Cognitive Disorders and Delirium Quiz

Neurocognitive Disorders

• Neurocognitive disorders is a new global term that encompasses delirium and dementia diagnoses (DSM-5, 2013). Previously, these were called organic mental syndrome and disorder.

Causes of Cognitive Impairment Disorders

• Cognitive psychotic conditions have various etiologies.
• A mnemonic device, "MEND A MIND", helps recall possible causes:
• M - Metabolic disorder
• E - Electrical disorder
• N - Neoplastic disease
• D - Degeneration
• A - Arterial disease
• M - Mechanical disease
• I - Infectious disease
• N - Nutritional disease
• D - Drug toxicity

Delirium

• Definition: An acute organic mental syndrome marked by clouding of consciousness, disorientation, memory impairment, and decreased concentration. It is reversible.
• Prevalence: Up to 15% of patients over 65 are delirious upon hospital admission.
• Risk factors: Increasing age, underlying dementia, and physical illness.
• Outcome: Typically full recovery.
• Onset: Sudden and tends to resolve rapidly when the cause is identified and treated.
• Types: General medical condition, substance-induced delirium (including substance intoxication and withdrawal), delirium due to multiple etiologies, delirium not otherwise specified.
• Causes of Infections: Systemic infections like malaria, typhoid fever, pneumonia.
• Causes of Drug Intoxication/Withdrawal: Alcohol, anxiolytics, opioids, CNS stimulants, cocaine, crack, amphetamines, marijuana
• Causes of neurological disorders: Intracranial problems like meningitis, encephalitis, cerebral malaria; seizures; head trauma; Hypertensive encephalopathy.
• Drugs (Post-operative/ Post-partum): Antibiotics, Antiparkinsonian, Anticholinergics/Antituberculosis, Anticonvulsants, Analgesics, Anti-inflammatory, Cardiac, Sedatives, Hypnotics.
• Metals and Gases: Mercury, Lead, Arsenic, Carbon Monoxide.

Dementia

• Definition: Characterized by the (usually) insidious (but sometimes acute) development of generalized brain dysfunction with multiple cognitive deficits. Impairment in social and/or occupational functioning results in a decline from the patient's previous level of functioning.
• Awareness & Alertness: In early dementia, awareness & mental alertness is typically intact and stable in contrast to delirium's unstable alternating level of consciousness.
• Memory Impairment (common): Ability to learn new information and recall previously learned information is impaired.
• Types: Alzheimer's type, Vascular Dementia, HIV related, Head trauma related. Parkinson's disease related, Huntington's disease related, Rick's disease related, Creutzfeldt-Jakob Disease related, Other General Medical Conditions related, Substance-Induced Persisting Dementia, multiple etiology related, not otherwise specified
• Causes (Partial): Alcohol-related, Alzheimer's Disease, Amyotrophic lateral sclerosis, Bromide poisoning, Chronic granulomatous meningitis (e.g., tuberculosis, fungal), Folic Acid deficiency, Head trauma, HIV, Huntington's chorea, Hypothyroidism, Multi-infarct Dementia, Multiple sclerosis, Neoplasms, Normal-pressure hydrocephalus, Postanoxic state, Progressive Supranuclear Palsy, Transmissible virus dementia (e.g., Jacob Creutzfeldt), Vitamin B12 deficiency.

Other Cognitive Impairment Disorders

• Amnestic Syndrome: Cognitive impairment disorder where consciousness is not affected; short-term and long-term memory is impaired.
• Organic Delusional Syndrome: Predominant delusion without change in consciousness, intellectual abilities, or mood.
• Organic Hallucinations: Hallucinations without changes in consciousness, intellectual abilities, or mood, and without delusions.
• Organic Mood Syndrome: Change in mental status with two of the symptoms for a manic or major depressive episode. No changes in consciousness or intellectual abilities, no hallucinations or delusions.
• Organic Anxiety Syndrome: Characterized by active, recurrent panic attacks or generalized anxiety.
• Organic Personality Syndrome: Major change in personality style, including emotional swings, decrease in impulse control.

Pre-Senile Dementia

• Chronic organic mental condition causing intellectual and emotional impairment before the age of 65 due to organic cerebral changes.
• Examples: Huntington's chorea (severe cerebral degeneration, genetic onset 30-50 years), Pick's disease (atrophy of the frontal lobe of cerebrum), Alzheimer's disease (premature degeneration of CNS).

Senile Dementia

• Chronic organic mental illness due to degenerative brain changes resulting from old age (often age 65 and above). Characterized by permanent impairment symptoms and behavioral changes.

Clinical Features (Senile/Pre-senile Dementia)

• Psychological Features: Feeling rejected, regression (behaving like a child), loss of memory/amnesia, overtalkative, delusions of persecution, regression to childhood.
• Physical Features: Incontinence, general bodily weakness, loss of appetite, shuffling gait, blurred-incoherent speech, weight loss, blurred vision, deafness, wrinkled/ inelastic skin, loss of teeth, fragile bones, neglect of personal hygiene, epileptic fits, paranoid and hypochondriac delusions.
• Physical Features (Developmental): Delayed developmental stages (sitting, standing, walking, talking), physical abnormalities (stigmata).

General Paralysis of the Insane (GPI)

• Chronic form of syphilis affecting the CNS.
• Progresses through stages (Primary, Secondary, Tertiary) over 5-75 years.

Clinical Features (GPI)

• Symptoms are neurological and psychological, ranging from slow to quickly excitable symptoms.
• Psychological Symptoms: Loss of memory, impaired judgment, disorientation, lack of initiative/concentration; grandeur delusions, nihilistic delusions, mood swings, credulousness.
• Neurologic symptoms: Pupils small, unequal, irregular, do not react to light (Argyll Robertson); Tremors of lips, tongue, facial muscles – slurred indistinct speech. Tremors of hands, incoordination of movements; epileptic attacks. Ongoing deterioration leads to complete dementia, physical deterioration, and increase in appetite.

Parkinson's Disease (Paralysis Agitans)

• Affects approximately 1 in 1000 of the general population and 1% of those over 70. Peak incidence is in the sixth decade of life.
• Clinical syndrome: tremor, rigidity, and bradykinesia.
• Associated conditions: neuroleptic drugs, Wilson's disease, cerebral anoxia, Shy-Drager syndrome
• Clinical features often include Akinesia, Rigidity, Pill-rolling tremor, Postural abnormality, Shuffling gait, Difficulty in handwriting or walking. Depression, Anxiety, Bradyphrenia, Slow thinking, Slurred speech, Masklike face

Epilepsy

• Brain disorder characterized by recurring excessive neuronal discharge. Manifested as transient episodes of motor, sensory or psychic dysfunction, with or without unconsciousness or convulsive movements. Marked changes are recorded in electrical brain activity.

• Causes: Many causes remain unknown.

• Constitutional: Genetic predisposition, endocrine disorders, age, body build

• Predisposing: Intracranial infections, degenerative diseases, brain tumors, head injuries, metabolic disorders

• Precipitants: Emotional stress, unknown causes, drugs, boredom, sensory stimulus, fatigue, crowd of people

• Other/Specific: Sexual activity, excitement, strong emotions, fevers.

• Types/Classifications: Generalized (grand-mal, petit-mal), Focal/Partial (psychomotor, Jacksonian).

Generalized Epilepsy (Grand-mal)

• Characterized by 4 distinctive phases:
• Aura/warning phase
• Tonic phase (prolonged muscle contraction)
• Clonic phase (muscle spasm and relaxation)
• Coma phase (complete unconsciousness)

Epilepsy (Petit-mal)

• Brief loss of consciousness, lasting 5-20 seconds.
• Patient may appear lost/confused; stop activity; stare and blink.

Partial or Focal Epilepsy

• In this type, consciousness may be retained while the abnormal discharge is localized in one region of the brain. Includes psychomotor seizures and Jacksonian seizure, among others.

Epileptic Dementia

• Gradual mental decline and deterioration in later life, often in patients with severe early-onset epilepsy, whose condition hasn't responded to treatment.

Mental Retardation

• Impairment in adaptive behavior due to low intelligence, learning disabilities, and slowed developmental process before the age of 18 years.
• Onset: Manifests during developmental period before 18 years. If similar clinical picture occurs after age 18, it is considered dementia.
• Genetic Factors: Abnormal genes responsible for physical or mental abnormalities that may be passed from parents.
• Environmental Factors:
• Prenatal life: Infections (rubella, congenital syphilis, mumps, meningitis) malnutrition, repeated exposure to radiation, chemical exposure (e.g., thalidomide, large doses of insulin or alcohol), threatened abortion.
• During birth: Improper forceps delivery, difficult/prolonged labor, hemorrhage into brain tissue, placental abnormalities
• Childhood/infancy: Malnutrition
• Diagnosis: Based on physical outlook, mental development, school/occupational performance. IQ testing (Mental Age/Chronological Age x 100).
• Levels: Mild, Moderate, Severe, Profound.

Substance (Drug and Alcohol) Abuse

• Definition: Excessive intake of mind-altering agents that interfere with biological, physiological, and socio-cultural integrity. It includes taking drugs/alcohol other than prescribed dosage.
• Examples of drugs: Marijuana, Cocaine, Herion, Mescaline, LSD, Amphetamines, Barbiturates, Morphine.
• Causes: Hereditary factors, familiar factors, Anxiety, peer group influence, psychological problems, chronic physical illness, specific job types, rebellion, curiosity.
• Characteristics of Substance Dependence: Compulsive/repeated use despite adverse effects, Chemical/physical dependence.
• Other Characteristics: Craving, tolerance (need for larger doses to get same effect), addiction (physically/psychologically dependent on drug), and withdrawal syndrome.
• Examples of Withdrawal Symptoms from Alcohol: Tremors of hands, nausea, vomiting, high blood pressure, tachycardia, sweating, headache, anxiety, insomnia, hallucinations, illusions, delusions, seizures, craving.
• Examples of Withdrawal Symptoms from other drugs: Depression, fatigue, insomnia, disorientation (from amphetamines); depression, irritability, insomnia, severe craving (from cocaine); anger, frustration, lack of concentration, decreased appetite, craving (from marijuana).
• Diagnosis: History from client, friends, or relatives; blood/urine screening; breathalyzer for alcohol detection.

Prevention of Drug and Alcohol Dependence

• Education campaigns targeting youth and general public.
• Legal measures like placing restrictions on drug sales, drug distribution, regulation of proper prescribing.

Alcoholic Psychoses

• Pathological Intoxication: Acute excitement marked by violence, disorientation, and loss of self-control
• Management of Intoxication: Induce vomiting, administer warm sweet drinks, encourage sleep.

Dipsomania

• Characterized by periodic bouts of excessive alcohol consumption lasting 2-3 weeks. Person usually neglects work, hygiene, can accept any alcohol. The person is sober between bouts. Psychotherapies are used for treatment.

Delirium Tremens (Alcohol Withdrawal Delirium)

• Psychiatric disorder characterized by signs and symptoms in chronic alcoholics within 72 hours of alcohol withdrawal (due to hospitalization, imprisonment, or other reasons).
• Causes: Sudden withdrawal following prolonged consumption; existing physical illness
• Symptoms: Tremors, nausea/vomiting, headache/insomnia, sweating, palpitation (increased heart rate), gastritis, furred tongue, high temperature, malaise, high blood pressure, seizures, confusion, disorientation, irritability, depression, anxiety, restlessness, illusions/hallucinations;

Korsakoff's Psychosis

• Psychiatric disorder in alcoholism due to thiamine deficiency (vitamin B1); can lead to Wernicke's Encephalopathy.
• Causes: Alcoholism, malabsorption syndrome, severe anorexia, upper gastrointestinal obstruction, prolonged intravenous feeding (with vitamin deficiencies), thyroid issues
• Symptoms: Poor memory of recent events (anterograde amnesia), difficulty identifying family members (mistaking identity), episodes of confusion and disorientation, emotional liability, illusions, lack of insight. Physical Symptoms: Malnutrition, damage to peripheral nerves (pain & tenderness in calfs, weak feet muscles), sensory loss, eye palsies (nystagmus).

Chronic Alcoholism

• Prolonged/habitual alcohol consumption leading to gradual mental and physical deterioration, including clinical manifestations like neglect of work, personal hygiene, memory issues, failure in judgment, irritability, childishness. Potential suicidal tendencies, cirrhosis of the liver, and tremors. 

Management of Chronic Alcoholism

• General: Hospitalization, prevent delirium tremens.
• Specific: Nutritional care, tranquilizers, observation for suicide tendencies, attention to physical & personal hygiene, aversion therapy (antabuse), psychotherapy, counseling, support groups (e.g., AA), occupation/rehabilitation therapy.

Test your knowledge on cognitive disorders, specifically focusing on senile dementia and delirium. This quiz covers characteristics, symptoms, causes, and definitions related to these conditions. Ideal for those studying psychology or healthcare-related fields.