental Status Exam:
• Basis for understanding what you are seeing with the person and their functional capabilities
• Look at orientation (date, time, season, month, year)
• Series of tests (repeat after me these three things: apple, table, penny) (count backwards by threes)(spell world backward) *Short term memory last about 60 seconds**Long term is anything longer than 60 seconds*
• Have a picture and ask the patient to copy picture
• Ask patient to write a sentence (shows can read and write)
• Appearance, mood, sensorium, intellectual functioning, thought process

Delirium
• Commonly seen in hospitals (Fever, UTI) 25% of elderly In a hospital develop delirium, those with dementia at higher risk. Surgery is a significant risk factor in all ages.
• Always secondary to another condition
• Usually affects elderly
• Sudden onset, altered LOC, cognitive problems (forgetfulness, judgment problems, decreased attention span), sleeping problems, perceptual disturbances (illusions, hallucinations, difficulty processing stimuli)
• Hallucination vs. Illusion=Illusion is misperception-seeing something incorrectly (clock says 6 when really 3:30) Hallucination is something that is absolutely not there (seeing dead people, bugs, etc.) *Pt says is hallucination-ask if hearing voices and if telling you to do something negative/positive. Also need to know if male/female voice because it could be self-talk*
• Tactile hallucination- feel something touching you that isn’t
• Olfactory hallucination- smelling something that is not there *Big sign of brain tumor*

Delirium Symptoms:
• Emotional issues- labile(up and down) moods, suspiciousness, hallucinations, delusions
• Speech and language- rapid, incoherent
• Sundowning- results in increased wandering and falls
• Safety issues
• Autonomic instability-diaphoresis, flushing, dilated pupils, tachycardia, hypertension

Treatment of Delirium:
• Treat underlying cause- UTI, etc.(untreated delirium has high morbidity)
• Avoid use of new medication
• Agitation/psychotic symptoms
• Monitor for safety needs- Bed in low position, bed exit alarm
• Patient should be neither sensory deprived nor overstimulated
• Use visual cues- Clocks, pictures of family, calendar

Dementia
• Deterioration of intellectual function
• LOC decreases, difficulty performing ADLs, deterioration of personality and impaired judgment
• Diagnosis=rule out other diseases
• Alzheimer’s type and vascular type
• Alzheimer’s type: Most prevalent type, present in 1 out of 10 people over 65, cause unknown, hallmark pathologic features=neurofibrillary tangles and beta amyloid plaques in the brain- definite diagnosis is postmortem
• Result of plaque in brain or lack of blood flow

Symptoms seen with Alzheimer’s:
• Aphasia-problems understanding or using language
• Apraxia-loss of purposeful movement. Unable to use objects and tools and identify them when previously could
• Amnesia-memory loss
• Agnosia-inability to recognize familiar objects, tastes, sounds, and other sensations
• Confabulation-makes up stories/answers to questions to questions to maintain self esteem
• Change in executive function-problems with planning, problem solving, and perseverance need to complete a task.