Cognitive

Impairments
Week 2
NURS 150
Winter 2025
Concept: Cognition
(Giddens)
Pages 362-373
 Cognition
• Mental action/process of acquiring knowledge and understanding through
thought, experiences and senses
• 6 domains of Cognitive Function:
1) Perceptual motor function
2) Language
3) Leaning & memory
4) Social cognition
5) Complex attention
6) Executive function

• Intact vs impaired
• Changes over time
• Temporary vs chronic or mild vs severe
 •Temporary (hours or a few days), rapid onset
Delirium •Memory, judgement are impaired, disorientation, restlessness,
agitation/aggression

Neurocognitive •Chronic, progressive impairment (memory, judgement, attention, thinking)

(Dementia) •Many types (Alzheimer's, Parkinson's, Lewy, HIV etc)

Categories Cognitive Impairment •Occurs with aging but does not interfere with functional ability.
(Not Dementia) •Can progress to Dementia

of Cognitive
Impairment Focal Cognitive •Single area of cognitive function
Disorders •May be memory, language, visuospatial ability, or executive function

Intellectual Disabilities •Neurodevelopmental Disorders –begin in childhood

(ID’s) •Deficits in intellectual functioning & difficulties with adaptive functioning

Learning Disabilities •Genetic or Developmental factors affecting brain functioning

•Basic/higher level skills can be affected in learning environment or relationships
(LD’s) •Does not define intelligence
 Cognition

• Age Related changes

• Cognitive development occurs in an orderly and sequential manner
• Rapid growth to decline

• Impairment:
• Deficits in Intellectual Functioning
 Cognition

• Consequences
• Increased risk for injury
• Complicates disease management
• Decreased functional ability including capacity for independent living and normal social
interaction
• Increased need for assistive services
• Financial hardship
• Caregiver burden
• Risk Factors
• Male vs female
• Individual RF’s
 Nursing Process

• Assessment:
• History
• Examination
• General appearance
• Behavior
• Assessment of cognitive function

• Testing
• Lab
• Neuropshychometric Testing
• Imaging
 Clinical Management: Primary Prevention
• Promoting a healthy lifestyle
• Educational and community programs (ie substance abuse high risk behaviors, healthy
eating etc).
• Genetic counseling
• Practices to reduce the risk for delirium
• Collaborative Practice/Interventions
• General Management Strategies
• Promoting general health and comfort
• Reorientation
• Pain management
• Regulation of stimulation
• Behavioral management
• Sensory aids
• Caregiver support
Dementia & Delierium
Lewis Ch 62: 1541-1544
Dementia and Delirium
Dementia Delirium

 Loss of brain function that occurs with certain  Sudden severe confusion and rapid changes
diseases. in brain function.

 It affects memory, thinking, language,  Occurs with physical or mental illness

judgment and behaviour. (deprives brain of oxygen).

 Nonreversible—Alzheimer’s disease (most  Temporary or reversible.

common type).

 Causes—Abnormal protein structures in  Causes—Alcohol or sedative drug withdrawal,

certain areas of the brain (brain tumors, drug abuse, electrolyte or other body chemical
chronic alcohol use or drugs, low vitamin B12 disturbances.
levels).
 Delirium
• Acute and can be life threating.
• Impaired attention, awareness and cognition, medical emergency
• Prevention and detection are key
• Related to multiple process occurring cognitively (ie inflammation, hypoxia, other biological/physiological
factors etc)
• All ages with older adult at highest risk

• Risk Factors:
• Bladder catheter
• Medications/Polypharmacy
• Sedatives or hypnotics
• Infection
• Physiological (increased serum urea or BUN; creatinine ratio; abnormal serum albumin, glucose, or potassium; metabolic
acidosis)
• Overstimulating or under stimulating environment
• Physical restraints
• Surgery/Trauma
 Dementia
• NOT a normal part of aging
• Medical conditions also can lead to dementia:
• Infections that can affect the brain
• Vascular Disease (ie TIAs)

• Other causes that may be stopped/reversed if they are found soon enough, including:
• Brain injury
• Brain tumors
• Chronic alcohol abuse
• Changes in blood sugar, sodium, and calcium levels
• Low vitamin B12 levels
• Use of certain medications

It is rare in people under age 60. The risk for dementia increases as a person gets older.
 Dementia
• Various types of Dementia:
1) Alzheimer’s
• Chronic/progressive and degenerative, etiology unknown (strong genetic base and age)
• Amyloid plaques (abnormal quantitates), neurofibrillary tangles, loss of connections bt
cells/cell death

2) Vascular (multi-infarct)
• Due to ischemic/hypoxic or hemorrhagic brain damage
• Decreased blood/oxygen supply and cell death

3) Lewy Body
• Lewy body deposits (type of protein) throughout ANS, cortex, brainstem
• Similar to Parkinson
Clinical Manifestations
Dementia * 8 A’s + table 62.8 Delirium

 Inability to take care of oneself.  Quick mental change (from lethargy to

agitation).

 Change in sleep patterns.  Changes in alertness.

 Difficulty doing basic tasks.  Changes in level of consciousness or

awareness.

 Forgetting details about current events.  Changes in sleep patterns.

 Losing awareness of oneself.  Disorientated.

 Hallucinations.  Decrease in short term memory and recall.

 Unable to recognize family members.  Speech that does not make sense.

 Withdrawn from social contact.  Emotional or personality changes.

 Diagnostic Tests - Delerium

• Assessment:
• Patient history
• physical exam
• Lab tests (Blood/Urine work – BUN, CBC, Electrolytes etc)
• Environmental factors
• Scans (history of head injury, lesions)

• Behavioral Observation
• Mental Status Assessment
Diagnostic Tests -Dementia
 Physical exam and medical history, neurological exam,
blood tests (B12 level, drug or alcohol level—toxicity
screen), EEG, CT scan and MRI of head.

http://img.gizmag.com/blood-test-predicts-future-alzheimers-patients.jpg?ch=Width&fit=crop&h=394&q=60&w=700&s=2b2a0e83052597141a3bf4b2a1e4e9e1
 Nursing Management & Collaborative Care
• Delirium:
• Prevention is key
• Identify and treat underlying cause, maintain stability, ensure patient safety
• Review of medications, diet

• Dementia:
• Treat the underlying causes.
• Stop or change medications
• Medications to control behavior problems (antipsychotics, mood stabilizers, sedatives)
• Monitor for common infections (UTI, pneumonias)
• Family support (respite care, placement) and Safety plan
• Strategies for verbal/nonverbal communication
Summary
Dementia Delirium

Onset and course Slow onset over months or Sudden onset over hours
years or days

Speech Normal Slurred

Attention Normal Inattentive, easily

distracted

Memory Gradual memory loss More forgetful than usual

Hallucinations Possible Common

Mood Normal or depressed Anxious, fearful,

suspicious, indifferent

General health Usual Sign of illness or drug side

effect