Normal Cognition

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Questions and Answers

Cognition is the complex set of mental processes by which individuals acquire, store, retrieve, and use ______.

information

Cognition primarily involves activities that are controlled by the ______ hemispheres.

cerebral

A definition of normal cognition depends on social and cultural ______ and the environment in which the individual operates.

norms

The desired and most basic consequences of normal cognition are to obtain a level of ______ and adaptation.

survival Signup and view all the answers

Normal cognition enables individuals to function effectively as a ______ being.

social Signup and view all the answers

What is the primary function of normal cognition in terms of social interaction?

To function effectively as a social being Signup and view all the answers

Which of the following is NOT a direct consequence of normal cognition?

Emotional well-being Signup and view all the answers

What is the primary characteristic of normal cognition in terms of information processing?

Controlled processing of information Signup and view all the answers

How does normal cognition vary across different cultures and environments?

It is influenced by social and cultural norms Signup and view all the answers

What is the ultimate goal of normal cognition in terms of individual development?

To engage in meaningful and purposeful activity Signup and view all the answers

Perception refers to an interpretation of ______ or inputs that takes place in the brain.

stimuli Signup and view all the answers

External stimuli or inputs include touch, taste, vision, hearing, and ______.

smell Signup and view all the answers

Internal stimuli include proprioceptive sensations that contribute to ______ function and spatial awareness.

motor Signup and view all the answers

Orientation is a component of normal perception that includes four basic elements: person, place, time, and ______.

situation Signup and view all the answers

Orientation to person is the ability to correctly identify one’s own ______.

name Signup and view all the answers

What is the primary function of external stimuli in perception?

To process and interpret sensory information Signup and view all the answers

Which of the following is an example of internal stimuli?

Proprioceptive sensations Signup and view all the answers

What is the purpose of orientation to time in normal perception?

To correctly identify the time of day, the date, and the season Signup and view all the answers

Which of the following is NOT a component of normal perception?

Memory Signup and view all the answers

What is the primary role of proprioceptive sensations in perception?

To contribute to motor function and spatial awareness Signup and view all the answers

The reticular activating system (RAS), thalamus, and frontal cortex are the structures that are primarily involved in ______ and attention.

arousal Signup and view all the answers

The neurotransmitters dopamine and ______ both play a major role in regulating attention.

norepinephrine Signup and view all the answers

Individual ______ depends on the ability to attend and focus.

safety Signup and view all the answers

Attention refers to the brain’s ability to remain ______ and aware while selectively prioritizing concentration on a stimulus.

alert Signup and view all the answers

Variations in attention span are typical among healthy individuals and may be impacted by ______, genetics, biological rhythms, culture, and other environmental factors.

development Signup and view all the answers

What is the primary function of the structures involved in arousal and attention?

To selectively prioritize concentration on a stimulus Signup and view all the answers

What is the significance of a change in an individual's level of awareness and attention span?

It often signifies an underlying change or alteration in biophysical or psychosocial status Signup and view all the answers

What is the primary role of dopamine in regulating attention?

To enhance focus and concentration Signup and view all the answers

What is the primary factor that influences variations in attention span among healthy individuals?

Cultural and environmental factors Signup and view all the answers

What is the primary consequence of impaired attention in terms of individual safety?

Increased risk of accidents and injuries Signup and view all the answers

Memory refers to the process by which individuals retain, store, and retrieve information gained from previous ______.

experiences Signup and view all the answers

Sensory ______ refers to the earliest stage of memory, in which visual input and auditory information are retained for less than a few seconds.

memory Signup and view all the answers

Short-term ______ refers to the active processing and manipulation of information in conscious awareness.

memory Signup and view all the answers

Long-term ______ is used to describe the final sequence or destination of information that can be stored indefinitely.

memory Signup and view all the answers

Declarative memories are those that are explicit and can be consciously accessed; they are distinguished as semantic (storing ______ and verbal information) and episodic (composed of personal experiences).

facts Signup and view all the answers

What is the primary function of short-term memory?

To actively process and manipulate information in conscious awareness Signup and view all the answers

What is the primary characteristic of declarative memories?

Explicit and consciously accessed Signup and view all the answers

What is the primary limitation of short-term memory?

Finite capacity Signup and view all the answers

What is the primary role of working memory?

To manipulate information in short-term memory Signup and view all the answers

What is the primary difference between declarative and nondeclarative memories?

Declarative memories are explicit, while nondeclarative memories are implicit Signup and view all the answers

Memory plays a significant role in communication and ______.

speech Signup and view all the answers

Social cognition is the ability to process and apply ______ information accurately and effectively.

social Signup and view all the answers

Motor coordination refers to the planning, organizing, and execution of complex ______ tasks.

motor Signup and view all the answers

Cognitive function and motor coordination are carried out by shared ______ pathways in the brain.

neuronal Signup and view all the answers

Individuals with intact cognition exhibit normal variations in ______ function and coordination.

motor Signup and view all the answers

What is the primary function of social cognition?

To process and apply social information accurately and effectively Signup and view all the answers

Which brain regions are responsible for cognitive function and motor coordination?

Shared neuronal pathways Signup and view all the answers

What is the characteristic of motor function in individuals with intact cognition?

Normal variations Signup and view all the answers

What is the role of memory in communication and social cognition?

To play a significant role in speech Signup and view all the answers

What is the primary characteristic of individuals with impaired motor function?

They have impaired motor function and coordination Signup and view all the answers

Executive function is an umbrella term that is used to describe the mental skills involved in planning and executing complex ______.

tasks Signup and view all the answers

Intellectual function is a general term used to describe the mental capacity of an individual in relation to learning, reasoning, and ______.

problem solving Signup and view all the answers

Adaptive behavior refers to a set of practical skills people need to function in their everyday ______.

lives Signup and view all the answers

Cognition largely depends on brain and ______ system functioning.

nervous Signup and view all the answers

The three categories of adaptive behavior are conceptual skills, social skills, and ______ skills.

practical Signup and view all the answers

What is the primary purpose of executive function in cognitive processes?

To coordinate complex task execution and planning Signup and view all the answers

Which of the following is NOT a category of adaptive behavior?

Cognitive skills Signup and view all the answers

What is the primary role of the limbic system in cognition?

Regulation of emotions and motivation Signup and view all the answers

What is the primary function of the cerebral cortex in cognition?

Processing of sensory information Signup and view all the answers

What is the primary characteristic of intelligence quotient (IQ) scores?

They are relative measures of intelligence compared to a normative sample Signup and view all the answers

Research demonstrates that genetic makeup accounts for as much as 80% of the ______ in cognition found in the general population.

variations Signup and view all the answers

Different genes can be linked to particular components of ______ function, such as attention in working memory in healthy adults.

cognitive Signup and view all the answers

The pathophysiology of these conditions is generally related to conditions causing abnormalities in the ______ and function of the brain.

structure Signup and view all the answers

Perceptual disturbances may be a function of structural and physiologic ______ abnormalities in several areas of the cerebral cortex.

brain Signup and view all the answers

Illogical thinking may be the result of ______ lobe dysfunction and dopamine imbalance.

frontal Signup and view all the answers

What percentage of variations in cognition found in the general population can be attributed to genetic makeup?

80% Signup and view all the answers

What is the primary pathophysiological mechanism underlying alterations in cognitive function?

Abnormalities in the structure and function of the brain Signup and view all the answers

What is the primary cognitive component affected in individuals with frontal lobe dysfunction and dopamine imbalance?

Thinking Signup and view all the answers

Which of the following brain regions is responsible for perceptual processing?

Cerebral cortex Signup and view all the answers

What is the primary consequence of dysregulation of one or more of the key components of normal cognition?

Cognitive dysfunction Signup and view all the answers

Confusion is a general term used to describe increased difficulty in thinking clearly, making judgments, and focusing ______.

attention Signup and view all the answers

Disorientation is an element of confusion in which the individual is unable to correctly identify one or more of the following: person, place, ______, and situation.

time Signup and view all the answers

Delusions are rigid, false beliefs—for example, believing that members of a healthcare team are actually government ______ assigned to gather information that will be used to harm the patient or others.

spies Signup and view all the answers

Hallucinations are sensory experiences that do not represent reality, such as hearing, seeing, feeling, or smelling things that are not actually ______.

present Signup and view all the answers

Types of hallucinations include auditory, in which an individual hears voices or sounds that are not there; visual, in which an individual sees things that are not there or sees distortions of things that are ______.

there Signup and view all the answers

What is the primary difference between disorientation and delusions?

Disorientation is a cognitive impairment that affects an individual's sense of time, place, and person, while delusions are false beliefs. Signup and view all the answers

What is the primary characteristic of hallucinations?

They are sensory experiences that do not represent reality. Signup and view all the answers

What is the primary indicator of altered thought processes and content in an individual with psychosis?

Their speech and behaviors. Signup and view all the answers

What is the primary difference between delusions of persecution and delusions of reference?

Delusions of persecution are false beliefs about others' intentions, while delusions of reference are false beliefs about public events or people. Signup and view all the answers

What is the primary characteristic of an individual with confusion?

They have difficulty with thinking clearly, making judgments, and focusing attention due to cognitive impairments. Signup and view all the answers

Alterations in attention are characteristic of many of the cognitive disorders discussed in this module and may also occur as a distinct disorder classified as attention-deficit disorder (ADD) or attention-deficit/hyperactivity disorder (______).

ADHD Signup and view all the answers

Memory impairments may be temporary or chronic and may range from ______ to severe.

mild Signup and view all the answers

Issues in processing arise from the inability to control output—meaning that an individual may lack the ability to preview and inhibit an inappropriate or unsafe ______ or action.

response Signup and view all the answers

Amnesia is a general term that is used to refer to the loss of recent or remote ______.

memory Signup and view all the answers

Patients experiencing memory loss may unconsciously attempt to compensate for memory gaps by filling them in with fabricated events through a process known as ______.

confabulation Signup and view all the answers

Which of the following is a characteristic of individuals with attention difficulties?

Difficulty determining what information is salient Signup and view all the answers

What is a possible underlying cause of memory impairments?

All of the above Signup and view all the answers

What is confabulation?

A process of filling in memory gaps with fabricated events Signup and view all the answers

What is a characteristic of alterations in attention?

Difficulty sustaining effort required to complete tasks Signup and view all the answers

What is a possible consequence of impaired attention?

Increased risk of accidents and injuries Signup and view all the answers

Memory loss may manifest as problems related to ______ or long-term memory.

short-term Signup and view all the answers

Individuals with ______ memory loss may retain the ability to remember events that occurred 15 years ago.

short-term Signup and view all the answers

Deficits in semantic memory can be manifested as ______, the inability to recognize objects through the use of one or more senses.

agnosia Signup and view all the answers

[Blank] is the inability to use or understand language.

Aphasia Signup and view all the answers

Alogia refers to a lack of (sometimes called impoverished) ______.

speech Signup and view all the answers

What is the primary distinction between short-term and long-term memory loss?

Duration of memory retention Signup and view all the answers

Which of the following is NOT a type of aphasia?

Semantic aphasia Signup and view all the answers

What is the primary role of working memory in cognitive function?

Sequencing of numbers and following directions Signup and view all the answers

What is the primary consequence of impaired attention in terms of individual safety?

Increased risk of accidents Signup and view all the answers

What is the primary distinction between agnosia and anomia?

Recognition of objects versus recall of names Signup and view all the answers

Frontal-lobe and right-brain dysfunction impact spatial awareness to the extent that affected individuals have difficulty gauging physical aspects of social ______, such as how close to stand to someone else.

communication Signup and view all the answers

The pathways used for cognitive processing and motor ______ and function are shared.

coordination Signup and view all the answers

Dyspraxia is a general term used to describe difficulty with the acquisition of motor ______ and coordination through the process of growth and development.

learning Signup and view all the answers

Apraxia refers to alterations in ______ as a result of impaired motor function.

speech Signup and view all the answers

Ataxia is a term used to describe problems with ______ and coordination associated with neurologic dysfunction.

balance Signup and view all the answers

Which of the following is a result of impaired visual processing in social communication?

Demonstrating rude or annoying behaviors Signup and view all the answers

What is a term used to describe difficulty with the acquisition of motor learning and coordination through the process of growth and development?

Dyspraxia Signup and view all the answers

Which of the following is an example of a complex tic?

Cluster of movements that appear coordinated and more purposeful Signup and view all the answers

What is the primary consequence of impaired spatial awareness in social communication?

Difficulty gauging physical aspects of social communication Signup and view all the answers

Which of the following is a term used to describe problems with balance and coordination associated with neurologic dysfunction?

Ataxia Signup and view all the answers

Tremors are unintentional rhythmic movements manifested in shaking of the affected part of the ______.

body Signup and view all the answers

Essential ______ are those that are not associated with another condition and may be genetic in origin.

tremors Signup and view all the answers

Akathisia is an internal feeling of ______ that may lead to rocking, pacing, or other constant movement.

restlessness Signup and view all the answers

Executive function is significantly affected by structural and physiologic abnormalities impacting the ______ cortex.

frontal Signup and view all the answers

Avolition is decreased motivation, or the inability to initiate ______-directed activity, and may be in part related to deficits in executive dysfunction.

goal Signup and view all the answers

What is the primary characteristic of resting tremors?

Coarse, rhythmic tremor often observed in resting arms and hands Signup and view all the answers

Which of the following is an example of a dyskinesia?

Akathisia Signup and view all the answers

What is the primary manifestation of impaired executive function?

Emotional dysregulation Signup and view all the answers

What is the primary characteristic of bradykinesia?

Slow movement Signup and view all the answers

What is the primary characteristic of avolition?

Decreased motivation Signup and view all the answers

Alterations in intellectual function and learning may be either ______ or acquired.

developmental Signup and view all the answers

Learning disabilities are a group of disorders that impact an individual’s ability to ______ information.

process Signup and view all the answers

Intellectual disabilities are characterized by significant limitations in intellectual functioning and ______ behavior that begin prior to age 18.

adaptive Signup and view all the answers

An IQ score of 70 to 75 or below is considered indicative of limited ______ functioning.

intellectual Signup and view all the answers

Nurses are in a key position to assess for variations in development that may suggest an underlying ______ issue.

learning Signup and view all the answers

What is a characteristic of individuals with learning disabilities?

Average to above-average intelligence Signup and view all the answers

What is the primary role of nurses in assessing learning disabilities?

To assess for variations in development that may suggest an underlying learning issue Signup and view all the answers

What is a common challenge faced by individuals with learning disabilities?

Significant challenges with interpersonal relationships and adaptive function Signup and view all the answers

What is the criteria for intellectual disability?

IQ score of 70 to 75 or below Signup and view all the answers

What is a potential cause of learning disabilities?

Genetics and environmental factors Signup and view all the answers

The classification of cognitive disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders is referred to as ______.

DSM-5 Signup and view all the answers

Two common learning disabilities recognized by the DSM-5 are auditory processing disorder (APD) and ______.

language processing disorder Signup and view all the answers

Individuals with ______ may have difficulty processing and acting on verbal instructions and benefit from visual cues.

auditory processing disorder Signup and view all the answers

Nurses support patients with learning difficulties and their families in seeking appropriate ______ and accommodations.

services Signup and view all the answers

Nurses encourage activities that focus on ______ and build self-esteem in patients with learning difficulties.

strengths Signup and view all the answers

What is the primary focus of nursing care for individuals with cognitive disorders, regardless of medical diagnosis?

Supporting adaptive function and collaborating with healthcare professionals Signup and view all the answers

Which of the following learning disabilities involves difficulty processing sounds and recognizing their source?

Auditory processing disorder (APD) Signup and view all the answers

What is the benefit of using visual cues, pictorial schedules, and active demonstrations for individuals with auditory processing disorder (APD)?

Supporting learning and adapting to instructions Signup and view all the answers

What is the primary goal of nursing care for individuals with learning difficulties?

Supporting individuals and their families in seeking appropriate services and accommodations Signup and view all the answers

What is the primary role of nurses in supporting individuals with learning difficulties?

Collaborating with healthcare professionals to provide holistic care Signup and view all the answers

Down Syndrome is characterized by ______ hands with a single traverse palmar crease.

Broad Signup and view all the answers

Fragile X Syndrome is often accompanied by ______ ears located low on the head.

Small Signup and view all the answers

Fetal Alcohol Syndrome typically involves ______ eyes and a flattened nasal bridge.

Small Signup and view all the answers

Individuals with Down Syndrome often have a ______ likelihood of diabetes, leukemia, and heart defects.

Increased Signup and view all the answers

Fragile X Syndrome can also cause ______ risk of middle ear infections.

Increased Signup and view all the answers

What is a common physical characteristic of individuals with Down syndrome?

Broad hands with a single traverse palmar crease Signup and view all the answers

Which of the following conditions is caused by alcohol consumption during pregnancy?

Fetal alcohol spectrum disorders (FASD) Signup and view all the answers

What is a common cognitive feature of individuals with fragile X syndrome?

Increased likelihood of middle ear infections Signup and view all the answers

What is a common physical characteristic of individuals with fetal alcohol syndrome?

Small eyes Signup and view all the answers

What do Down syndrome, fragile X syndrome, and fetal alcohol spectrum disorders (FASD) have in common?

They are all present at birth and affect individuals for the rest of their lives Signup and view all the answers

Down syndrome occurs when an individual’s cells contain a third full or partial copy of the ______ chromosome

21st Signup and view all the answers

Fragile X syndrome arises from a single recessive abnormality on the ______ chromosome

X Signup and view all the answers

Individuals with Down syndrome are at increased risk of several problems not normally seen in childhood, including ______ defects

congenital heart Signup and view all the answers

Children with Down syndrome are also more likely to experience ______ loss

hearing Signup and view all the answers

Affected individuals with fragile X syndrome may also exhibit autistic behaviors; speech ______; anxiety and mood problems

problems Signup and view all the answers

What is the primary cause of intellectual disability and physical impairments in individuals with Down syndrome?

Presence of an extra full or partial copy of the 21st chromosome Signup and view all the answers

What is the typical life expectancy of individuals with Down syndrome?

50-60 years Signup and view all the answers

What is the primary characteristic of fragile X syndrome?

Mutation in the FMR-1 gene Signup and view all the answers

What is the primary health concern for individuals with Down syndrome?

All of the above Signup and view all the answers

What is the primary difference between Down syndrome and fragile X syndrome?

Mutation in the FMR-1 gene Signup and view all the answers

Fetal Alcohol Spectrum Disorders are completely preventable conditions caused by maternal ______ intake during pregnancy.

alcohol Signup and view all the answers

Alcohol crosses the placenta and the fetal ______ cannot process it, the fetus has the same blood alcohol content as its mother.

liver Signup and view all the answers

A diagnosis of FAS requires growth deficits, characteristic facial abnormalities, and ______ abnormalities.

CNS Signup and view all the answers

Early treatment can help lessen some symptoms and improve an affected individual’s ______ of life.

quality Signup and view all the answers

FASDs involve some degree of physical, intellectual, behavioral, and/or ______ disability.

learning Signup and view all the answers

What is the primary way to prevent Fetal Alcohol Spectrum Disorders (FASDs)?

Abstaining from consuming alcohol during pregnancy Signup and view all the answers

What is the characteristic of facial abnormalities in children with Fetal Alcohol Syndrome (FAS)?

A smooth philtrum and thin vermillion border Signup and view all the answers

What is the result of the nervous system abnormalities in FASDs?

A combination of intellectual, learning, and communication disabilities Signup and view all the answers

What is the effect of alcohol on the fetus during pregnancy?

The fetus has the same blood alcohol content as the mother Signup and view all the answers

What is the benefit of early treatment for individuals with FASDs?

Lessening of some symptoms and improvement in quality of life Signup and view all the answers

Prematurity and low birth weight forecast ______ more reliably than any other conditions.

disability Signup and view all the answers

Delirium is usually an acute change in mental state that is characterized by ______; inability to focus, shift, or sustain attention;

confusion Signup and view all the answers

Malnutrition, childhood diseases, exposure to environmental health hazards, and a lack of ______ stimulation early in life are also factors that have been linked to intellectual disability.

intellectual Signup and view all the answers

Comprehensive prenatal care, including testing for diseases and administering ______ acid to expectant mothers, also reduces the risk of intellectual disability.

folic Signup and view all the answers

In the United States and in other countries around the world, prevalence rates of intellectual ______ have dropped thanks to public health measures.

disability Signup and view all the answers

Which of the following is NOT a preventable cause of intellectual disability?

Genetic mutations Signup and view all the answers

What is the primary consequence of delirium in individuals?

Acute change in mental state Signup and view all the answers

Which of the following is a result of public health measures in the United States and other countries?

Decreased prevalence of intellectual disability Signup and view all the answers

What is the primary cause of delirium?

All of the above Signup and view all the answers

Which of the following is a common complication observed during stays in acute-care settings?

Delirium Signup and view all the answers

Dementia is a general term used to describe the loss of one or more cortical functions or cognitive attributes as a result of degeneration of the neurologic systems of the ______.

brain Signup and view all the answers

The DSM-5 uses the term mild and major ______ neurocognitive disorder (NCD) to replace the older term dementia.

neurocognitive Signup and view all the answers

Alzheimer disease is the most common form of ______, accounting for about 80% of all cases.

dementia Signup and view all the answers

Vascular dementia often results from multiple small strokes or ______ that block major blood vessels in the brain.

infarcts Signup and view all the answers

Low blood pressure (hypoperfusion) from other conditions, such as blood clots, ruptured blood vessels, or narrowing or hardening of blood vessels that supply the ______, can also lead to vascular dementia.

brain Signup and view all the answers

What is the primary distinction between individuals with mild and major neurocognitive disorders (NCDs)?

Level of independence Signup and view all the answers

Which of the following is a common characteristic of vascular dementia?

Symptoms vary widely depending on severity of blood vessel damage Signup and view all the answers

What is the term used to replace the older term 'dementia' in the DSM-5?

Mild and major neurocognitive disorder (NCD) Signup and view all the answers

What is the approximate percentage of all dementia cases accounted for by Alzheimer disease?

80% Signup and view all the answers

Which of the following can exacerbate or cause dementia?

Metabolic problems, nutritional deficiencies, infections, and poisoning Signup and view all the answers

Nurses and other healthcare professionals need to recognize that a variety of conditions can mimic ______, especially in older individuals.

dementia Signup and view all the answers

Psychotic disorders encompass a broad range of ______ alterations that result in altered perceptions of reality and abnormal thinking in the absence of an underlying condition.

cognitive Signup and view all the answers

Schizophrenia represents one type of ______ disorder identified in the DSM-5 and is discussed in detail as an exemplar for cognition.

psychotic Signup and view all the answers

Most developmental and acquired cognitive disorders have a nonmodifiable familial/______ component that predisposes individuals to the development of a specific disorder.

genetic Signup and view all the answers

Most cognitive disorders are believed to be multifactorial or the consequence of ______ factors and age, sex, lifestyle behaviors, environmental exposures, or other health conditions.

genetic Signup and view all the answers

What is the primary reason why depression and emotional problems may cause cognitive slowing and disorientation in older individuals?

Due to the overlap of symptoms with dementia Signup and view all the answers

What is the estimated percentage of the population that experiences some type of psychotic disorder?

Approximately 1-4% of the population Signup and view all the answers

What is the common risk factor among most developmental and acquired cognitive disorders?

Nonmodifiable familial/genetic component Signup and view all the answers

What is the primary reason why diagnostic tests should be run to rule out any underlying illness or causative agent in psychotic disorders?

Because psychosis can result from an underlying medical condition or ingestion of one or more substances Signup and view all the answers

What is the primary characteristic of cognitive disorders?

They are typically multifactorial or the consequence of genetic factors and age, sex, lifestyle behaviors, environmental exposures, or other health conditions Signup and view all the answers

Cerebral perfusion is necessary for normal ______ functioning

cognitive Signup and view all the answers

Chronic and subtle mechanisms involved in decreased ______ supply to the brain can negatively impact cognitive function

oxygen Signup and view all the answers

Inflammation can occur in the brain and CNS as a direct result of ______, cerebral infarction, or infection

trauma Signup and view all the answers

Substances such as ______, illicit drugs, and some pharmaceuticals can impact cognitive function

alcohol Signup and view all the answers

Cognitive function and other systems tend to be interdependent, so determining the extent to which other ______ or systems are involved can be difficult

concepts Signup and view all the answers

Which of the following can result in chronic and subtle mechanisms involved in decreased oxygen supply to the brain?

Chronic obstructive pulmonary disease (COPD) Signup and view all the answers

Which of the following is a primary consequence of chronic or persistent inflammation?

Irreversible neuronal changes Signup and view all the answers

Which of the following can impact cognitive function?

All of the above Signup and view all the answers

Which of the following is a consequence of acute alterations in cognitive function due to subtle variations in perfusion?

Delirium Signup and view all the answers

Which of the following is a primary factor that influences cognitive function?

Cerebral perfusion Signup and view all the answers

Prevention of cognitive disorders includes measures to reduce modifiable risk factors and enhance ______ factors.

protective Signup and view all the answers

Universal prevention of cognitive disorders targets the ______ population and includes interventions such as public health campaigns.

general Signup and view all the answers

Indicated prevention is aimed at individuals who have minimal but detectable manifestations of ______ disorder.

cognitive Signup and view all the answers

A general assessment of ______ status is an essential component of the nursing assessment of all patients.

cognitive Signup and view all the answers

The priority assessment focuses on addressing potentially life-threatening factors that may be contributing to the problem through physical assessment, history, and diagnostic ______ procedures.

laboratory Signup and view all the answers

What is the primary goal of universal prevention of cognitive disorders?

To reduce modifiable risk factors and enhance protective factors in the general population. Signup and view all the answers

Which type of prevention is aimed at individuals who have minimal but detectable manifestations of cognitive disorder?

Indicated prevention Signup and view all the answers

What is the primary focus of the priority assessment when a patient presents with the onset of cognitive changes?

Addressing potentially life-threatening factors that may be contributing to the problem. Signup and view all the answers

In which settings can screening and detection of cognitive disorders occur?

In a variety of settings, including primary care, community health, and schools. Signup and view all the answers

What is an essential component of the nursing assessment of all patients?

A general assessment of cognitive status. Signup and view all the answers

Any changes in cognition require immediate ______ to ensure the safety of patients.

attention Signup and view all the answers

Cognitive assessment is performed during an initial ______ or home care visit.

provider Signup and view all the answers

The Comprehensive Geriatric Assessment (CGA) is a multidimensional, multidisciplinary assessment of the medical, mental, and functional ______ of older people with frailty.

problems Signup and view all the answers

The nurse may also make general observations related to social skills, motor function, activity level, ability to attend and focus on the ______, and ability to provide logical and coherent responses to questions.

assessment Signup and view all the answers

When assessing pediatric patients or patients with moderate to severe cognitive impairment, a family member or ______ may be asked to provide information.

caregiver Signup and view all the answers

What is the primary reason for prompt assessment of a patient's cognitive impairment?

To identify the underlying cause of the impairment Signup and view all the answers

Which of the following individuals is at increased risk for cognitive problems and warrants more frequent assessment of cognitive status?

Older adults who are hospitalized Signup and view all the answers

What is the primary source of information when assessing cognitive function in patients?

The patient themselves Signup and view all the answers

What is the purpose of observing a patient's appearance and dress during an initial assessment?

To assess their ability to maintain self-care Signup and view all the answers

Why is it critical to initiate safety measures quickly in response to changes in cognition?

To reduce the risk of injury to the patient Signup and view all the answers

The medical history includes gathering information about both the presenting problem and the presence or development of altered health patterns across the ______.

lifespan Signup and view all the answers

Initial questions may proceed from broad questions about a typical day, including ______, self-care activities, and perceived level of health and wellness.

ADLs Signup and view all the answers

When patients or family members report changes in cognitive function, ask nonthreatening questions such as: Can you describe the ______?

changes Signup and view all the answers

Be sure to obtain a list of all current ______ with the dose, route, and frequency and to inquire about the use of any complementary health approaches.

medications Signup and view all the answers

Depending on the patient's responses, seek additional detail about the impact on daily ______, frequency and duration of symptoms, suspected causes or contributing factors.

functioning Signup and view all the answers

When gathering information about the patient's current problem, what is the primary focus of the initial questions?

The patient's perception of the problem and its impact on daily functioning Signup and view all the answers

What is the purpose of asking questions about the patient's ability to pay attention and remember things?

To assess the patient's cognitive function Signup and view all the answers

What is the purpose of inquiring about the patient's use of complementary health approaches?

To identify potential interactions with prescribed medications Signup and view all the answers

What is the purpose of obtaining a list of the patient's current medications?

To identify potential interactions with other medications Signup and view all the answers

What is the purpose of asking questions about the frequency and duration of symptoms?

To understand the impact of the symptoms on daily functioning Signup and view all the answers

A thorough history of patient development, illness and injury, and health behaviors (including substance use) is necessary when working with patients with alterations in ______.

cognition Signup and view all the answers

When assessing ______ in children, consider parenting techniques and capabilities, as well as access to activities and stimulation that promote cognitive development.

cognition Signup and view all the answers

The mental status exam includes a series of procedures and tools used to detect alterations in ______ and thinking.

perception Signup and view all the answers

Determine the possibility of any current or past exposures to toxic substances at ______ or at work.

home Signup and view all the answers

The physical examination incorporates an organized pattern of assessment to identify alterations that may be contributing to ______ dysfunction.

cognitive Signup and view all the answers

When assessing cognition in children, which of the following factors should be considered?

Parenting techniques and capabilities, as well as access to activities and stimulation that promote cognitive development Signup and view all the answers

What is the purpose of the mental status examination in the assessment of cognitive alterations?

To identify alterations in perception and thinking Signup and view all the answers

Why is it important to ask about family members with disorders such as dementia, schizophrenia, and developmental or learning problems?

To determine the patient's risk of developing these disorders Signup and view all the answers

What should the nurse consider when assessing environmental factors that may be contributing to the patient's cognitive status?

All of the above, as well as the patient's access to education and social support Signup and view all the answers

What is the primary purpose of the physical examination in the assessment of cognitive alterations?

To detect physical alterations that may be contributing to cognitive dysfunction Signup and view all the answers

Changes in cognitive function are often an early sign of decreased oxygenation or perfusion or an alteration in another biophysical ______.

process Signup and view all the answers

Auscultation of the heart and lungs may reveal an underlying problem with gas ______ or perfusion.

exchange Signup and view all the answers

An assessment of peripheral perfusion may indicate vascular problems that are compromising cerebral ______.

perfusion Signup and view all the answers

Observable physical alterations may be associated with many cognitive syndromes, including intellectual disabilities and ______.

schizophrenia Signup and view all the answers

An important component of the physical examination includes an assessment of ______ function.

motor Signup and view all the answers

What is the primary purpose of assessing peripheral perfusion during a physical examination?

To evaluate cerebral perfusion Signup and view all the answers

Which of the following physical alterations may be associated with cognitive syndromes, including intellectual disabilities and schizophrenia?

Small head circumference and wide-set eyes Signup and view all the answers

What is the primary component of the physical examination that helps rule out perceptual problems related to impaired sensory function?

Evaluation of hearing, vision, touch, taste, and smell Signup and view all the answers

What is the significance of changes in gait or other evidence of movement disorders during a physical examination?

It may be a sign of impaired motor function Signup and view all the answers

What is the primary purpose of genetic testing and serum and urine tests in a physical examination?

To investigate suspicions of genetic and metabolic/biochemical disorders Signup and view all the answers

Laboratory tests may include toxicology screens to rule out ______ or substances as a causative factor for changes in mental status

alcohol Signup and view all the answers

Liver function tests, complete blood count, and thyroid function are used to rule out ______ conditions that may contribute to alterations in mental status

metabolic Signup and view all the answers

Diagnostic imaging may detect conditions requiring emergency management, such as ______ edema

cerebral Signup and view all the answers

Genetic testing can identify ______ factors or underlying causes of a variety of cognitive disorders

risk Signup and view all the answers

MRIs and CT scans can detect abnormalities suggestive of certain ______ disorders

neurocognitive Signup and view all the answers

Which of the following laboratory tests is used to identify biomarkers for schizophrenia?

Blood tests Signup and view all the answers

What is the primary purpose of conducting a complete blood count (CBC) in a patient with altered mental status?

To rule out metabolic, inflammatory, and infectious conditions Signup and view all the answers

What is the purpose of conducting a fluorescent treponemal antibody absorption (FTA-abs) test in a patient with altered mental status?

To detect syphilis Signup and view all the answers

Which of the following laboratory tests is used to detect abnormalities suggestive of certain neurocognitive, neurodevelopmental, and psychotic disorders?

MRIs and CTs Signup and view all the answers

What is the primary purpose of conducting genetic testing in a patient with altered mental status?

To identify risk factors or underlying causes of cognitive disorders Signup and view all the answers

According to Jean Piaget, cognitive development is an ______ and sequential process.

orderly Signup and view all the answers

Psychometric tests include a variety of standardized tests that are usually administered by a ______ or neuropsychologist.

psychologist Signup and view all the answers

Nurses in community health and primary care settings play a critical role in addressing health-related behaviors and suggesting ______ measures that can reduce the risk of developing cognitive disorders.

protective Signup and view all the answers

Nursing interventions include teaching prevention, coordinating care and making appropriate ______, and advocating for the needs of individuals impacted by alterations in cognition.

referrals Signup and view all the answers

Independent Interventions include teaching prevention, coordinating care and making appropriate referrals, implementing measures to promote individual/family ______ and well-being, and advocating for the needs of individuals impacted by alterations in cognition.

safety Signup and view all the answers

What is the primary role of nurses in community health and primary care settings with respect to cognitive disorders?

Addressing health-related behaviors and suggesting protective measures to reduce the risk of developing cognitive disorders Signup and view all the answers

According to Jean Piaget, what is the primary way children learn and adapt to their environment?

By physically interacting with their environment and revising their schemes Signup and view all the answers

What is the primary purpose of rating scales in comprehensive neuropsychological testing?

To contribute to an overall understanding of the presentation of a problem across various domains Signup and view all the answers

What is a key component of cognitive development, according to Jean Piaget?

The active revision of cognitive schemes in response to environmental stimuli Signup and view all the answers

What is the primary role of independent interventions in health promotion, according to the content?

To promote individual and family safety, and advocate for the needs of individuals impacted by alterations in cognition Signup and view all the answers

Nurses in all settings often plan care for individuals that promotes ______ and adaptive functioning.

safety Signup and view all the answers

The home health nurse may work with individuals with schizophrenia or Alzheimer disease, monitoring ______ to treatment, providing emotional support to the patient and family.

adherence Signup and view all the answers

When patients do require hospitalization for acute changes in cognition, the priority is to identify and manage underlying ______ that may be contributing to the problem.

conditions Signup and view all the answers

Evaluating risk of ______ or suicide is an example of interventions across settings.

injury Signup and view all the answers

Nurses have a role in ensuring that patients are not ______ or exploited and are able to partner in healthcare decisions to the greatest degree possible.

abused Signup and view all the answers

What is the primary goal of the nurse's interventions in patients with cognitive disorders?

To identify and address immediate safety concerns Signup and view all the answers

What is the role of the nurse in promoting the patient's autonomy in healthcare decisions?

To encourage patients to establish advance directives Signup and view all the answers

What is the primary benefit of the nurse's emotional support to patients with cognitive disorders?

It reduces anxiety and stress Signup and view all the answers

What is the primary goal of the nurse's assessment of patient and family strengths?

To support the patient's adaptive coping skills Signup and view all the answers

What is the primary benefit of the nurse's advocacy for patients with cognitive disorders?

It protects patients from abuse and exploitation Signup and view all the answers

The Americans with Disabilities Act of 1990 ensures that individuals with ______ have equal access to government services, employment, and public accommodations.

disabilities Signup and view all the answers

The Education for All Handicapped Children Act of 1975 requires that children with any type of ______ have access to free public education.

disability Signup and view all the answers

The Developmental Disabilities and Bill of Rights Act of 2000 provides federal funding to state, public, and nonprofit agencies that provide community-based ______ activities and education to individuals with developmental disabilities.

training Signup and view all the answers

When working with individuals at risk for or experiencing alterations in cognitive function, nurses should anticipate collaborating with the patient, family, other members of the healthcare team, and potentially professionals from other disciplines, such as ______ and law.

education Signup and view all the answers

Additional resources may be available through local chapters of organizations such as the Alzheimer’s Association, the American Psychiatric Association, the American Association of Intellectual and Developmental Disabilities, and the National Alliance on ______ Illness.

Mental Signup and view all the answers

Which of the following laws ensures that individuals with disabilities have equal access to government services, employment, and public accommodations?

The Americans with Disabilities Act of 1990 Signup and view all the answers

Which of the following professionals may be involved in the assessment, diagnosis, and treatment planning of individuals with cognitive impairments or intellectual disabilities?

Neuropsychologists Signup and view all the answers

What is the primary purpose of the U.S. Administration on Developmental Disabilities?

To oversee federal funding for state, public, and nonprofit agencies that provide community-based training activities and education Signup and view all the answers

Which of the following organizations may provide additional resources for individuals with cognitive impairments or intellectual disabilities?

The Alzheimer's Association Signup and view all the answers

What is the primary goal of collaborative therapies when working with individuals at risk for or experiencing alterations in cognitive function?

To anticipate collaborating with the patient, family, and other healthcare professionals Signup and view all the answers

Nurses are responsible for educating family and caregivers about administering medications and their ______ effects.

side Signup and view all the answers

Cognitive function is mediated by the interaction of ______ and experience, both of which provide the foundation for cognitive changes that occur across the lifespan.

genes Signup and view all the answers

Long-acting ______ formulations (e.g., extended-release tablets, transdermal drug patches) may enhance adherence.

drug Signup and view all the answers

Nurses must assess patients with cognitive alterations to determine their ability to ______-administer medication.

self Signup and view all the answers

Drugs for treating neurocognitive disorders are primarily aimed at slowing further ______ changes and deterioration in functioning.

brain Signup and view all the answers

What is the primary goal of medication therapy in treating neurocognitive disorders?

To slow further brain changes and deterioration in functioning Signup and view all the answers

What is a critical aspect of medication administration that nurses must assess in patients with cognitive alterations?

The patient's ability to self-administer medication Signup and view all the answers

What is abenefit of using long-acting drug formulations in treating cognitive disorders?

They increase medication adherence Signup and view all the answers

What is a key aspect of lifespan considerations in cognitive function?

Cognitive function is mediated by the interaction of genes and experience Signup and view all the answers

What is a critical role of nurses in medication administration for patients with cognitive disorders?

To educate family and caregivers about medications and their side effects Signup and view all the answers

Lev Vygotsky, a Russian psychologist, emphasized the importance of social interaction in the development of ______.

cognition Signup and view all the answers

Simple neuronal connections that shape ______ first occur shortly after the period of conception.

cognition Signup and view all the answers

Rapid development of neuronal connections occurs during the first few years of life and corresponds with the process through which children assimilate new information, revise cognitive constructs through a process called ______, and form new thinking structures or schemes to facilitate adaptation.

accommodation Signup and view all the answers

One aspect of normal development is called ______, a process by which unused connections are remodeled or eliminated in order to strengthen cognitive efficiency.

pruning Signup and view all the answers

During infancy and early childhood, for example, brains are primed for stimulation of visual pathways and ______.

language Signup and view all the answers

According to Vygotsky, social interactions influence the formation of:

Memories and cognitive constructs Signup and view all the answers

During brain development, what process eliminates unused connections to strengthen cognitive efficiency?

Pruning Signup and view all the answers

What influences the development of cognition from conception to adolescence?

Both environmental and genetic factors Signup and view all the answers

What is critical for the development of complex schemes and movement from one stage of development to the next?

Social interaction Signup and view all the answers

What is the primary consequence of insults during embryonic development?

Devastating impact on cognition Signup and view all the answers

Changes in activity in the ______ system are believed to account for increased sensation seeking and need for arousal.

limbic Signup and view all the answers

Deficits in decision making can place adolescents at increased risk for ______.

injuries Signup and view all the answers

Adolescents experiencing cognitive dysfunction are at increased risk for a number of problems, including ______, suicide, substance abuse, and antisocial behavior.

depression Signup and view all the answers

The social implications of cognitive disorders can have a devastating impact on ______ and peer relationships.

self-esteem Signup and view all the answers

Teaching focuses on providing developmentally and cognitively appropriate information on issues such as ______, sexuality, adaptive coping, and management of the cognitive condition.

safety Signup and view all the answers

What is the primary factor that contributes to deficits in decision making among adolescents?

Underdeveloped prefrontal cortex Signup and view all the answers

What is the consequence of new-onset cognitive dysfunction in adolescence?

Increased risk for depression and substance abuse Signup and view all the answers

What is the primary goal of teaching adolescents with cognitive alterations?

Providing information on safety and sexuality Signup and view all the answers

What is the impact of cognitive disorders on adolescents' social implications?

Devastating impact on self-esteem and peer relationships Signup and view all the answers

What is the primary role of dopamine in adolescent behavior?

Shifting orientation toward reward-seeking behavior Signup and view all the answers

Brain maturation, especially areas responsible for ______ function, are not fully mature until the mid- to late 20s.

executive Signup and view all the answers

Middle-aged adults demonstrate an enhanced ability to read other people’s ______ states.

emotional Signup and view all the answers

Vocabulary and other elements of accumulated facts and knowledge have been found to peak even later in ______.

life Signup and view all the answers

Research is mixed related to the impact of ______ and childbirth on maternal cognition.

pregnancy Signup and view all the answers

Older adults typically have more difficulty with ______ functions, such as word retrieval and episodic memory.

cognitive Signup and view all the answers

What is the age range when brain maturation, especially areas responsible for executive function, is not fully complete?

Mid-20s to early 30s Signup and view all the answers

Which cognitive function is enhanced in middle-aged adults?

Reading other people's emotional states Signup and view all the answers

What is the likely cause of reduced cognitive function in mothers after childbirth?

All of the above Signup and view all the answers

What is the result of modest shrinkage of brain tissue and decreased blood flow in older adults?

Subtle differences in cognitive processing Signup and view all the answers

Which cognitive function is typically more difficult for older adults?

Word retrieval and episodic memory Signup and view all the answers

Incoherence/word salad/neologisms refer to speaking in meaningless phrases with words that are seemingly ______ chosen

randomly Signup and view all the answers

Loose associations refer to a pattern of speech in which a person's ideas slip off track onto another unrelated or obliquely related ______

topic Signup and view all the answers

Tangentiality occurs when a person digresses from the ______ at hand and goes off on a tangent, starting an entirely new train of thought

topic Signup and view all the answers

Disorientation is characterized by difficulty with ______ attention

sustaining Signup and view all the answers

Hallucinations are a type of ______ disturbance

perceptual Signup and view all the answers

Illogicality refers to speech in which there is an absence of ______ and rationality

reason Signup and view all the answers

Memory problems can be addressed through ______ remediation

cognitive Signup and view all the answers

The Confusion Assessment Method (CAM) is a ______ interview-style exam that screens specifically for signs of delirium.

five-minute Signup and view all the answers

The Cornell Assessment of Pediatric Delirium is a validated, rapid ______ tool for screening children in intensive care for delirium.

observational Signup and view all the answers

The Geriatric Depression Scale (GDS) is a brief ______ that asks patients how they've felt over the past 7 days; it assesses for depression in older adults.

questionnaire Signup and view all the answers

The Mini-Mental State Examination (MMSE) is a ______ interview-style exam that assesses a patient's memory, language skills, attention level, and ability to engage in mental tasks.

thirty-question Signup and view all the answers

The Montreal Cognitive Assessment is a ______ test that briefly assesses a patient's ability in a variety of cognitive domains.

one-page Signup and view all the answers

The Hamilton Rating Scale for Depression (HRSD) is a ______ examination that assesses the severity of depression in adult patients.

twenty-minute Signup and view all the answers

The Weinberg Depression Scale for Children and Adolescents (WDSCA) is modeled on the HRSD and adapted for children over age ______.

5 Signup and view all the answers

The Edinburgh Depression Scale is a validated ______ item questionnaire used to screen for the presence and severity of symptoms of postnatal depression.

10 Signup and view all the answers

The Nonverbal Learning Disabilities (NVLD) Scale assesses deficits in the areas of ______ skills, visuospatial skills, and interpersonal skills.

motor Signup and view all the answers

Which alteration is characterized by difficulty in interpreting environmental stimuli, thinking clearly and logically, and maintaining orientation to person, place, time, and situation?

Perceptual disturbances/psychosis Signup and view all the answers

What is the primary goal of therapy for individuals with alterations in perception and attention?

To identify and treat underlying causes Signup and view all the answers

What is a characteristic of impaired attention?

Difficulty directing focus or avoiding distractions Signup and view all the answers

Which of the following is NOT a component of normal perception?

Emotion Signup and view all the answers

What is the primary function of reality orientation and validation therapy?

To promote reality orientation and validation Signup and view all the answers

What is the primary consequence of impairment in ability to recall information?

Difficulty with word finding and recognition Signup and view all the answers

Which of the following is not a characteristic of normal cognition?

Ability to process information in a sequential manner Signup and view all the answers

What is the primary function of internal stimuli in perception?

To contribute to spatial awareness and proprioceptive function Signup and view all the answers

What is the primary role of dopamine in regulating attention?

To regulate the brain's ability to remain focused and aware Signup and view all the answers

What is the primary limitation of short-term memory?

Limited duration for retaining information Signup and view all the answers

Memory problems can lead to ______ in ability to recall information.

impairment Signup and view all the answers

Individuals with memory problems may have difficulty with ______ finding and recognition.

word Signup and view all the answers

Cognitive remediation involves providing ______ strategies and memory aids.

compensatory Signup and view all the answers

Memory problems can result in difficulty remembering ______ events.

recent Signup and view all the answers

Memory problems can also lead to difficulty remembering ______ events.

remote Signup and view all the answers

Perceptual disturbances/psychosis can be characterized by alterations in ability to interpret _______ stimuli.

environmental Signup and view all the answers

Impaired attention is characterized by difficulty sustaining or directing _______ to focus.

one's Signup and view all the answers

Perceptual disturbances can result in _______ and disorientation.

disorientation Signup and view all the answers

Treatment for perceptual disturbances/psychosis includes identifying and treating the underlying _______ and reducing environmental stimulation.

cause Signup and view all the answers

Impaired attention can result in easily being _______ and avoiding situations that require sustained focus.

distracted Signup and view all the answers

Which of the following speech patterns is characterized by a rapid flow of words with an extreme sense of urgency, making it nearly impossible to interrupt the person?

Pressured/distractible speech Signup and view all the answers

What is the term for speaking in meaningless phrases with words that are seemingly randomly chosen, often made up, and not connected?

Incoherence/word salad/neologisms Signup and view all the answers

Which of the following speech patterns is characterized by digressing from the topic at hand and going off on a tangent, starting an entirely new train of thought?

Tangentiality Signup and view all the answers

What is the term for speech that is characterized by an absence of reason and rationality?

Illogicality Signup and view all the answers

Which of the following speech patterns is characterized by speaking little or responding briefly, with an absence of spontaneous speech?

Poverty of speech Signup and view all the answers

Pattern of speech in which a person's ideas slip off track onto another unrelated or obliquely related topic is also known as _______________.

derailment Signup and view all the answers

Speaking in meaningless phrases with words that are seemingly randomly chosen, often made up, and not connected is referred to as _______________.

incoherence Signup and view all the answers

A person who goes into excessive detail about an event and has difficulty getting to the point of the conversation is exhibiting _______________.

circumstantiality Signup and view all the answers

The opposite of pressured speech is characterized by the absence of spontaneous speech in an ordinary conversation and is referred to as _______________.

poverty of speech Signup and view all the answers

Speech in which there is an absence of reason and rationality is referred to as _______________.

illogicality Signup and view all the answers

What characteristic distinguishes delirium from dementia?

Acute onset Signup and view all the answers

Which of the following is a common characteristic of depression?

Anxiety Signup and view all the answers

What is the primary difference between delusions and hallucinations in delirium?

Delusions are false beliefs, while hallucinations are distorted perceptions Signup and view all the answers

Which of the following is NOT a characteristic of dementia?

Acute onset Signup and view all the answers

What is the primary difference between the outcome of delirium and dementia?

Delirium has a good outcome, while dementia has a poor outcome Signup and view all the answers

In delirium, le ______ es rapid e sudden.

onset Signup and view all the answers

In dementia, le ______ es slow e progressive.

onset Signup and view all the answers

Delirium es characterisate per ______ mood swings.

rapid Signup and view all the answers

In depression, le ______ es episolodic.

duration Signup and view all the answers

In dementia, le ______ es affectate in le stato final de la maladia.

outcome Signup and view all the answers

What is the primary etiology of dementia due to HIV?

Infection with HIV-1 Signup and view all the answers

What is the name of the dementing illness caused by HIV-1?

HIV-1-associated cognitive/motor complex Signup and view all the answers

What is a characteristic of symptoms in the early stages of HIV-1-associated cognitive/motor complex?

Variability Signup and view all the answers

What is the primary impact of HIV-1 on cognitive function?

Impaired cognitive processing Signup and view all the answers

What is a common feature of dementia due to HIV?

Variable symptoms Signup and view all the answers

What is the primary consequence of HIV-1-associated cognitive/motor complex?

Impaired cognitive function Signup and view all the answers

What is the relationship between cognitive function and motor coordination in individuals with HIV-1-associated cognitive/motor complex?

Interdependent Signup and view all the answers

Which type of dementia is characterized by cognitive and motor slowing, impaired memory, and impaired executive functioning?

Dementia due to Parkinson disease Signup and view all the answers

What is the typical age range for the onset of Huntington disease?

Late 30s to early 40s Signup and view all the answers

Which type of dementia is distinguished by the presence of Lewy bodies in the cortex and brainstem?

Lewy body dementia Signup and view all the answers

What is the most common neurobehavioral symptom following head trauma?

Amnesia Signup and view all the answers

In which percentage of people with Parkinson disease is dementia reported?

20-60% Signup and view all the answers

What is the duration of Huntington disease typically?

10-20 years Signup and view all the answers

What is the primary characteristic of Lewy body dementia in comparison to Alzheimer disease?

Earlier appearance of visual hallucinations Signup and view all the answers

What is the typical course of dementia due to Parkinson disease?

Slow and progressive Signup and view all the answers

Infection with HIV-1 produces a dementing illness called HIV-1-associated ______ complex.

cognitive/motor Signup and view all the answers

Symptoms of HIV-1-associated cognitive/motor complex vary in early ______.

stages Signup and view all the answers

Dementia due to HIV is a type of ______ illness.

dementing Signup and view all the answers

HIV-1-associated cognitive/motor complex is characterized by a range of ______ in early stages.

symptoms Signup and view all the answers

HIV-1-associated cognitive/motor complex affects an individual's ______ abilities.

cognitive Signup and view all the answers

Dementia due to HIV is caused by ______ with HIV-1.

infection Signup and view all the answers

Severe cognitive changes, particularly confusion, changes in behavior, and sometimes ______, are not uncommon in the later stages.

psychosis Signup and view all the answers

Any type of head trauma can lead to dementia due to ______ brain injury.

traumatic Signup and view all the answers

Dementia due to ______ disease is characterized by cognitive and motor slowing, impaired memory, and impaired executive functioning.

Parkinson Signup and view all the answers

Lewy body dementia is distinguished by the presence of ______ bodies---eosinophilic inclusion bodies---seen in the cortex and brainstem.

Lewy Signup and view all the answers

Clinically, Lewy body disease is similar to ______ disease; however, there is an earlier appearance of visual hallucinations and parkinsonian features.

Alzheimer Signup and view all the answers

The severity of symptoms is associated with the extent of the ______ pathology.

brain Signup and view all the answers

Amnesia is the most common ______ symptom following head trauma.

neurobehavioral Signup and view all the answers

What is the primary cause of dementia due to HIV?

Infection with HIV-1 Signup and view all the answers

What is the term for the dementing illness caused by HIV-1?

HIV-1-associated cognitive/motor complex Signup and view all the answers

What is the primary characteristic of dementia due to HIV in the early stages?

Varying symptoms Signup and view all the answers

What is the primary effect of HIV-1 on cognitive function?

Impaired attention and awareness Signup and view all the answers

What is the most common neurobehavioral symptom following head trauma?

Amnesia Signup and view all the answers

Approximately what percentage of people with Parkinson disease develop dementia?

20-60% Signup and view all the answers

What is the primary consequence of dementia due to HIV on daily life?

Impaired ability to perform daily tasks Signup and view all the answers

What is the primary difference between dementia due to HIV and other types of dementia?

Cause of the condition Signup and view all the answers

What is the primary characteristic of Lewy body dementia?

Presence of Lewy bodies in the cortex and brainstem Signup and view all the answers

What is the primary challenge in diagnosing dementia due to HIV?

Variability of symptoms in the early stages Signup and view all the answers

What is the typical age of onset for Huntington disease?

Late 30s to early 40s Signup and view all the answers

What is the primary cognitive symptom of dementia due to traumatic brain injury?

Amnesia Signup and view all the answers

What is the primary motor symptom of Parkinson disease?

All of the above Signup and view all the answers

What is the duration of Huntington disease?

10-20 years Signup and view all the answers

What is one difference between Lewy body dementia and Alzheimer disease?

Progresses more rapidly than Alzheimer disease Signup and view all the answers

What is the most common neurobehavioral symptom following head trauma?

Amnesia Signup and view all the answers

In Huntington disease, what type of deficits are commonly seen?

Both recent and remote memory Signup and view all the answers

What is the primary difference between Lewy body dementia and Alzheimer disease?

Earlier onset of visual hallucinations and parkinsonian features Signup and view all the answers

What percentage of people with Parkinson disease are reported to have dementia?

20-60% Signup and view all the answers

What is the typical age range for the onset of Huntington disease?

Late 30s to early 40s Signup and view all the answers

The Weinberg Depression Scale for Children and Adolescents (WDSCA) and the Children's Depression Rating Scale (CDRS-R) are modeled on the HRSD and adapted for children over age ______.

5 Signup and view all the answers

Mini-Mental State Examination (MMSE) is a ______-question interview-style exam that assesses a patient's memory, language skills, attention level, and ability to engage in mental tasks.

Thirty Signup and view all the answers

The Montreal Cognitive Assessment is a one-page test that briefly assesses a patient's ability in a variety of cognitive domains, including problem solving and sequencing, attention, memory, visuospatial construction and ______, and language.

reasoning Signup and view all the answers

The Nonverbal Learning Disabilities (NVLD) Scale assesses deficits in the areas of ______ skills, visuospatial skills, and interpersonal skills.

motor Signup and view all the answers

The Patient Health Questionnaire (PHQ) is a full-length ______-item tool that screens for depression and anxiety, somatic symptoms, and related disorders.

11 Signup and view all the answers

Ages & Stages Questionnaires (ASQ) are a set of questionnaires tailored to detect alterations in ______ in young children.

development Signup and view all the answers

The Cornell Assessment of Pediatric Delirium is a validated, rapid observational tool for screening children in ______ care for delirium.

intensive Signup and view all the answers

The Edinburgh Depression Scale is a validated 10-item questionnaire used to screen for the presence and severity of symptoms of ______ depression.

postnatal Signup and view all the answers

The Geriatric Depression Scale (GDS) is a brief questionnaire that asks patients how they've felt over the past ______ days.

7 Signup and view all the answers

The Hamilton Rating Scale for Depression (HRSD) is a ______-minute, 17-question examination that assesses severity of depression in adult patients.

20 Signup and view all the answers

Which cognitive assessment tool is specifically designed for children over the age of 5 and is modeled on the HRSD?

Weinberg Depression Scale for Children and Adolescents (WDSCA) Signup and view all the answers

What cognitive assessment tool is used to detect positive, negative, and other manifestations of psychotic disorders and schizophrenia?

Positive and Negative Symptoms Scale (PANSS) Signup and view all the answers

Which cognitive assessment tool is a full-length 11-item tool that screens for depression and anxiety, somatic symptoms, and related disorders?

Patient Health Questionnaire (PHQ) Signup and view all the answers

What is the primary function of the Postpartum Depression Predictors Inventory (PDPI)?

To predict the risk of maternal depression Signup and view all the answers

Which cognitive assessment tool is a one-page test that briefly assesses a patient's ability in a variety of cognitive domains, including problem solving and sequencing?

Montreal Cognitive Assessment Signup and view all the answers

Which of the following questionnaires is specifically designed to detect signs of delirium in children?

Cornell Assessment of Pediatric Delirium Signup and view all the answers

What is the primary purpose of the Geriatric Depression Scale (GDS)?

To assess for signs of depression in older adults Signup and view all the answers

Which of the following tools is used to screen for the presence and severity of symptoms of postnatal depression?

Edinburgh Depression Scale Signup and view all the answers

What is the primary purpose of the Cornell Scale for Depression in Dementia?

To assess for signs of depression in individuals known to have dementia Signup and view all the answers

Which of the following tools is a kit for health promotion and prevention published by the American Academy of Pediatrics?

American Academy of Pediatrics---Bright Futures Signup and view all the answers

Children may have ______ symptoms of psychological disorders.

frequent Signup and view all the answers

The assessment of the patient's decision-making ability involves asking about a ______ situation.

personal Signup and view all the answers

Cognitive development can be explained by level of ______ development or sociocultural factors.

cognitive Signup and view all the answers

Normal cognition enables individuals to function effectively as a ______ being.

human Signup and view all the answers

The primary function of normal cognition is to obtain a level of ______ and adaptation.

survival Signup and view all the answers

A definition of normal cognition depends on social and cultural ______ and the environment.

factors Signup and view all the answers

Normal cognition primarily involves activities that are controlled by the ______ hemispheres.

cerebral Signup and view all the answers

Perception refers to an interpretation of ______ or inputs that takes place in the brain.

sensory Signup and view all the answers

Internal stimuli include proprioceptive sensations that contribute to ______ function and spatial awareness.

motor Signup and view all the answers

Memory refers to the process by which individuals retain, store, and retrieve information gained from previous ______.

experiences Signup and view all the answers

What is the primary purpose of assessing a patient's perceptions and thinking abilities?

To identify underlying cognitive disorders Signup and view all the answers

Which of the following is an example of an internal stimulus?

Proprioceptive sensations Signup and view all the answers

What is the primary role of orientation in normal perception?

To maintain a sense of self and awareness Signup and view all the answers

What is the primary function of the reticular activating system (RAS) in attention?

To control arousal and awareness Signup and view all the answers

What is the primary characteristic of declarative memories?

They are explicit and can be consciously accessed Signup and view all the answers

What is the primary role of working memory in cognitive function?

To actively process and manipulate information in conscious awareness Signup and view all the answers

What is the primary consequence of impaired attention in terms of individual safety?

Increased risk of injury or accidents Signup and view all the answers

What is the primary factor that influences variations in attention span among healthy individuals?

All of the above Signup and view all the answers

What is the primary purpose of assessing a patient's mood and affect?

To evaluate the patient's emotional state and mental health Signup and view all the answers

What is the primary characteristic of individuals with impaired motor function?

Abnormal motor coordination and execution Signup and view all the answers

During the sensorimotor stage, children develop a sense of ______ and 'other'.

self Signup and view all the answers

In the preoperational stage, children participate in ______ play and begin to recognize that others don't see the world the same way they do.

imaginative Signup and view all the answers

During the concrete operational stage, children are no longer fooled by ______.

appearances Signup and view all the answers

In the preoperational stage, thought is ______ and children cannot adopt the perspectives of others.

egocentric Signup and view all the answers

Children develop ______ schemes during the sensorimotor stage, which begin to produce images or mental schemes.

behavioral Signup and view all the answers

Study Notes

Cognition

Cognition refers to the complex set of mental processes that enable individuals to acquire, store, retrieve, and use information.
These mental processes are primarily controlled by the cerebral hemispheres.
Cognition involves various activities, including:
- Perception
- Attention
- Memory
- Communication
- Decision making
- Problem solving

Normal Cognition

Normal cognition is defined by social and cultural norms and the environment in which an individual operates.
The desired consequences of normal cognition include:
- Obtaining a level of survival and adaptation
- Functioning effectively as a social being
- Engaging in meaningful and purposeful activity

Cognition

Cognition refers to the complex set of mental processes that enable individuals to acquire, store, retrieve, and use information.
These mental processes are primarily controlled by the cerebral hemispheres.
Cognition involves various activities, including:
- Perception
- Attention
- Memory
- Communication
- Decision making
- Problem solving

Normal Cognition

Normal cognition is defined by social and cultural norms and the environment in which an individual operates.
The desired consequences of normal cognition include:
- Obtaining a level of survival and adaptation
- Functioning effectively as a social being
- Engaging in meaningful and purposeful activity

Perception

Interpretation of external stimuli or inputs, including touch, taste, vision, hearing, and smell, that takes place in the brain.
Includes internal stimuli, such as proprioceptive sensations that contribute to motor function and spatial awareness.

Orientation

A component of normal perception that includes four basic elements: person, place, time, and situation.
Orientation to person: ability to correctly identify one's own name.
Orientation to place: ability to identify one's location.
Orientation to time: ability to correctly identify the time of day, the date, and the season.
Orientation to situation: ability to describe the global circumstances surrounding a particular event.

Perception

Interpretation of external stimuli or inputs, including touch, taste, vision, hearing, and smell, that takes place in the brain.
Includes internal stimuli, such as proprioceptive sensations that contribute to motor function and spatial awareness.

Orientation

A component of normal perception that includes four basic elements: person, place, time, and situation.
Orientation to person: ability to correctly identify one's own name.
Orientation to place: ability to identify one's location.
Orientation to time: ability to correctly identify the time of day, the date, and the season.
Orientation to situation: ability to describe the global circumstances surrounding a particular event.

Attention and Alertness

Attention is the brain's ability to remain alert and aware while selectively prioritizing concentration on a stimulus or mental event.
Structures involved in arousal and attention: reticular activating system (RAS), thalamus, and frontal cortex.

Neurotransmitters and Attention

Dopamine and norepinephrine play a major role in regulating attention.
These neurotransmitters impact attention span and ability to focus.

Factors Influencing Attention Span

Development: attention span can change as individuals grow and develop.
Genetics: genetic factors can influence an individual's attention span.
Biological rhythms: internal biological rhythms can impact attention span.
Culture: cultural background and environment can influence attention span.
Environmental factors: other environmental factors can also impact attention span.

Importance of Attention

Individual safety depends on the ability to attend and focus.
Changes in attention span can signify an underlying change or alteration in biophysical or psychosocial status.

Attention and Alertness

Attention is the brain's ability to remain alert and aware while selectively prioritizing concentration on a stimulus or mental event.
Structures involved in arousal and attention: reticular activating system (RAS), thalamus, and frontal cortex.

Neurotransmitters and Attention

Dopamine and norepinephrine play a major role in regulating attention.
These neurotransmitters impact attention span and ability to focus.

Factors Influencing Attention Span

Development: attention span can change as individuals grow and develop.
Genetics: genetic factors can influence an individual's attention span.
Biological rhythms: internal biological rhythms can impact attention span.
Culture: cultural background and environment can influence attention span.
Environmental factors: other environmental factors can also impact attention span.

Importance of Attention

Individual safety depends on the ability to attend and focus.
Changes in attention span can signify an underlying change or alteration in biophysical or psychosocial status.

Memory

Memory is the process of retaining, storing, and retrieving information gained from previous experiences.
The ability to remember meaningful information provides the foundation for learning and adaptation from birth to death.

Models of Memory

Models of memory classify subtypes according to their sequence and duration.
The three main subtypes of memory are:
- Sensory memory
- Short-term memory
- Long-term memory

Information-Processing Model of Memory

Many stimuli register in sensory memory, and those that are noticed are briefly stored in short-term memory.
Those that are encoded are transferred to long-term memory.
Forgetting can be caused by failures of attention, encoding, or retrieval.

Sensory Memory

Sensory memory is the earliest stage of memory, lasting less than a few seconds.
It retains visual input and auditory information.

Short-Term Memory

Short-term memory refers to the active processing and manipulation of information in conscious awareness.
It lasts only several seconds, but can be rehearsed or repeated and transferred into long-term memory.
The total amount of information that can be managed in short-term memory is finite, with a limit of 5-9 digits.

Working Memory

Working memory is the capacity to manipulate information stored in short-term memory.
Examples include following a sequence of directions and performing mental mathematical calculations.

Long-Term Memory

Long-term memory is the final sequence or destination of information that can be stored indefinitely.
It is further broken down into declarative and nondeclarative memories.

Declarative Memories

Declarative memories are explicit and can be consciously accessed.
They are distinguished as:
- Semantic memories (storing facts and verbal information)
- Episodic memories (composed of personal experiences)

Nondeclarative Memories

Nondeclarative memories are characterized by information that is outside of our conscious awareness.
Examples include procedural memories, which enable individuals to perform learned skills and tasks, such as:
- Walking
- Riding a bike
- Driving a car

Memory

Memory is the process of retaining, storing, and retrieving information gained from previous experiences.
The ability to remember meaningful information provides the foundation for learning and adaptation from birth to death.

Models of Memory

Models of memory classify subtypes according to their sequence and duration.
The three main subtypes of memory are:
- Sensory memory
- Short-term memory
- Long-term memory

Information-Processing Model of Memory

Many stimuli register in sensory memory, and those that are noticed are briefly stored in short-term memory.
Those that are encoded are transferred to long-term memory.
Forgetting can be caused by failures of attention, encoding, or retrieval.

Sensory Memory

Sensory memory is the earliest stage of memory, lasting less than a few seconds.
It retains visual input and auditory information.

Short-Term Memory

Short-term memory refers to the active processing and manipulation of information in conscious awareness.
It lasts only several seconds, but can be rehearsed or repeated and transferred into long-term memory.
The total amount of information that can be managed in short-term memory is finite, with a limit of 5-9 digits.

Working Memory

Working memory is the capacity to manipulate information stored in short-term memory.
Examples include following a sequence of directions and performing mental mathematical calculations.

Long-Term Memory

Long-term memory is the final sequence or destination of information that can be stored indefinitely.
It is further broken down into declarative and nondeclarative memories.

Declarative Memories

Declarative memories are explicit and can be consciously accessed.
They are distinguished as:
- Semantic memories (storing facts and verbal information)
- Episodic memories (composed of personal experiences)

Nondeclarative Memories

Nondeclarative memories are characterized by information that is outside of our conscious awareness.
Examples include procedural memories, which enable individuals to perform learned skills and tasks, such as:
- Walking
- Riding a bike
- Driving a car

Memory plays a significant role in communication and speech.
Social cognition is the ability to process and apply social information accurately and effectively.
Social cognition depends on the integrated function of areas responsible for visual motor processing, language, and executive function.
Individuals can apply an understanding of others' needs and interpret verbal and nonverbal information or social cues with some degree of proficiency.
Social cognition is essential for adaptive functioning across the lifespan.

Motor Coordination

Motor coordination refers to the planning, organizing, and execution of complex motor tasks.
Cognitive function and motor coordination are carried out by shared neuronal pathways in the brain.
The ability to plan and coordinate motor functions progresses through expected stages of development.
Adults exhibit praxis, the ability to control movement in a deliberate, smooth, and coordinated fashion.
Individuals with intact cognition exhibit normal variations in motor function and coordination.
Impaired motor function is characteristic of many alterations discussed in this module.

Memory plays a significant role in communication and speech.
Social cognition is the ability to process and apply social information accurately and effectively.
Social cognition depends on the integrated function of areas responsible for visual motor processing, language, and executive function.
Individuals can apply an understanding of others' needs and interpret verbal and nonverbal information or social cues with some degree of proficiency.
Social cognition is essential for adaptive functioning across the lifespan.

Motor Coordination

Motor coordination refers to the planning, organizing, and execution of complex motor tasks.
Cognitive function and motor coordination are carried out by shared neuronal pathways in the brain.
The ability to plan and coordinate motor functions progresses through expected stages of development.
Adults exhibit praxis, the ability to control movement in a deliberate, smooth, and coordinated fashion.
Individuals with intact cognition exhibit normal variations in motor function and coordination.
Impaired motor function is characteristic of many alterations discussed in this module.

Executive Function

Enables individuals to selectively focus, control emotions, problem-solve, and organize speech and motor activity
Incorporates coordination of cognitive attributes for planning and executing complex tasks
Examples include following multistep directions and prioritizing to manage time on a project

Intellectual Function

Refers to the mental capacity for learning, reasoning, and problem-solving
Measured through psychometric tests, such as Stanford-Binet Intelligence Scales and Wechsler Intelligence Scales
Subtest scores provide insight into individual strengths and weaknesses in areas like general knowledge, quantitative and verbal reasoning, visuospatial processing, and working memory
Average subtest scores calculate the overall or full-scale intelligence quotient (IQ)

Adaptive Behavior

Refers to practical skills necessary for everyday functioning
Comprises three categories: conceptual skills (language, reading, telling time), social skills (following rules, interacting with others), and practical skills (work, daily living activities)

Physiology Review

Cognition depends on brain and nervous system functioning
Cerebral cortex is responsible for most aspects of sensory information processing
Limbic system, RAS, and cerebellum contribute to arousal, motivation, emotional regulation, and balance
Neurons carry messages through electrical and chemical signals
Microglia regulate response to inflammation in the brain
Neurotransmitters carry nerve impulses across synaptic gaps between neurons
Abnormalities in cellular and neurotransmitter function are associated with many cognitive disorders

Executive Function

Enables individuals to selectively focus, control emotions, problem-solve, and organize speech and motor activity
Incorporates coordination of cognitive attributes for planning and executing complex tasks
Examples include following multistep directions and prioritizing to manage time on a project

Intellectual Function

Refers to the mental capacity for learning, reasoning, and problem-solving
Measured through psychometric tests, such as Stanford-Binet Intelligence Scales and Wechsler Intelligence Scales
Subtest scores provide insight into individual strengths and weaknesses in areas like general knowledge, quantitative and verbal reasoning, visuospatial processing, and working memory
Average subtest scores calculate the overall or full-scale intelligence quotient (IQ)

Adaptive Behavior

Refers to practical skills necessary for everyday functioning
Comprises three categories: conceptual skills (language, reading, telling time), social skills (following rules, interacting with others), and practical skills (work, daily living activities)

Physiology Review

Cognition depends on brain and nervous system functioning
Cerebral cortex is responsible for most aspects of sensory information processing
Limbic system, RAS, and cerebellum contribute to arousal, motivation, emotional regulation, and balance
Neurons carry messages through electrical and chemical signals
Microglia regulate response to inflammation in the brain
Neurotransmitters carry nerve impulses across synaptic gaps between neurons
Abnormalities in cellular and neurotransmitter function are associated with many cognitive disorders

Genetic Influences on Cognition

Research suggests that genetic makeup accounts for approximately 80% of cognitive variations in the general population.
Different genes are linked to specific components of cognitive function, such as attention in working memory in healthy adults.

Alterations in Cognitive Function

Alterations in mental processing are characterized by dysregulation of one or more key components of normal cognition.
Such alterations can be found in various conditions that impair cognitive function, including diseases that affect cognitive function differently.

General Manifestations of Altered Cognitive Function

Alterations in different aspects of cognition occur to varying degrees in various conditions related to cognitive dysfunction.
These conditions often result from brain structure and function abnormalities.
Understanding these general manifestations is crucial for providing nursing care to individuals with cognitive problems, regardless of their medical diagnosis.

Alterations in Perception

Altered perception and thinking are common features of many conditions that impact cognition across the lifespan.
Perceptual disturbances can be caused by structural and physiologic brain abnormalities in various areas of the cerebral cortex.
Such disturbances may be related to primary cognitive disorders (e.g., dementia, schizophrenia) or underlying medical conditions.
Illogical thinking can result from frontal lobe dysfunction and dopamine imbalance.
Distortions in perceptual processing often result from abnormalities in the lobes responsible for sensory processing.

Genetic Influences on Cognition

Research suggests that genetic makeup accounts for approximately 80% of cognitive variations in the general population.
Different genes are linked to specific components of cognitive function, such as attention in working memory in healthy adults.

Alterations in Cognitive Function

Alterations in mental processing are characterized by dysregulation of one or more key components of normal cognition.
Such alterations can be found in various conditions that impair cognitive function, including diseases that affect cognitive function differently.

General Manifestations of Altered Cognitive Function

Alterations in different aspects of cognition occur to varying degrees in various conditions related to cognitive dysfunction.
These conditions often result from brain structure and function abnormalities.
Understanding these general manifestations is crucial for providing nursing care to individuals with cognitive problems, regardless of their medical diagnosis.

Alterations in Perception

Altered perception and thinking are common features of many conditions that impact cognition across the lifespan.
Perceptual disturbances can be caused by structural and physiologic brain abnormalities in various areas of the cerebral cortex.
Such disturbances may be related to primary cognitive disorders (e.g., dementia, schizophrenia) or underlying medical conditions.
Illogical thinking can result from frontal lobe dysfunction and dopamine imbalance.
Distortions in perceptual processing often result from abnormalities in the lobes responsible for sensory processing.

Mental Health Concepts

Confusion refers to difficulty in thinking clearly, making judgments, and focusing attention.

Disorientation

Disorientation is a component of confusion, characterized by the individual's inability to accurately identify one or more of the following: person, place, time, and situation.

Psychosis

Psychosis is an abnormal mental state that alters an individual's thought processes and content, which impairs their perception of reality.
Altered thought processes and content are often observed through the patient's speech and behaviors.

Delusions

Delusions are rigid, false beliefs that are not based on reality.
Examples of delusions include:
- Delusions of persecution: beliefs that others are hostile or trying to harm the individual.
- Delusions of reference: beliefs that public events or people are directly related to the individual.
- Delusions of grandeur: inflated sense of self-worth and abilities.

Hallucinations

Hallucinations are sensory experiences that do not represent reality.
Examples of hallucinations include:
- Auditory hallucinations: hearing voices or sounds that are not there.
- Visual hallucinations: seeing things that are not there or seeing distortions of things that are there.
- Tactile (somatic or haptic) hallucinations: feeling things that are not present.
The type of hallucination experienced can provide clues to the underlying cause.

Mental Health Concepts

Confusion refers to difficulty in thinking clearly, making judgments, and focusing attention.

Disorientation

Disorientation is a component of confusion, characterized by the individual's inability to accurately identify one or more of the following: person, place, time, and situation.

Psychosis

Psychosis is an abnormal mental state that alters an individual's thought processes and content, which impairs their perception of reality.
Altered thought processes and content are often observed through the patient's speech and behaviors.

Delusions

Delusions are rigid, false beliefs that are not based on reality.
Examples of delusions include:
- Delusions of persecution: beliefs that others are hostile or trying to harm the individual.
- Delusions of reference: beliefs that public events or people are directly related to the individual.
- Delusions of grandeur: inflated sense of self-worth and abilities.

Hallucinations

Hallucinations are sensory experiences that do not represent reality.
Examples of hallucinations include:
- Auditory hallucinations: hearing voices or sounds that are not there.
- Visual hallucinations: seeing things that are not there or seeing distortions of things that are there.
- Tactile (somatic or haptic) hallucinations: feeling things that are not present.
The type of hallucination experienced can provide clues to the underlying cause.

Alterations in Attention

Individuals with attention difficulties exhibit deficits in focusing, shifting, and sustaining attention consistently.
Attention deficits are characteristic of cognitive disorders, such as attention-deficit disorder (ADD) and attention-deficit/hyperactivity disorder (ADHD).
Short-term difficulties with attention can occur due to acute stress, anxiety, and acute illness.
Attention problems can be related to any condition that affects the structure and function of the brain.
Deficits in mental energy affect an individual's ability to sustain effort required to complete tasks.
Individuals with altered attention have difficulty determining what information is salient and connecting new information to prior knowledge.
Issues in processing arise from the inability to control output, leading to uninhibited responses or actions.

Alterations in Memory

Memory impairment may be an initial manifestation of a cognitive disorder, impacting one or more memory functions.
Imbalances of acetylcholine, dopamine, GABA, and glutamate have been linked to memory problems.
Memory impairments can be temporary or chronic, ranging from mild to severe.
They may be related to an underlying illness or trauma, or caused by a medical treatment or medication.
Amnesia is a general term referring to the loss of recent or remote memory.
Patients experiencing memory loss may unconsciously attempt to compensate by filling in memory gaps with fabricated events through confabulation.

Alterations in Attention

Individuals with attention difficulties exhibit deficits in focusing, shifting, and sustaining attention consistently.
Attention deficits are characteristic of cognitive disorders, such as attention-deficit disorder (ADD) and attention-deficit/hyperactivity disorder (ADHD).
Short-term difficulties with attention can occur due to acute stress, anxiety, and acute illness.
Attention problems can be related to any condition that affects the structure and function of the brain.
Deficits in mental energy affect an individual's ability to sustain effort required to complete tasks.
Individuals with altered attention have difficulty determining what information is salient and connecting new information to prior knowledge.
Issues in processing arise from the inability to control output, leading to uninhibited responses or actions.

Alterations in Memory

Memory impairment may be an initial manifestation of a cognitive disorder, impacting one or more memory functions.
Imbalances of acetylcholine, dopamine, GABA, and glutamate have been linked to memory problems.
Memory impairments can be temporary or chronic, ranging from mild to severe.
They may be related to an underlying illness or trauma, or caused by a medical treatment or medication.
Amnesia is a general term referring to the loss of recent or remote memory.
Patients experiencing memory loss may unconsciously attempt to compensate by filling in memory gaps with fabricated events through confabulation.

Memory Loss

Short-term memory loss: difficulty recalling information from a few minutes ago, while retaining memories from 15 years ago
Problems with working memory: struggling to follow multistep directions, remember number sequences, or perform simple calculations
Long-term memory loss: difficulty recalling events and learning from the distant past, such as forgetting work skills learned 10 years ago or important life events

Deficits in Semantic Memory

Agnosia: inability to recognize objects through one or more senses
Examples: difficulty recognizing objects or people, even with normal sensory function

Communication impairment: contingent on adequate perception, attention, and memory
Injury to brain areas responsible for language, gestures, and written/spoken words can impair communication and social cognition
Related terms:
- Aphasia: inability to use or understand language
  - Expressive aphasia: difficulty expressing thoughts and ideas
  - Receptive aphasia: difficulty understanding language
  - Mixed (global) aphasia: combination of expressive and receptive aphasia
- Anomia: inability to recall names of everyday objects, often related to semantic memory loss in dementia
- Alogia: lack of speech, also known as impoverished speech

Memory Loss

Short-term memory loss: difficulty recalling information from a few minutes ago, while retaining memories from 15 years ago
Problems with working memory: struggling to follow multistep directions, remember number sequences, or perform simple calculations
Long-term memory loss: difficulty recalling events and learning from the distant past, such as forgetting work skills learned 10 years ago or important life events

Deficits in Semantic Memory

Agnosia: inability to recognize objects through one or more senses
Examples: difficulty recognizing objects or people, even with normal sensory function

Communication impairment: contingent on adequate perception, attention, and memory
Injury to brain areas responsible for language, gestures, and written/spoken words can impair communication and social cognition
Related terms:
- Aphasia: inability to use or understand language
  - Expressive aphasia: difficulty expressing thoughts and ideas
  - Receptive aphasia: difficulty understanding language
  - Mixed (global) aphasia: combination of expressive and receptive aphasia
- Anomia: inability to recall names of everyday objects, often related to semantic memory loss in dementia
- Alogia: lack of speech, also known as impoverished speech

Frontal-lobe and right-brain dysfunction can affect spatial awareness, leading to difficulties in gauging physical aspects of social communication, such as standing distance to others.
Impaired visual processing can result in inability to accurately read and respond to nonverbal cues, leading to misconceptions of rudeness or annoyance.

Motor Coordination Deficits

Problems with speed, fluency, and quality of movement are associated with many cognitive disorders and can be a side effect of certain medications.
Dyspraxia: difficulty with motor learning and coordination, particularly during growth and development.
Apraxia: alterations in speech due to impaired motor function.
Ataxia: problems with balance and coordination associated with neurologic dysfunction.

Involuntary Movements

Tics: semi-involuntary movements that are sudden, repetitive, and nonrhythmic, involving muscle groups or vocalizations.
Simple tics: brief movements involving one muscle group, such as eye blinking and head jerking (motor tics) and throat clearing and humming (phonic tics).
Complex tics: clusters of movements that appear coordinated and purposeful, including:
- Complex motor tics: pulling at clothing, touching people or objects, echopraxia, copropraxia, and carphologia.
- Complex phonic tics: echolalia, coprolalia.

Associated Risks

Deficits in communication and social function can lead to health problems, social isolation, victimization, depression, and anxiety.

Frontal-lobe and right-brain dysfunction can affect spatial awareness, leading to difficulties in gauging physical aspects of social communication, such as standing distance to others.
Impaired visual processing can result in inability to accurately read and respond to nonverbal cues, leading to misconceptions of rudeness or annoyance.

Motor Coordination Deficits

Problems with speed, fluency, and quality of movement are associated with many cognitive disorders and can be a side effect of certain medications.
Dyspraxia: difficulty with motor learning and coordination, particularly during growth and development.
Apraxia: alterations in speech due to impaired motor function.
Ataxia: problems with balance and coordination associated with neurologic dysfunction.

Involuntary Movements

Tics: semi-involuntary movements that are sudden, repetitive, and nonrhythmic, involving muscle groups or vocalizations.
Simple tics: brief movements involving one muscle group, such as eye blinking and head jerking (motor tics) and throat clearing and humming (phonic tics).
Complex tics: clusters of movements that appear coordinated and purposeful, including:
- Complex motor tics: pulling at clothing, touching people or objects, echopraxia, copropraxia, and carphologia.
- Complex phonic tics: echolalia, coprolalia.

Associated Risks

Deficits in communication and social function can lead to health problems, social isolation, victimization, depression, and anxiety.

Tremors

Unintentional rhythmic movements of the affected body part
Types of tremors:
- Essential tremors: not associated with another condition, may be genetic in origin
- Physiologic tremors: occur normally due to physiologic exhaustion or emotional stress
Examples of common tremors:
- Resting tremors: coarse, rhythmic tremor often observed in resting arms and hands, characteristic of Parkinson disease
- Dystonic tremors: sustained involuntary muscle contractions causing twisting repetitive movements and painful or abnormal postures

Dyskinesia

General category of difficulty with or distortions of movement
May be associated with acquired disorders such as Parkinson disease or as a side effect of some medications
Types of dyskinesias:
- Akathisia: internal feeling of restlessness leading to rocking, pacing, or constant movement
- Akinesia: diminished movement due to difficulty initiating movement
- Bradykinesia: dyskinesia characterized by slow movement
- Dystonia: acute episode of muscle contractions
- Rigidity: resistance to movement; cogwheel rigidity refers to ratchet-like resistance when attempting to move the joints

Alterations in Executive Function

Executive function significantly affected by structural and physiologic abnormalities impacting the frontal cortex
Manifestations of impaired function:
- Emotional dysregulation
- Poor judgment and decision making
- Reduced insight
- Forgetfulness
- Difficulty in planning, organizing, and concrete thinking
- Personality changes
Severity of difficulties can range from mild to severe
Avolition: decreased motivation or inability to initiate goal-directed activity, related to deficits in executive dysfunction

Tremors

Unintentional rhythmic movements of the affected body part
Types of tremors:
- Essential tremors: not associated with another condition, may be genetic in origin
- Physiologic tremors: occur normally due to physiologic exhaustion or emotional stress
Examples of common tremors:
- Resting tremors: coarse, rhythmic tremor often observed in resting arms and hands, characteristic of Parkinson disease
- Dystonic tremors: sustained involuntary muscle contractions causing twisting repetitive movements and painful or abnormal postures

Dyskinesia

General category of difficulty with or distortions of movement
May be associated with acquired disorders such as Parkinson disease or as a side effect of some medications
Types of dyskinesias:
- Akathisia: internal feeling of restlessness leading to rocking, pacing, or constant movement
- Akinesia: diminished movement due to difficulty initiating movement
- Bradykinesia: dyskinesia characterized by slow movement
- Dystonia: acute episode of muscle contractions
- Rigidity: resistance to movement; cogwheel rigidity refers to ratchet-like resistance when attempting to move the joints

Alterations in Executive Function

Executive function significantly affected by structural and physiologic abnormalities impacting the frontal cortex
Manifestations of impaired function:
- Emotional dysregulation
- Poor judgment and decision making
- Reduced insight
- Forgetfulness
- Difficulty in planning, organizing, and concrete thinking
- Personality changes
Severity of difficulties can range from mild to severe
Avolition: decreased motivation or inability to initiate goal-directed activity, related to deficits in executive dysfunction

Alterations in Intellectual Function and Learning

Alterations in intellectual function and learning can be either developmental or acquired.
Learning disabilities are a group of disorders that impact an individual's ability to process information.
The cause of learning disabilities is not entirely understood, but researchers believe that subtle variations in brain structure and function may be responsible.
Both genetics and environmental factors probably contribute to these variations.
Individuals with learning disabilities have average to above-average intelligence but demonstrate a gap between their actual and potential achievement.

Impact of Learning Disabilities

The impact of learning disabilities goes beyond difficulty with basic academic skills.
Individuals with specific learning difficulties often experience problems with social cognition, executive function, memory, processing speed, attention, and motor coordination.
They face significant challenges with interpersonal relationships and other aspects of adaptive function.

Intellectual Disabilities

Intellectual disabilities are characterized by significant limitations in intellectual functioning and adaptive behavior that begin prior to age 18.
An IQ score of 70 to 75 or below is considered indicative of limited intellectual functioning.
Intellectual disability can result from prenatal errors in central nervous system (CNS) development, external factors that damage the CNS, or pre- or postnatal changes in an individual's biological environment.
Sometimes, these changes produce only mental limitations, while in other cases, intellectual disability is one of a constellation of symptoms linked to a particular cause.

Alterations in Intellectual Function and Learning

Alterations in intellectual function and learning can be either developmental or acquired.
Learning disabilities are a group of disorders that impact an individual's ability to process information.
The cause of learning disabilities is not entirely understood, but researchers believe that subtle variations in brain structure and function may be responsible.
Both genetics and environmental factors probably contribute to these variations.
Individuals with learning disabilities have average to above-average intelligence but demonstrate a gap between their actual and potential achievement.

Impact of Learning Disabilities

The impact of learning disabilities goes beyond difficulty with basic academic skills.
Individuals with specific learning difficulties often experience problems with social cognition, executive function, memory, processing speed, attention, and motor coordination.
They face significant challenges with interpersonal relationships and other aspects of adaptive function.

Intellectual Disabilities

Intellectual disabilities are characterized by significant limitations in intellectual functioning and adaptive behavior that begin prior to age 18.
An IQ score of 70 to 75 or below is considered indicative of limited intellectual functioning.
Intellectual disability can result from prenatal errors in central nervous system (CNS) development, external factors that damage the CNS, or pre- or postnatal changes in an individual's biological environment.
Sometimes, these changes produce only mental limitations, while in other cases, intellectual disability is one of a constellation of symptoms linked to a particular cause.

Selected Alterations in Cognition

The exemplars in this module represent only a fraction of the disorders that impair cognition.
The DSM-5 (2013) provides a context for understanding both similarities and differences in the exemplars and related conditions.

Selected Learning Disabilities

The DSM-5 recognizes specific learning disabilities, including auditory processing disorder (APD) and language processing disorder (LPD).
APD: individuals have difficulty processing sounds and recognizing their source.
Individuals with APD may have difficulty processing and acting on verbal instructions.
Benefits of accommodations for APD: visual cues, pictorial schedules, and active demonstrations.
Nurses' role: support patients and families in seeking services and accommodations, and encourage activities that focus on strengths and build self-esteem.

Selected Alterations in Cognition

The exemplars in this module represent only a fraction of the disorders that impair cognition.
The DSM-5 (2013) provides a context for understanding both similarities and differences in the exemplars and related conditions.

Selected Learning Disabilities

The DSM-5 recognizes specific learning disabilities, including auditory processing disorder (APD) and language processing disorder (LPD).
APD: individuals have difficulty processing sounds and recognizing their source.
Individuals with APD may have difficulty processing and acting on verbal instructions.
Benefits of accommodations for APD: visual cues, pictorial schedules, and active demonstrations.
Nurses' role: support patients and families in seeking services and accommodations, and encourage activities that focus on strengths and build self-esteem.

Intellectual Disabilities

Three conditions associated with intellectual disability: Down syndrome, fragile X syndrome, and fetal alcohol spectrum disorders (FASD)

Down Syndrome

Caused by genetic errors during prenatal development
Present at birth and affects individuals for the rest of their lives
Physical characteristics:
- Broad hands with a single traverse palmar crease
- Congenital cataracts
- Decreased muscle tone
- Epicanthic eye folds
- Flattened nose
- Hearing impairment
- Protruding tongue
- Short, stocky neck
- Small ears located low on the head
- Small head
- Wide space between first two toes
Increased likelihood of:
- Diabetes
- Leukemia
- Heart defects

Fragile X Syndrome

Caused by genetic errors during prenatal development
Present at birth and affects individuals for the rest of their lives
Physical characteristics:
- Crossed eyes
- Enlarged testicles
- Epicanthic eye folds
- Excessively flexible joints
- High palate
- Large ears
- Long head with protruding jaw
- Scoliosis
Increased likelihood of:
- Middle ear infections
- Seizures

Fetal Alcohol Spectrum Disorders (FASD)

Caused by alcohol consumption during pregnancy
Present at birth and affects individuals for the rest of their lives
Physical characteristics:
- Small eyes
- Abnormal joints and bones
- CNS abnormalities
- Flattened nasal bridge
- Growth deficits
- Hearing impairment
- Lack of coordination
- Small nose that turns up at the tip
- Small palpebral fissures
- Smooth philtrum
- Thin vermillion border

Intellectual Disabilities

Three conditions associated with intellectual disability: Down syndrome, fragile X syndrome, and fetal alcohol spectrum disorders (FASD)

Down Syndrome

Caused by genetic errors during prenatal development
Present at birth and affects individuals for the rest of their lives
Physical characteristics:
- Broad hands with a single traverse palmar crease
- Congenital cataracts
- Decreased muscle tone
- Epicanthic eye folds
- Flattened nose
- Hearing impairment
- Protruding tongue
- Short, stocky neck
- Small ears located low on the head
- Small head
- Wide space between first two toes
Increased likelihood of:
- Diabetes
- Leukemia
- Heart defects

Fragile X Syndrome

Caused by genetic errors during prenatal development
Present at birth and affects individuals for the rest of their lives
Physical characteristics:
- Crossed eyes
- Enlarged testicles
- Epicanthic eye folds
- Excessively flexible joints
- High palate
- Large ears
- Long head with protruding jaw
- Scoliosis
Increased likelihood of:
- Middle ear infections
- Seizures

Fetal Alcohol Spectrum Disorders (FASD)

Caused by alcohol consumption during pregnancy
Present at birth and affects individuals for the rest of their lives
Physical characteristics:
- Small eyes
- Abnormal joints and bones
- CNS abnormalities
- Flattened nasal bridge
- Growth deficits
- Hearing impairment
- Lack of coordination
- Small nose that turns up at the tip
- Small palpebral fissures
- Smooth philtrum
- Thin vermillion border

Down Syndrome

Down syndrome occurs when an individual's cells contain a third full or partial copy of the 21st chromosome.
Trisomy 21 is the most common form, where a full copy of the extra chromosome is present.
The excess genetic material leads to intellectual disability and physical impairments, ranging from mild to severe.
Individuals with Down syndrome are at increased risk of:
- Congenital heart defects (around 50% of cases)
- Hearing loss
- Gastrointestinal blockages
- Celiac disease
- Vision problems
- Thyroid disease
- Skeletal abnormalities
- Orthodontic problems
- Leukemia
- Eventual dementia
With appropriate support, individuals with Down syndrome can lead healthy lives and sometimes live and work independently.
Average life expectancy for individuals with Down syndrome is about 60 years, although some individuals live 10 or even 20 years longer.

Fragile X Syndrome

Fragile X syndrome arises from a single recessive abnormality on the X chromosome.
A mutation in the FMR-1 gene causes a repeated section of DNA, leading to errors in brain development and function.
Associated signs and symptoms include:
- Intellectual disability
- Behavioral problems (such as ADHD)
- Autistic behaviors
- Speech problems
- Anxiety and mood problems
- Delays in learning to sit, walk, and talk
- Enhanced sensitivity to environmental stimuli
Most individuals with fragile X syndrome are in generally good health and have a normal lifespan.
Approximately 15% of affected males and 6-8% of females will experience seizures and require anticonvulsant medications.
Males are usually more severely affected than females due to the lack of a compensatory mechanism (having only one X chromosome).

Down Syndrome

Down syndrome occurs when an individual's cells contain a third full or partial copy of the 21st chromosome.
Trisomy 21 is the most common form, where a full copy of the extra chromosome is present.
The excess genetic material leads to intellectual disability and physical impairments, ranging from mild to severe.
Individuals with Down syndrome are at increased risk of:
- Congenital heart defects (around 50% of cases)
- Hearing loss
- Gastrointestinal blockages
- Celiac disease
- Vision problems
- Thyroid disease
- Skeletal abnormalities
- Orthodontic problems
- Leukemia
- Eventual dementia
With appropriate support, individuals with Down syndrome can lead healthy lives and sometimes live and work independently.
Average life expectancy for individuals with Down syndrome is about 60 years, although some individuals live 10 or even 20 years longer.

Fragile X Syndrome

Fragile X syndrome arises from a single recessive abnormality on the X chromosome.
A mutation in the FMR-1 gene causes a repeated section of DNA, leading to errors in brain development and function.
Associated signs and symptoms include:
- Intellectual disability
- Behavioral problems (such as ADHD)
- Autistic behaviors
- Speech problems
- Anxiety and mood problems
- Delays in learning to sit, walk, and talk
- Enhanced sensitivity to environmental stimuli
Most individuals with fragile X syndrome are in generally good health and have a normal lifespan.
Approximately 15% of affected males and 6-8% of females will experience seizures and require anticonvulsant medications.
Males are usually more severely affected than females due to the lack of a compensatory mechanism (having only one X chromosome).

Fetal Alcohol Spectrum Disorders (FASDs)

FASDs are completely preventable conditions caused by maternal alcohol intake during pregnancy.
Abstinence from alcohol consumption during pregnancy is the only way to prevent FASD.

Characteristics of FASDs

Physical, intellectual, behavioral, and/or learning disabilities are involved in all FASDs.
Fetal alcohol syndrome (FAS) is the most severe form of FASD.

Effects of Alcohol on the Fetus

Alcohol crosses the placenta and the fetal liver cannot process it, resulting in the fetus having the same blood alcohol content as its mother.
Even small amounts of alcohol can cause facial, skeletal, and organ abnormalities, as well as other problems.

Diagnosis of Fetal Alcohol Syndrome (FAS)

Growth deficits are required for a diagnosis of FAS.
Characteristic facial abnormalities include:
- Smooth philtrum (ridge between the nose and upper lip)
- Thin vermillion border (line between the lips and surrounding skin)
- Small palpebral fissures (separations between the upper and lower eyelids)
CNS (Central Nervous System) abnormalities, including structural, neurologic, and/or functional abnormalities, are required for a diagnosis of FAS.
These abnormalities often result in:
- Intellectual disability
- Learning disability
- Communication problems
- Poor memory
- Limited attention span

Treatment and Prognosis

Early treatment can help lessen some symptoms and improve the quality of life for individuals affected by FAS.
The effects of FAS last a lifetime.

Fetal Alcohol Spectrum Disorders (FASDs)

FASDs are completely preventable conditions caused by maternal alcohol intake during pregnancy.
Abstinence from alcohol consumption during pregnancy is the only way to prevent FASD.

Characteristics of FASDs

Physical, intellectual, behavioral, and/or learning disabilities are involved in all FASDs.
Fetal alcohol syndrome (FAS) is the most severe form of FASD.

Effects of Alcohol on the Fetus

Alcohol crosses the placenta and the fetal liver cannot process it, resulting in the fetus having the same blood alcohol content as its mother.
Even small amounts of alcohol can cause facial, skeletal, and organ abnormalities, as well as other problems.

Diagnosis of Fetal Alcohol Syndrome (FAS)

Growth deficits are required for a diagnosis of FAS.
Characteristic facial abnormalities include:
- Smooth philtrum (ridge between the nose and upper lip)
- Thin vermillion border (line between the lips and surrounding skin)
- Small palpebral fissures (separations between the upper and lower eyelids)
CNS (Central Nervous System) abnormalities, including structural, neurologic, and/or functional abnormalities, are required for a diagnosis of FAS.
These abnormalities often result in:
- Intellectual disability
- Learning disability
- Communication problems
- Poor memory
- Limited attention span

Treatment and Prognosis

Early treatment can help lessen some symptoms and improve the quality of life for individuals affected by FAS.
The effects of FAS last a lifetime.

Preventable Causes of Intellectual Disability

Maternal drug use, smoking, malnutrition, exposure to environmental toxins, and illness during pregnancy can cause intellectual disability.
Prematurity and low birth weight are strong indicators of potential intellectual disability.
Difficulties at delivery, such as oxygen deprivation or birth injury, can cause problems in intellectual functioning.
Head injuries, near-drowning, and diseases like whooping cough, chickenpox, measles, and Haemophilus influenzae type B (Hib) can damage the brain in childhood.
Childhood exposure to toxins, especially lead, can cause irreparable damage to the nervous system.
Malnutrition, childhood diseases, exposure to environmental health hazards, and a lack of intellectual stimulation early in life are also linked to intellectual disability.

Reduction in Prevalence of Intellectual Disability

Prevalence rates of intellectual disability have decreased globally thanks to public health measures, including:
- Mandatory newborn screening for phenylketonuria
- Vaccinations for Hib, measles, encephalitis, and rubella
- Comprehensive prenatal care, including testing for diseases and administering folic acid to expectant mothers

Delirium

Delirium is an acute change in mental state characterized by:
- Confusion
- Inability to focus, shift, or sustain attention
- Disorientation
- Sleep-wake cycle disturbances
- Disorganized thinking
- Perceptual abnormalities
- Mood changes
- Psychomotor retardation and agitation
Delirium typically results from a medical condition, trauma, or chemical/substance exposure or withdrawal.
Delirium is a common complication observed during acute-care settings.

Preventable Causes of Intellectual Disability

Maternal drug use, smoking, malnutrition, exposure to environmental toxins, and illness during pregnancy can cause intellectual disability.
Prematurity and low birth weight are strong indicators of potential intellectual disability.
Difficulties at delivery, such as oxygen deprivation or birth injury, can cause problems in intellectual functioning.
Head injuries, near-drowning, and diseases like whooping cough, chickenpox, measles, and Haemophilus influenzae type B (Hib) can damage the brain in childhood.
Childhood exposure to toxins, especially lead, can cause irreparable damage to the nervous system.
Malnutrition, childhood diseases, exposure to environmental health hazards, and a lack of intellectual stimulation early in life are also linked to intellectual disability.

Reduction in Prevalence of Intellectual Disability

Prevalence rates of intellectual disability have decreased globally thanks to public health measures, including:
- Mandatory newborn screening for phenylketonuria
- Vaccinations for Hib, measles, encephalitis, and rubella
- Comprehensive prenatal care, including testing for diseases and administering folic acid to expectant mothers

Delirium

Delirium is an acute change in mental state characterized by:
- Confusion
- Inability to focus, shift, or sustain attention
- Disorientation
- Sleep-wake cycle disturbances
- Disorganized thinking
- Perceptual abnormalities
- Mood changes
- Psychomotor retardation and agitation
Delirium typically results from a medical condition, trauma, or chemical/substance exposure or withdrawal.
Delirium is a common complication observed during acute-care settings.

Dementia Overview

Dementia is a general term describing the loss of one or more cortical functions or cognitive attributes due to brain degeneration.
The DSM-5 uses the term mild and major neurocognitive disorder (NCD) to replace the older term dementia.

Mild Neurocognitive Disorder (NCD)

Characterized by limited impairment, individuals with mild NCDs can maintain independent functioning with some modifications (e.g. medication reminders).
Often in the initial stages of disease progression.

Major Neurocognitive Disorder (NCD)

Characterized by the loss of additional cortical functions, leading to a loss of independence.

Causes and Risk Factors

Metabolic problems
Nutritional deficiencies
Infections
Poisoning
Medications
Conditions that compromise oxygenation and perfusion

Subtypes of NCDs

Classified by etiology
Examples include Alzheimer disease and vascular dementia

Alzheimer Disease

The most common form of dementia, accounting for about 80% of all cases
Affects more than 5 million adults in the United States

Vascular Dementia

Often results from multiple small strokes or infarcts that block major blood vessels in the brain
Can also be caused by low blood pressure (hypoperfusion) from other conditions
Symptoms vary widely, depending on severity of blood vessel damage and part of the brain affected
Memory loss may or may not be a significant symptom
Often accompanied by seizures, especially after a stroke
Progression follows a "sawtooth" or stair-step pattern, with cognitive decline followed by periods of stabilization

Dementia Overview

Dementia is a general term describing the loss of one or more cortical functions or cognitive attributes due to brain degeneration.
The DSM-5 uses the term mild and major neurocognitive disorder (NCD) to replace the older term dementia.

Mild Neurocognitive Disorder (NCD)

Characterized by limited impairment, individuals with mild NCDs can maintain independent functioning with some modifications (e.g. medication reminders).
Often in the initial stages of disease progression.

Major Neurocognitive Disorder (NCD)

Characterized by the loss of additional cortical functions, leading to a loss of independence.

Causes and Risk Factors

Metabolic problems
Nutritional deficiencies
Infections
Poisoning
Medications
Conditions that compromise oxygenation and perfusion

Subtypes of NCDs

Classified by etiology
Examples include Alzheimer disease and vascular dementia

Alzheimer Disease

The most common form of dementia, accounting for about 80% of all cases
Affects more than 5 million adults in the United States

Vascular Dementia

Often results from multiple small strokes or infarcts that block major blood vessels in the brain
Can also be caused by low blood pressure (hypoperfusion) from other conditions
Symptoms vary widely, depending on severity of blood vessel damage and part of the brain affected
Memory loss may or may not be a significant symptom
Often accompanied by seizures, especially after a stroke
Progression follows a "sawtooth" or stair-step pattern, with cognitive decline followed by periods of stabilization

Conditions that Mimic Dementia

Depression and emotional problems can cause cognitive slowing and disorientation in older individuals, mimicking dementia
Delirium symptoms can be difficult to distinguish from those of dementia

Schizophrenia Spectrum and Other Psychotic Disorders

Psychotic disorders encompass a broad range of cognitive alterations that result in altered perceptions of reality and abnormal thinking
Schizophrenia is a type of psychotic disorder, affecting approximately 1-4% of the population, with 1% meeting the criteria for schizophrenia
The DSM-5 identifies multiple psychotic disorders beyond schizophrenia spectrum disorder
Psychosis can result from an underlying medical condition or substance ingestion, so diagnostic tests should be run to rule out underlying causes

Risk Factors for Altered Cognitive Function

Developmental and acquired cognitive disorders often have a nonmodifiable familial/genetic component
Other risk factors include population-specific factors, lifestyle behaviors, environmental exposures, and certain health conditions
Most cognitive disorders are believed to be multifactorial, resulting from genetic factors, age, sex, lifestyle behaviors, environmental exposures, or other health conditions

Conditions that Mimic Dementia

Depression and emotional problems can cause cognitive slowing and disorientation in older individuals, mimicking dementia
Delirium symptoms can be difficult to distinguish from those of dementia

Schizophrenia Spectrum and Other Psychotic Disorders

Psychotic disorders encompass a broad range of cognitive alterations that result in altered perceptions of reality and abnormal thinking
Schizophrenia is a type of psychotic disorder, affecting approximately 1-4% of the population, with 1% meeting the criteria for schizophrenia
The DSM-5 identifies multiple psychotic disorders beyond schizophrenia spectrum disorder
Psychosis can result from an underlying medical condition or substance ingestion, so diagnostic tests should be run to rule out underlying causes

Risk Factors for Altered Cognitive Function

Developmental and acquired cognitive disorders often have a nonmodifiable familial/genetic component
Other risk factors include population-specific factors, lifestyle behaviors, environmental exposures, and certain health conditions
Most cognitive disorders are believed to be multifactorial, resulting from genetic factors, age, sex, lifestyle behaviors, environmental exposures, or other health conditions

Cognitive Function and Interdependent Systems

Cerebral perfusion is necessary for normal cognitive functioning, which depends on adequate oxygen intake and osmotic pressure to maintain blood flow.
Subtle variations in perfusion can cause acute alterations in cognitive function, such as delirium, with older adults being more sensitive to these changes due to diminished functional reserves.

Cerebral Perfusion and Cognitive Integrity

Cerebral perfusion and cognitive integrity depend on normal gas exchange.
Chronic and subtle mechanisms involved in decreased oxygen supply to the brain (e.g., COPD, anemia) can negatively impact neurochemical signaling and synaptic plasticity necessary for normal cognitive development and function.

Genetic and Environmental Factors

Genetic factors and early environmental insults can influence development in utero or in the child's first years, affecting learning, cognition, and speech and language development.
Exposure to alcohol or other toxins during pregnancy can have long-term implications for child health and cognition.

Inflammation and Cognitive Function

Inflammation plays a key role in altered cognitive function, triggered by stress, infection, surgery, and cancer.
Inflammation can occur in the brain and CNS as a direct result of trauma, cerebral infarction, or infection, or peripherally (outside of the CNS) with implications for affective, cognitive, and behavioral responses.
Chronic or persistent inflammation can lead to irreversible neuronal changes, whereas initial inflammation is adaptive, enabling individuals to conserve energy necessary for healing.

Substances and Cognitive Function

Substances such as alcohol, illicit drugs, and some pharmaceuticals can impact cognitive function.

Cognitive Function and Interdependent Systems

Cerebral perfusion is necessary for normal cognitive functioning, which depends on adequate oxygen intake and osmotic pressure to maintain blood flow.
Subtle variations in perfusion can cause acute alterations in cognitive function, such as delirium, with older adults being more sensitive to these changes due to diminished functional reserves.

Cerebral Perfusion and Cognitive Integrity

Cerebral perfusion and cognitive integrity depend on normal gas exchange.
Chronic and subtle mechanisms involved in decreased oxygen supply to the brain (e.g., COPD, anemia) can negatively impact neurochemical signaling and synaptic plasticity necessary for normal cognitive development and function.

Genetic and Environmental Factors

Genetic factors and early environmental insults can influence development in utero or in the child's first years, affecting learning, cognition, and speech and language development.
Exposure to alcohol or other toxins during pregnancy can have long-term implications for child health and cognition.

Inflammation and Cognitive Function

Inflammation plays a key role in altered cognitive function, triggered by stress, infection, surgery, and cancer.
Inflammation can occur in the brain and CNS as a direct result of trauma, cerebral infarction, or infection, or peripherally (outside of the CNS) with implications for affective, cognitive, and behavioral responses.
Chronic or persistent inflammation can lead to irreversible neuronal changes, whereas initial inflammation is adaptive, enabling individuals to conserve energy necessary for healing.

Substances and Cognitive Function

Substances such as alcohol, illicit drugs, and some pharmaceuticals can impact cognitive function.

Prevention of Cognitive Disorders

Prevention of cognitive disorders involves reducing modifiable risk factors and enhancing protective factors
Universal prevention targets the general population, using interventions such as public health campaigns to promote safety device use (e.g. seat belts)
Selective prevention targets high-risk subgroups based on biological, psychological, or socioeconomic factors (e.g. early intervention programs for disadvantaged children, counseling for trauma-exposed individuals)
Indicated prevention aims to intervene in individuals with detectable symptoms or biomarkers of cognitive disorders (e.g. treating prodromal schizophrenia symptoms or dementia biomarkers)

Screening and Early Detection

Early detection and intervention can positively impact the progression and impact of many cognitive disorders
Screening and detection occur in various settings, including primary care, community health, and schools
Various screening tools are used in assessment (detailed in later sections)

Nursing Assessment

A general cognitive status assessment is essential in nursing assessments for all patients
When patients present with cognitive changes, priority assessment focuses on addressing potentially life-threatening factors through physical assessment, history, and diagnostic procedures (e.g. laboratory values)

Prevention of Cognitive Disorders

Prevention of cognitive disorders involves reducing modifiable risk factors and enhancing protective factors
Universal prevention targets the general population, using interventions such as public health campaigns to promote safety device use (e.g. seat belts)
Selective prevention targets high-risk subgroups based on biological, psychological, or socioeconomic factors (e.g. early intervention programs for disadvantaged children, counseling for trauma-exposed individuals)
Indicated prevention aims to intervene in individuals with detectable symptoms or biomarkers of cognitive disorders (e.g. treating prodromal schizophrenia symptoms or dementia biomarkers)

Screening and Early Detection

Early detection and intervention can positively impact the progression and impact of many cognitive disorders
Screening and detection occur in various settings, including primary care, community health, and schools
Various screening tools are used in assessment (detailed in later sections)

Nursing Assessment

A general cognitive status assessment is essential in nursing assessments for all patients
When patients present with cognitive changes, priority assessment focuses on addressing potentially life-threatening factors through physical assessment, history, and diagnostic procedures (e.g. laboratory values)

Cognitive Assessment and Safety

Any changes in cognition require immediate attention to prevent injury and identify underlying causes.
Rapid initiation of safety measures is critical to address cognitive disturbances.

Importance of Cognitive Assessment

Cognitive assessment is performed for initial screening and monitoring changes in cognition over time.
Assessment should be performed during initial provider or home care visits, after changes in medical treatment, during transitions in care, and prior to obtaining consent for procedures.

High-Risk Individuals

Certain individuals, such as hospitalized older adults, are at increased risk for cognitive problems and require more frequent assessment.
Clinical guidelines recommend comprehensive geriatric assessment (CGA) for hospitalized older adults.
CGA promotes collaborative, integrated care by assessing medical, mental, and functional problems in older people with frailty.

Observation and Patient Interview

Initial observation focuses on appearance, behavioral manifestations, and social skills to assess cognitive function.
The patient is the best source of information, but family members or caregivers may be asked to provide information for pediatric patients or those with moderate to severe cognitive impairment.
Direct questioning is used to elicit information on biophysical and psychosocial history, development, family history, and environmental factors.

Considerations for Patient Interview

Judgment is required when questioning individuals with established cognitive and perceptual problems, as they may not respond logically.
Patients with cognitive problems, such as perceptual problems and delusional thinking, may experience increased anxiety and exhibit inappropriate behaviors during the patient interview and examination.

Cognitive Assessment and Safety

Any changes in cognition require immediate attention to prevent injury and identify underlying causes.
Rapid initiation of safety measures is critical to address cognitive disturbances.

Importance of Cognitive Assessment

Cognitive assessment is performed for initial screening and monitoring changes in cognition over time.
Assessment should be performed during initial provider or home care visits, after changes in medical treatment, during transitions in care, and prior to obtaining consent for procedures.

High-Risk Individuals

Certain individuals, such as hospitalized older adults, are at increased risk for cognitive problems and require more frequent assessment.
Clinical guidelines recommend comprehensive geriatric assessment (CGA) for hospitalized older adults.
CGA promotes collaborative, integrated care by assessing medical, mental, and functional problems in older people with frailty.

Observation and Patient Interview

Initial observation focuses on appearance, behavioral manifestations, and social skills to assess cognitive function.
The patient is the best source of information, but family members or caregivers may be asked to provide information for pediatric patients or those with moderate to severe cognitive impairment.
Direct questioning is used to elicit information on biophysical and psychosocial history, development, family history, and environmental factors.

Considerations for Patient Interview

Judgment is required when questioning individuals with established cognitive and perceptual problems, as they may not respond logically.
Patients with cognitive problems, such as perceptual problems and delusional thinking, may experience increased anxiety and exhibit inappropriate behaviors during the patient interview and examination.

Biophysical and Psychosocial History

Gathering information about both the presenting problem and the presence or development of altered health patterns across the lifespan.
Focus on the patient's perception of the problem and what brings them to the healthcare setting currently.

History of the Current Problem

Initial questions focus on the patient's daily life, including:
- ADLs (Activities of Daily Living)
- Self-care activities
- Perceived level of health and wellness
Questions to ask when patients or family members report changes in cognitive function:
- Describe the changes
- What may be contributing to the changes?
- When did the changes start?
- Are the changes constant and how frequently do they occur?
- Have you previously sought medical advice or care related to these changes?

Additional Questions

Are you experiencing changes in:
- Ability to pay attention or remember things
- Ability to plan and organize things
- Hearing, seeing, or smelling things that are not apparent to others
- Learning or functioning in school (or work)
- Expressing yourself or understanding others
Questions to ask depending on the patient's responses:
- Impact on daily functioning
- Frequency and duration of symptoms
- Suspected causes or contributing factors (e.g. preexisting medical or psychiatric diagnosis)
- How the patient has been treating or managing the symptoms
Obtain a list of all current medications with:
- Dose
- Route
- Frequency
Inquire about the use of any complementary health approaches

Biophysical and Psychosocial History

Gathering information about both the presenting problem and the presence or development of altered health patterns across the lifespan.
Focus on the patient's perception of the problem and what brings them to the healthcare setting currently.

History of the Current Problem

Initial questions focus on the patient's daily life, including:
- ADLs (Activities of Daily Living)
- Self-care activities
- Perceived level of health and wellness
Questions to ask when patients or family members report changes in cognitive function:
- Describe the changes
- What may be contributing to the changes?
- When did the changes start?
- Are the changes constant and how frequently do they occur?
- Have you previously sought medical advice or care related to these changes?

Additional Questions

Are you experiencing changes in:
- Ability to pay attention or remember things
- Ability to plan and organize things
- Hearing, seeing, or smelling things that are not apparent to others
- Learning or functioning in school (or work)
- Expressing yourself or understanding others
Questions to ask depending on the patient's responses:
- Impact on daily functioning
- Frequency and duration of symptoms
- Suspected causes or contributing factors (e.g. preexisting medical or psychiatric diagnosis)
- How the patient has been treating or managing the symptoms
Obtain a list of all current medications with:
- Dose
- Route
- Frequency
Inquire about the use of any complementary health approaches

History of Prior Biophysical and Psychosocial Alterations

Assess patient's history of development, illness, injury, and health behaviors, including substance use, to identify potential contributors to cognitive alterations.
Evaluate children's achievement of expected milestones and identify factors that may impede normal growth and development, such as chronic illness or exposure to trauma.
Inquire about family history of disorders, such as dementia, schizophrenia, and developmental or learning problems, using lay terms to describe symptoms and behaviors.

Environmental and Lifestyle Factors

Assess environmental factors contributing to cognitive status, including:
- Nutrition and lifestyle considerations
- Use of medications or herbal supplements
- Accommodations or services supporting independent function
Evaluate parenting techniques and capabilities, as well as access to activities promoting cognitive development in children.

Toxic Substances Exposure

Determine possibility of current or past exposures to toxic substances at home or at work.

Physical and Mental Status Examination

Conduct a physical assessment to identify alterations contributing to cognitive dysfunction, using an organized pattern of assessment.
Perform a mental status examination, including a series of procedures and tools, to detect alterations in perception and thinking.

History of Prior Biophysical and Psychosocial Alterations

Assess patient's history of development, illness, injury, and health behaviors, including substance use, to identify potential contributors to cognitive alterations.
Evaluate children's achievement of expected milestones and identify factors that may impede normal growth and development, such as chronic illness or exposure to trauma.
Inquire about family history of disorders, such as dementia, schizophrenia, and developmental or learning problems, using lay terms to describe symptoms and behaviors.

Environmental and Lifestyle Factors

Assess environmental factors contributing to cognitive status, including:
- Nutrition and lifestyle considerations
- Use of medications or herbal supplements
- Accommodations or services supporting independent function
Evaluate parenting techniques and capabilities, as well as access to activities promoting cognitive development in children.

Toxic Substances Exposure

Determine possibility of current or past exposures to toxic substances at home or at work.

Physical and Mental Status Examination

Conduct a physical assessment to identify alterations contributing to cognitive dysfunction, using an organized pattern of assessment.
Perform a mental status examination, including a series of procedures and tools, to detect alterations in perception and thinking.

Physical Examination in Cognitive Evaluation

Begin with obtaining complete vital signs and assessing the patient's level of pain to detect early signs of decreased oxygenation or perfusion.
Auscultation of the heart and lungs can reveal underlying problems with gas exchange or perfusion, such as murmurs in infants and young children indicating congenital heart defects.
Assess peripheral perfusion to identify vascular problems that may compromise cerebral perfusion.

Neurological Assessment

Neurological signs are a crucial part of cognitive evaluation (refer to Module 11, Intracranial Regulation).
Evaluate sensory functions: hearing, vision, touch, taste, and smell to rule out perceptual problems.

Physical Development and Characteristics

Physical development, height, weight, and fat distribution should be within normal limits for the patient's age.
Observable physical alterations may be associated with cognitive syndromes, such as:
Small head circumference
Wide- or close-set eyes
Prominent forehead
Epicanthic eye folds
Asymmetry or malformation of facial features and ears
Tongue protrusion
Palate and mouth abnormalities
Flattened face or nose
Limb abnormalities
Small stature
Poor muscle tone
Birthmarks
Palmar folds
Altered posture

Investigations and Motor Function

Genetic testing and serum and urine tests can investigate suspicions of genetic and metabolic/biochemical disorders accompanying developmental delay.
Assess motor function, ensuring movements are consistent with age and development.
Note any changes in gait or evidence of movement disorders.

Physical Examination in Cognitive Evaluation

Begin with obtaining complete vital signs and assessing the patient's level of pain to detect early signs of decreased oxygenation or perfusion.
Auscultation of the heart and lungs can reveal underlying problems with gas exchange or perfusion, such as murmurs in infants and young children indicating congenital heart defects.
Assess peripheral perfusion to identify vascular problems that may compromise cerebral perfusion.

Neurological Assessment

Neurological signs are a crucial part of cognitive evaluation (refer to Module 11, Intracranial Regulation).
Evaluate sensory functions: hearing, vision, touch, taste, and smell to rule out perceptual problems.

Physical Development and Characteristics

Physical development, height, weight, and fat distribution should be within normal limits for the patient's age.
Observable physical alterations may be associated with cognitive syndromes, such as:
Small head circumference
Wide- or close-set eyes
Prominent forehead
Epicanthic eye folds
Asymmetry or malformation of facial features and ears
Tongue protrusion
Palate and mouth abnormalities
Flattened face or nose
Limb abnormalities
Small stature
Poor muscle tone
Birthmarks
Palmar folds
Altered posture

Investigations and Motor Function

Genetic testing and serum and urine tests can investigate suspicions of genetic and metabolic/biochemical disorders accompanying developmental delay.
Assess motor function, ensuring movements are consistent with age and development.
Note any changes in gait or evidence of movement disorders.

Mental Status Examination

A broad screening tool used to assess an individual's current cognitive functioning.
Assesses orientation, perception, thought content, attention, concentration, memory, speech/language/communication, mood, affect, and psychomotor activity.
Can help rule out conditions like depression or mood disorders, and gather information on developmental status and functional impairment.

Diagnostic Tests

Nurses collaborate with other disciplines to support diagnostic assessment of individuals with cognitive disorders.
Laboratory tests and diagnostic imaging are used to rule out underlying medical conditions.
Priority diagnostic assessment focuses on life-threatening conditions that may manifest in cognitive alterations.

Laboratory Tests

Toxicology screens to rule out substance abuse as a cause of mental status changes.
Drug levels to rule out mental status changes related to toxic levels of therapeutic agents.
Liver function tests (LFTs), complete blood count (CBC), thyroid function, B1 (thiamine), sedimentation rate, urinalysis, HIV titer, and fluorescent treponemal antibody absorption (FTA-abs) to rule out metabolic, inflammatory, and infectious conditions.

Biomarkers and Genetic Testing

Analysis of blood and cerebrospinal fluid (CSF) can identify biomarkers associated with Alzheimer disease and schizophrenia.
Blood tests to identify biomarkers for schizophrenia.
CSF and blood markers to identify biomarkers for certain conditions.
Genetic testing to identify risk factors or underlying causes of cognitive disorders.

Imaging and Screening

Metabolic screening to detect 26 to 40 metabolic disorders that can cause learning and intellectual disabilities in newborns.
Diagnostic imaging (MRIs and CT) to detect conditions requiring emergency management, such as cerebral edema, cerebral vascular accidents, tumors, and traumatic injuries.

Mental Status Examination

A broad screening tool used to assess an individual's current cognitive functioning.
Assesses orientation, perception, thought content, attention, concentration, memory, speech/language/communication, mood, affect, and psychomotor activity.
Can help rule out conditions like depression or mood disorders, and gather information on developmental status and functional impairment.

Diagnostic Tests

Nurses collaborate with other disciplines to support diagnostic assessment of individuals with cognitive disorders.
Laboratory tests and diagnostic imaging are used to rule out underlying medical conditions.
Priority diagnostic assessment focuses on life-threatening conditions that may manifest in cognitive alterations.

Laboratory Tests

Toxicology screens to rule out substance abuse as a cause of mental status changes.
Drug levels to rule out mental status changes related to toxic levels of therapeutic agents.
Liver function tests (LFTs), complete blood count (CBC), thyroid function, B1 (thiamine), sedimentation rate, urinalysis, HIV titer, and fluorescent treponemal antibody absorption (FTA-abs) to rule out metabolic, inflammatory, and infectious conditions.

Biomarkers and Genetic Testing

Analysis of blood and cerebrospinal fluid (CSF) can identify biomarkers associated with Alzheimer disease and schizophrenia.
Blood tests to identify biomarkers for schizophrenia.
CSF and blood markers to identify biomarkers for certain conditions.
Genetic testing to identify risk factors or underlying causes of cognitive disorders.

Imaging and Screening

Metabolic screening to detect 26 to 40 metabolic disorders that can cause learning and intellectual disabilities in newborns.
Diagnostic imaging (MRIs and CT) to detect conditions requiring emergency management, such as cerebral edema, cerebral vascular accidents, tumors, and traumatic injuries.

Cognitive Development

Jean Piaget believed that cognitive development is constructed by the individual through active interaction with the environment.
Cognitive development is an orderly, sequential process in which children form adaptive cognitive structures (schemes) in response to environmental stimuli.
Children revise their schemes to better fit with the reality they observe through physical interaction with the world.

Psychometric Tests

Psychometric tests are standardized tests that measure cognitive function in various areas.
Comprehensive neuropsychologic testing involves using multiple tests administered over several days.
Rating scales completed by nurses, teachers, parents, and patients contribute to an overall understanding of the problem across different domains.

Independent Interventions

Nurses play a crucial role in health promotion with respect to cognitive disorders.
Independent interventions include teaching prevention, coordinating care, making referrals, promoting individual/family safety and well-being, and advocating for individuals impacted by cognitive disorders.
Examples of independent interventions:
- Teaching about healthy diet and lifestyle, and preventive healthcare
- Ensuring patients use protective headgear during sports and activities
- Stressing the importance of developmentally appropriate activities
- Administering routine developmental and cognitive screenings
- Making referrals to other interprofessional team members

Cognitive Development

Jean Piaget believed that cognitive development is constructed by the individual through active interaction with the environment.
Cognitive development is an orderly, sequential process in which children form adaptive cognitive structures (schemes) in response to environmental stimuli.
Children revise their schemes to better fit with the reality they observe through physical interaction with the world.

Psychometric Tests

Psychometric tests are standardized tests that measure cognitive function in various areas.
Comprehensive neuropsychologic testing involves using multiple tests administered over several days.
Rating scales completed by nurses, teachers, parents, and patients contribute to an overall understanding of the problem across different domains.

Independent Interventions

Nurses play a crucial role in health promotion with respect to cognitive disorders.
Independent interventions include teaching prevention, coordinating care, making referrals, promoting individual/family safety and well-being, and advocating for individuals impacted by cognitive disorders.
Examples of independent interventions:
- Teaching about healthy diet and lifestyle, and preventive healthcare
- Ensuring patients use protective headgear during sports and activities
- Stressing the importance of developmentally appropriate activities
- Administering routine developmental and cognitive screenings
- Making referrals to other interprofessional team members

Promoting Safety and Well-Being

Nurses in various settings plan care that promotes safety and adaptive functioning for individuals with cognitive disorders, such as schizophrenia and Alzheimer disease.
Home health nurses monitor treatment adherence, provide emotional support, and assess comorbid health conditions.
When patients require hospitalization, the priority is to identify and manage underlying conditions contributing to the problem.
Priority interventions focus on immediate safety, followed by secondary interventions, including teaching, emotional support, and discharge preparation.

Interventions Across Settings

Evaluating risk of injury or suicide
Implementing environmental modifications to support patient safety
Educating patients and families about diseases, medications, and therapeutic interventions
Identifying patient and family strengths
Encouraging adaptive coping skills
Supporting cultural and spiritual needs
Providing ongoing emotional support to patients and families
Ensuring healthcare needs are met
Monitoring the effectiveness of care

Advocating for Patients

Nurses ensure patients are not abused or exploited and can participate in healthcare decisions to the greatest extent possible.
They encourage patients to establish advance directives and provide teaching on legal protections.
Other advocacy interventions include teaching on legal rights and assisting caregivers and community members to understand cognitive disorders.
Nurses in pediatric settings refer families to early childhood intervention services.

Promoting Safety and Well-Being

Nurses in various settings plan care that promotes safety and adaptive functioning for individuals with cognitive disorders, such as schizophrenia and Alzheimer disease.
Home health nurses monitor treatment adherence, provide emotional support, and assess comorbid health conditions.
When patients require hospitalization, the priority is to identify and manage underlying conditions contributing to the problem.
Priority interventions focus on immediate safety, followed by secondary interventions, including teaching, emotional support, and discharge preparation.

Interventions Across Settings

Evaluating risk of injury or suicide
Implementing environmental modifications to support patient safety
Educating patients and families about diseases, medications, and therapeutic interventions
Identifying patient and family strengths
Encouraging adaptive coping skills
Supporting cultural and spiritual needs
Providing ongoing emotional support to patients and families
Ensuring healthcare needs are met
Monitoring the effectiveness of care

Advocating for Patients

Nurses ensure patients are not abused or exploited and can participate in healthcare decisions to the greatest extent possible.
They encourage patients to establish advance directives and provide teaching on legal protections.
Other advocacy interventions include teaching on legal rights and assisting caregivers and community members to understand cognitive disorders.
Nurses in pediatric settings refer families to early childhood intervention services.

Legal Protections for Patients with Cognitive Dysfunction

The Americans with Disabilities Act of 1990 ensures equal access to government services, employment, and public accommodations for individuals with disabilities.
The Education for All Handicapped Children Act of 1975 requires access to free public education for children with disabilities.
Amendments to this act in 1986 provide federal funding to states that offer early intervention services.
The Developmental Disabilities and Bill of Rights Act of 2000 provides federal funding to state, public, and nonprofit agencies for community-based training activities and education for individuals with developmental disabilities.
The law creates the U.S. Administration on Developmental Disabilities to oversee these efforts.

Collaborative Therapies

Nurses should collaborate with patients, families, healthcare teams, and professionals from other disciplines, such as education and law, when working with individuals at risk of or experiencing cognitive alterations.
Members of the interprofessional team include healthcare professionals, developmental pediatricians, developmental psychologists, neuropsychologists, and neurologists.
Additional resources may be available through local chapters of organizations such as the Alzheimer’s Association, the American Psychiatric Association, the American Association of Intellectual and Developmental Disabilities, and the National Alliance on Mental Illness.

Legal Protections for Patients with Cognitive Dysfunction

The Americans with Disabilities Act of 1990 ensures equal access to government services, employment, and public accommodations for individuals with disabilities.
The Education for All Handicapped Children Act of 1975 requires access to free public education for children with disabilities.
Amendments to this act in 1986 provide federal funding to states that offer early intervention services.
The Developmental Disabilities and Bill of Rights Act of 2000 provides federal funding to state, public, and nonprofit agencies for community-based training activities and education for individuals with developmental disabilities.
The law creates the U.S. Administration on Developmental Disabilities to oversee these efforts.

Collaborative Therapies

Nurses should collaborate with patients, families, healthcare teams, and professionals from other disciplines, such as education and law, when working with individuals at risk of or experiencing cognitive alterations.
Members of the interprofessional team include healthcare professionals, developmental pediatricians, developmental psychologists, neuropsychologists, and neurologists.
Additional resources may be available through local chapters of organizations such as the Alzheimer’s Association, the American Psychiatric Association, the American Association of Intellectual and Developmental Disabilities, and the National Alliance on Mental Illness.

Pharmacologic Therapy for Cognitive Alterations

Nurses play a crucial role in medication administration, education, and adherence for patients with cognitive alterations.
The primary goal of pharmacologic therapy is to slow down brain changes and deterioration in functioning.
Medications for treating psychosis target presenting symptoms to balance brain chemistry and normalize behaviors.

Medication Administration and Education

Nurses must be familiar with different classes of drugs prescribed for cognitive alterations.
They should consult with the pharmacist or physician if they have medication questions.
Nurses are responsible for educating family and caregivers about administering medications and their side effects, including adverse drug reactions.

Safety Considerations

Nurses must assess patients' ability to self-administer medication, as many patients may require caregiver administration.
Missed doses can result in a return or exacerbation of symptoms, increasing the patient's risk for deterioration or injury.
Long-acting drug formulations can enhance adherence.

Lifespan Considerations

Cognitive function is influenced by the interaction of genes and experience.
Nurses should consider the impact of normal growth and development on cognitive changes across the lifespan.
This knowledge helps nurses modify assessment and interventions for individuals at risk for or experiencing cognitive alterations.

Pharmacologic Therapy for Cognitive Alterations

Nurses play a crucial role in medication administration, education, and adherence for patients with cognitive alterations.
The primary goal of pharmacologic therapy is to slow down brain changes and deterioration in functioning.
Medications for treating psychosis target presenting symptoms to balance brain chemistry and normalize behaviors.

Medication Administration and Education

Nurses must be familiar with different classes of drugs prescribed for cognitive alterations.
They should consult with the pharmacist or physician if they have medication questions.
Nurses are responsible for educating family and caregivers about administering medications and their side effects, including adverse drug reactions.

Safety Considerations

Nurses must assess patients' ability to self-administer medication, as many patients may require caregiver administration.
Missed doses can result in a return or exacerbation of symptoms, increasing the patient's risk for deterioration or injury.
Long-acting drug formulations can enhance adherence.

Lifespan Considerations

Cognitive function is influenced by the interaction of genes and experience.
Nurses should consider the impact of normal growth and development on cognitive changes across the lifespan.
This knowledge helps nurses modify assessment and interventions for individuals at risk for or experiencing cognitive alterations.

Lev Vygotsky's Theory

Emphasized the importance of social interaction in the development of cognition
Argued that social interactions help individuals find meaning, form memories, and are culturally influenced
Provided the theoretical underpinnings for collaborative education and online learning
Viewed learning as a social process

Cognitive Development from Conception to Adolescence

Simple neuronal connections that shape cognition occur shortly after conception
These connections become increasingly complex circuits over time
Insults during embryonic development (e.g., toxic substances, maternal stress, nutritional deficits, illness) can negatively impact cognition
Rapid development of neuronal connections occurs during the first few years of life
Children assimilate new information, revise cognitive constructs, and form new thinking structures or schemes to facilitate adaptation

Brain Development and Pruning

Pruning is the process of eliminating or remodeling unused connections to strengthen cognitive efficiency
Pruning occurs during sensitive periods of brain development (e.g., infancy and early childhood)
Brains are primed for stimulation of visual pathways and language during these periods
If these pathways are not activated, they will be eliminated, impacting cognitive capabilities

Factors Affecting Cognitive Development

Medical illness and adverse childhood experiences can alter cognitive development and mental function
Young children have limited functional reserves to compensate for certain conditions (e.g., dehydration, infection)
Cognitive changes (e.g., confusion, hallucinations) may occur in young children in the presence of these conditions

Lev Vygotsky's Theory

Emphasized the importance of social interaction in the development of cognition
Argued that social interactions help individuals find meaning, form memories, and are culturally influenced
Provided the theoretical underpinnings for collaborative education and online learning
Viewed learning as a social process

Cognitive Development from Conception to Adolescence

Simple neuronal connections that shape cognition occur shortly after conception
These connections become increasingly complex circuits over time
Insults during embryonic development (e.g., toxic substances, maternal stress, nutritional deficits, illness) can negatively impact cognition
Rapid development of neuronal connections occurs during the first few years of life
Children assimilate new information, revise cognitive constructs, and form new thinking structures or schemes to facilitate adaptation

Brain Development and Pruning

Pruning is the process of eliminating or remodeling unused connections to strengthen cognitive efficiency
Pruning occurs during sensitive periods of brain development (e.g., infancy and early childhood)
Brains are primed for stimulation of visual pathways and language during these periods
If these pathways are not activated, they will be eliminated, impacting cognitive capabilities

Factors Affecting Cognitive Development

Medical illness and adverse childhood experiences can alter cognitive development and mental function
Young children have limited functional reserves to compensate for certain conditions (e.g., dehydration, infection)
Cognitive changes (e.g., confusion, hallucinations) may occur in young children in the presence of these conditions

Cognition from Adolescence to Adulthood

Brain structure continues to undergo significant changes during adolescence, with rapid generation and remodeling of neuronal pathways.
The limbic system's increased activity is associated with sensation seeking and the need for arousal, while the underdeveloped prefrontal cortex struggles to regulate impulses.
Deficits in decision making increase the risk of injuries and substance abuse among adolescents.
Changes in dopamine systems drive adolescents towards reward-seeking behavior, and positive reinforcement can enhance self-regulation.
New-onset cognitive dysfunction in adolescence may indicate underlying illness, recent trauma, or developing mental illness.
Cognitive dysfunction in adolescence increases the risk of depression, suicide, substance abuse, and antisocial behavior.
Social implications of cognitive disorders can have a devastating impact on self-esteem and peer relationships.
Concerns about being different can negatively impact adherence to treatment.
Normal changes of adolescence, including increased independence, hormonal shifts, and sexual development, can present challenges for adolescents with cognitive alterations and their parents.
Teaching strategies for adolescents with cognitive conditions focus on providing developmentally and cognitively appropriate information on issues such as safety, sexuality, adaptive coping, and condition management.

Cognition from Adolescence to Adulthood

Brain structure continues to undergo significant changes during adolescence, with rapid generation and remodeling of neuronal pathways.
The limbic system's increased activity is associated with sensation seeking and the need for arousal, while the underdeveloped prefrontal cortex struggles to regulate impulses.
Deficits in decision making increase the risk of injuries and substance abuse among adolescents.
Changes in dopamine systems drive adolescents towards reward-seeking behavior, and positive reinforcement can enhance self-regulation.
New-onset cognitive dysfunction in adolescence may indicate underlying illness, recent trauma, or developing mental illness.
Cognitive dysfunction in adolescence increases the risk of depression, suicide, substance abuse, and antisocial behavior.
Social implications of cognitive disorders can have a devastating impact on self-esteem and peer relationships.
Concerns about being different can negatively impact adherence to treatment.
Normal changes of adolescence, including increased independence, hormonal shifts, and sexual development, can present challenges for adolescents with cognitive alterations and their parents.
Teaching strategies for adolescents with cognitive conditions focus on providing developmentally and cognitively appropriate information on issues such as safety, sexuality, adaptive coping, and condition management.

Cognition from Adulthood through Middle Age

Brain maturation, especially in areas responsible for executive function, is not fully complete until the mid- to late 20s, and may not be fully mature for men until the early 30s.
Middle-aged adults have an enhanced ability to read other people's emotional states.
Vocabulary and accumulated knowledge peak later in life.
Cognitive strengths of patients across the lifespan should be focused on, rather than perpetuating myths about cognitive decline with aging.
Nursing care for adults with cognitive problems should consider the patient's need for intimate relationships and vocational goals.
Teaching about family planning and sexually responsible behaviors should be incorporated into care.
Research suggests that pregnancy and childbirth may affect maternal cognition, with reduced function in processing speed, verbal recall, and attention.
Hormonal shifts likely contribute to these changes, enabling the mother to be more in tune with the newborn's needs.
Fatigue and sleep deprivation may also contribute to cognitive alterations and trigger other mental health issues.

Cognition in Older Adults

Typical changes in the brain with aging lead to subtle differences in cognitive processing.
Modest shrinkage of brain tissue and decreased blood flow to areas responsible for memory, executive function, and cognitive flexibility contribute to these changes.
Older adults may have difficulty with cognitive functions, such as word retrieval and episodic memory, but the impact on overall cognitive function should be minimal.
Visuospatial tasks like drawing may diminish slightly with age.
Moderate to severe cognitive decline is not a normal part of aging and may indicate an underlying medical or mental health issue.

Cognition from Adulthood through Middle Age

Brain maturation, especially in areas responsible for executive function, is not fully complete until the mid- to late 20s, and may not be fully mature for men until the early 30s.
Middle-aged adults have an enhanced ability to read other people's emotional states.
Vocabulary and accumulated knowledge peak later in life.
Cognitive strengths of patients across the lifespan should be focused on, rather than perpetuating myths about cognitive decline with aging.
Nursing care for adults with cognitive problems should consider the patient's need for intimate relationships and vocational goals.
Teaching about family planning and sexually responsible behaviors should be incorporated into care.
Research suggests that pregnancy and childbirth may affect maternal cognition, with reduced function in processing speed, verbal recall, and attention.
Hormonal shifts likely contribute to these changes, enabling the mother to be more in tune with the newborn's needs.
Fatigue and sleep deprivation may also contribute to cognitive alterations and trigger other mental health issues.

Cognition in Older Adults

Typical changes in the brain with aging lead to subtle differences in cognitive processing.
Modest shrinkage of brain tissue and decreased blood flow to areas responsible for memory, executive function, and cognitive flexibility contribute to these changes.
Older adults may have difficulty with cognitive functions, such as word retrieval and episodic memory, but the impact on overall cognitive function should be minimal.
Visuospatial tasks like drawing may diminish slightly with age.
Moderate to severe cognitive decline is not a normal part of aging and may indicate an underlying medical or mental health issue.

Perceptual Disturbances/Psychosis

Alterations in ability to interpret environmental stimuli, think clearly and logically, and maintain orientation to person, place, time, and situation
Characterized by hallucinations, delusions, disordered thinking, and disorientation/confusion
Key strategies for management include identifying and treating underlying causes, reducing environmental stimulation, and reality orientation and validation therapy

Impaired Attention

Difficulty sustaining or directing focus
Characterized by being easily distracted, avoiding situations requiring sustained focus, and difficulty learning
Key strategies for management include identifying and treating underlying causes and reducing distractions

Memory Problems

Impairment in ability to recall information
Characterized by getting lost, difficulty with word finding and recognition, and difficulty remembering recent and remote events
Key strategies for management include identifying and treating underlying causes, cognitive remediation, and providing compensatory strategies and memory aids

Indicator Descriptions

Loose associations: pattern of speech in which a person's ideas slip off track onto another unrelated or obliquely related topic
Tangentiality: digressing from the topic at hand and going off on a tangent
Incoherence/word salad/neologisms: speaking in meaningless phrases with words that are seemingly randomly chosen, often made up, and not connected
Illogicality: speech in which there is an absence of reason and rationality

Assessment Tools

Confusion Assessment Method (CAM): five-minute interview-style exam that screens specifically for signs of delirium
Pediatric versions: pCAM/psCAM-ICU for critically ill infants and children
Cornell Assessment of Pediatric Delirium: validated, rapid observational tool for screening children in intensive care for delirium
Cornell Scale for Depression in Dementia: nineteen-question tool that involves interviews with both patients and their caregivers; assesses for signs of depression in individuals known to have dementia

Depression Screening Tools

Edinburgh Depression Scale: validated 10-item questionnaire used to screen for the presence and severity of symptoms of postnatal depression
Geriatric Depression Scale (GDS): brief questionnaire (15 or 30 items) that asks patients how they've felt over the past 7 days; assesses for depression in older adults
Hamilton Rating Scale for Depression (HRSD): twenty-minute, 17-question examination that assesses severity of depression in adult patients
The Weinberg Depression Scale for Children and Adolescents (WDSCA) and the Children's Depression Rating Scale (CDRS-R): modeled on the HRSD and adapted for children over age 5

Alteration Disturbances/Psychosis

Perceptual disturbances/psychosis involve alterations in the ability to interpret environmental stimuli, think clearly and logically, and maintain orientation to person, place, time, and situation.
Characteristics include hallucinations, delusions, disordered thinking, and disorientation/confusion.
Treatment involves identifying and treating the underlying cause, reducing environmental stimulation, and providing reality orientation and validation therapy.

Impaired Attention

Impaired attention involves difficulty sustaining or directing focus and easily getting distracted.
Characteristics include avoiding situations that require sustained focus, difficulty learning, and getting easily distracted.
Treatment involves identifying and treating the underlying cause and reducing distractions.

Memory Problems

Memory problems involve impairment in the ability to recall information.
Characteristics include getting lost, difficulty with word finding and recognition, and difficulty remembering recent and remote events.
Treatment involves identifying and treating the underlying cause, providing cognitive remediation, using compensatory strategies, and memory aids.

Alteration Disturbances/Psychosis

Perceptual disturbances/psychosis involve alterations in the ability to interpret environmental stimuli, think clearly and logically, and maintain orientation to person, place, time, and situation.
Characteristics include hallucinations, delusions, disordered thinking, and disorientation/confusion.
Treatment involves identifying and treating the underlying cause, reducing environmental stimulation, and providing reality orientation and validation therapy.

Impaired Attention

Impaired attention involves difficulty sustaining or directing focus and easily getting distracted.
Characteristics include avoiding situations that require sustained focus, difficulty learning, and getting easily distracted.
Treatment involves identifying and treating the underlying cause and reducing distractions.

Memory Problems

Memory problems involve impairment in the ability to recall information.
Characteristics include getting lost, difficulty with word finding and recognition, and difficulty remembering recent and remote events.
Treatment involves identifying and treating the underlying cause, providing cognitive remediation, using compensatory strategies, and memory aids.

Language and Communication

Loose associations: a pattern of speech where a person's ideas deviate from the topic to unrelated or obliquely related topics, also known as derailment.

Cognitive Distortions

Tangentiality: digressing from the main topic and starting a new, unrelated train of thought.

Speaking Patterns

Incoherence/word salad/neologisms: speaking in meaningless phrases with randomly chosen or made-up words that are not connected.
Illogicality: absence of reason and rationality in speech.

Communication Styles

Circumstantiality: providing excessive details about an event, making it difficult to get to the point of the conversation.
Pressured/distractible speech: rapid speech with a sense of urgency or frenzy, accompanied by tangentiality, making it hard to interrupt.

Speech Abnormalities

Poverty of speech: the opposite of pressured speech, characterized by a lack of spontaneous speech in ordinary conversations, brief or empty responses, and an inability to engage in small talk.

Language and Communication

Loose associations: a pattern of speech where a person's ideas deviate from the topic to unrelated or obliquely related topics, also known as derailment.

Cognitive Distortions

Tangentiality: digressing from the main topic and starting a new, unrelated train of thought.

Speaking Patterns

Incoherence/word salad/neologisms: speaking in meaningless phrases with randomly chosen or made-up words that are not connected.
Illogicality: absence of reason and rationality in speech.

Communication Styles

Circumstantiality: providing excessive details about an event, making it difficult to get to the point of the conversation.
Pressured/distractible speech: rapid speech with a sense of urgency or frenzy, accompanied by tangentiality, making it hard to interrupt.

Speech Abnormalities

Poverty of speech: the opposite of pressured speech, characterized by a lack of spontaneous speech in ordinary conversations, brief or empty responses, and an inability to engage in small talk.

Delirium, Dementia, and Depression: Key Differences

Onset and Duration

Delirium: acute, sudden, and rapid onset, lasting from hours to days
Dementia: slow, progressive onset, lasting from months to years
Depression: variable onset, with episodic duration

Cognitive Impairment

Delirium: affects memory and consciousness
Dementia: affects abstract thinking and memory
Depression: affects memory and concentration

Mood and Emotional State

Delirium: characterized by rapid mood swings
Dementia: often presents with depression and apathy
Depression: marked by sadness and anxiety

Delusions and Hallucinations

Delirium: may involve both delusions and hallucinations, often visual
Dementia: may present with delusions in later stages
Depression: may involve delusions, but not hallucinations

Outcome

Delirium: recovery is possible
Dementia: poor outcome
Depression: recovery is possible

Delirium, Dementia, and Depression: Key Differences

Onset and Duration

Delirium: acute, sudden, and rapid onset, lasting from hours to days
Dementia: slow, progressive onset, lasting from months to years
Depression: variable onset, with episodic duration

Cognitive Impairment

Delirium: affects memory and consciousness
Dementia: affects abstract thinking and memory
Depression: affects memory and concentration

Mood and Emotional State

Delirium: characterized by rapid mood swings
Dementia: often presents with depression and apathy
Depression: marked by sadness and anxiety

Delusions and Hallucinations

Delirium: may involve both delusions and hallucinations, often visual
Dementia: may present with delusions in later stages
Depression: may involve delusions, but not hallucinations

Outcome

Delirium: recovery is possible
Dementia: poor outcome
Depression: recovery is possible

Dementia Disorders

Dementia due to HIV

Caused by HIV-1 infection, resulting in HIV-1-associated cognitive/motor complex
Symptoms vary in early stages, with severe cognitive changes, confusion, behavioral changes, and psychosis in later stages
Symptom severity is associated with brain pathology extent

Dementia due to Traumatic Brain Injury

Caused by any type of head trauma
Amnesia is the most common neurobehavioral symptom following head trauma
Permanent disturbance may persist in varying degrees

Dementia due to Parkinson Disease

Caused by death of neurons, including those producing dopamine, responsible for movement and coordination
Characterized by tremor, rigidity, bradykinesia, and postural instability
Dementia reported in 20-60% of people with Parkinson disease, with cognitive and motor slowing, impaired memory, and executive functioning
Onset and course are slow and progressive

Dementia due to Huntington Disease

Inherited, dominant-gene, neurodegenerative disease
Initial symptoms include facial contortions, twisting, and tongue movements
Cognitive symptoms include memory deficits, frontal executive function problems, personality changes, and dementia signs
Disease begins in late 30s or early 40s, lasting 10-20 years or more before death

Lewy Body Dementia

Distinguished by eosinophilic inclusion bodies (Lewy bodies) in cortex and brainstem
Clinically similar to Alzheimer disease, but with earlier visual hallucinations and parkinsonian features

Dementia Disorders

Dementia due to HIV

Caused by HIV-1 infection, resulting in HIV-1-associated cognitive/motor complex
Symptoms vary in early stages, with severe cognitive changes, confusion, behavioral changes, and psychosis in later stages
Symptom severity is associated with brain pathology extent

Dementia due to Traumatic Brain Injury

Caused by any type of head trauma
Amnesia is the most common neurobehavioral symptom following head trauma
Permanent disturbance may persist in varying degrees

Dementia due to Parkinson Disease

Caused by death of neurons, including those producing dopamine, responsible for movement and coordination
Characterized by tremor, rigidity, bradykinesia, and postural instability
Dementia reported in 20-60% of people with Parkinson disease, with cognitive and motor slowing, impaired memory, and executive functioning
Onset and course are slow and progressive

Dementia due to Huntington Disease

Inherited, dominant-gene, neurodegenerative disease
Initial symptoms include facial contortions, twisting, and tongue movements
Cognitive symptoms include memory deficits, frontal executive function problems, personality changes, and dementia signs
Disease begins in late 30s or early 40s, lasting 10-20 years or more before death

Lewy Body Dementia

Distinguished by eosinophilic inclusion bodies (Lewy bodies) in cortex and brainstem
Clinically similar to Alzheimer disease, but with earlier visual hallucinations and parkinsonian features

Dementia Disorders

Dementia due to HIV

Caused by HIV-1 infection, resulting in HIV-1-associated cognitive/motor complex
Symptoms vary in early stages, with severe cognitive changes, confusion, behavioral changes, and psychosis in later stages
Symptom severity is associated with brain pathology extent

Dementia due to Traumatic Brain Injury

Caused by any type of head trauma
Amnesia is the most common neurobehavioral symptom following head trauma
Permanent disturbance may persist in varying degrees

Dementia due to Parkinson Disease

Caused by death of neurons, including those producing dopamine, responsible for movement and coordination
Characterized by tremor, rigidity, bradykinesia, and postural instability
Dementia reported in 20-60% of people with Parkinson disease, with cognitive and motor slowing, impaired memory, and executive functioning
Onset and course are slow and progressive

Dementia due to Huntington Disease

Inherited, dominant-gene, neurodegenerative disease
Initial symptoms include facial contortions, twisting, and tongue movements
Cognitive symptoms include memory deficits, frontal executive function problems, personality changes, and dementia signs
Disease begins in late 30s or early 40s, lasting 10-20 years or more before death

Lewy Body Dementia

Distinguished by eosinophilic inclusion bodies (Lewy bodies) in cortex and brainstem
Clinically similar to Alzheimer disease, but with earlier visual hallucinations and parkinsonian features

Dementia Disorders

Dementia due to HIV

Caused by HIV-1 infection, resulting in HIV-1-associated cognitive/motor complex
Symptoms vary in early stages, with severe cognitive changes, confusion, behavioral changes, and psychosis in later stages
Symptom severity is associated with brain pathology extent

Dementia due to Traumatic Brain Injury

Caused by any type of head trauma
Amnesia is the most common neurobehavioral symptom following head trauma
Permanent disturbance may persist in varying degrees

Dementia due to Parkinson Disease

Caused by death of neurons, including those producing dopamine, responsible for movement and coordination
Characterized by tremor, rigidity, bradykinesia, and postural instability
Dementia reported in 20-60% of people with Parkinson disease, with cognitive and motor slowing, impaired memory, and executive functioning
Onset and course are slow and progressive

Dementia due to Huntington Disease

Inherited, dominant-gene, neurodegenerative disease
Initial symptoms include facial contortions, twisting, and tongue movements
Cognitive symptoms include memory deficits, frontal executive function problems, personality changes, and dementia signs
Disease begins in late 30s or early 40s, lasting 10-20 years or more before death

Lewy Body Dementia

Distinguished by eosinophilic inclusion bodies (Lewy bodies) in cortex and brainstem
Clinically similar to Alzheimer disease, but with earlier visual hallucinations and parkinsonian features

Developmental Screening Tools

Ages & Stages Questionnaires (ASQ): a set of questionnaires tailored to detect alterations in development in young children.
American Academy of Pediatrics---Bright Futures: a kit for health promotion and prevention that includes schedules for screening and care and a variety of questionnaires used to detect health problems, including developmental alterations.

Delirium Screening Tools

Confusion Assessment Method (CAM): a five-minute interview-style exam that screens specifically for signs of delirium.
Pediatric versions of CAM: available for children 5 years and older (pCAM/psCAM-ICU for critically ill infants and children).
Cornell Assessment of Pediatric Delirium: a validated, rapid observational tool for screening children in intensive care for delirium.

Depression Screening Tools

Edinburgh Depression Scale: a validated 10-item questionnaire used to screen for the presence and severity of symptoms of postnatal depression.
Geriatric Depression Scale (GDS): a brief questionnaire (15 or 30 items) that asks patients how they've felt over the past 7 days; assesses for depression in older adults.
Hamilton Rating Scale for Depression (HRSD): a twenty-minute, 17-question examination that assesses severity of depression in adult patients.
The Weinberg Depression Scale for Children and Adolescents (WDSCA) and the Children's Depression Rating Scale (CDRS-R): modeled on the HRSD and adapted for children over age 5.

Cognitive Function Screening Tools

Mini-Mental State Examination (MMSE): a thirty-question interview-style exam that assesses a patient's memory, language skills, attention level, and ability to engage in mental tasks; also known as the Folstein Mini-Mental State Examination.
Montreal Cognitive Assessment: a one-page test that briefly assesses a patient's ability in a variety of cognitive domains, including problem solving and sequencing, attention, memory, visuospatial construction and reasoning, and language.

Other Screening Tools

Nonverbal Learning Disabilities (NVLD) Scale: assesses deficits in the areas of motor skills, visuospatial skills, and interpersonal skills.
Patient Health Questionnaire (PHQ): a full-length 11-item tool that screens for depression and anxiety, somatic symptoms, and related disorders; abbreviated forms (PDQ-9 and PDQ-2) are used to more selectively screen for depression.
Positive and Negative Symptoms Scale (PANSS): a registered nurses and other licensed healthcare providers (HCPs) can administer to detect positive, negative, and other manifestations of psychotic disorders and schizophrenia.
Postpartum Depression Predictors Inventory (PDPI): a validated short inventory that can be integrated into all phases of perinatal care to predict the risk of maternal depression.
Cornell Scale for Depression in Dementia: a nineteen-question tool that involves interviews with both patients and their caregivers; assesses for signs of depression in individuals known to have dementia.

Developmental Screening Tools

Ages & Stages Questionnaires (ASQ): a set of questionnaires tailored to detect alterations in development in young children.
American Academy of Pediatrics---Bright Futures: a kit for health promotion and prevention that includes schedules for screening and care and a variety of questionnaires used to detect health problems, including developmental alterations.

Delirium Screening Tools

Confusion Assessment Method (CAM): a five-minute interview-style exam that screens specifically for signs of delirium.
Pediatric versions of CAM: available for children 5 years and older (pCAM/psCAM-ICU for critically ill infants and children).
Cornell Assessment of Pediatric Delirium: a validated, rapid observational tool for screening children in intensive care for delirium.

Depression Screening Tools

Edinburgh Depression Scale: a validated 10-item questionnaire used to screen for the presence and severity of symptoms of postnatal depression.
Geriatric Depression Scale (GDS): a brief questionnaire (15 or 30 items) that asks patients how they've felt over the past 7 days; assesses for depression in older adults.
Hamilton Rating Scale for Depression (HRSD): a twenty-minute, 17-question examination that assesses severity of depression in adult patients.
The Weinberg Depression Scale for Children and Adolescents (WDSCA) and the Children's Depression Rating Scale (CDRS-R): modeled on the HRSD and adapted for children over age 5.

Cognitive Function Screening Tools

Mini-Mental State Examination (MMSE): a thirty-question interview-style exam that assesses a patient's memory, language skills, attention level, and ability to engage in mental tasks; also known as the Folstein Mini-Mental State Examination.
Montreal Cognitive Assessment: a one-page test that briefly assesses a patient's ability in a variety of cognitive domains, including problem solving and sequencing, attention, memory, visuospatial construction and reasoning, and language.

Other Screening Tools

Nonverbal Learning Disabilities (NVLD) Scale: assesses deficits in the areas of motor skills, visuospatial skills, and interpersonal skills.
Patient Health Questionnaire (PHQ): a full-length 11-item tool that screens for depression and anxiety, somatic symptoms, and related disorders; abbreviated forms (PDQ-9 and PDQ-2) are used to more selectively screen for depression.
Positive and Negative Symptoms Scale (PANSS): a registered nurses and other licensed healthcare providers (HCPs) can administer to detect positive, negative, and other manifestations of psychotic disorders and schizophrenia.
Postpartum Depression Predictors Inventory (PDPI): a validated short inventory that can be integrated into all phases of perinatal care to predict the risk of maternal depression.
Cornell Scale for Depression in Dementia: a nineteen-question tool that involves interviews with both patients and their caregivers; assesses for signs of depression in individuals known to have dementia.

Assessing the Patient's Communication

The patient's ability to communicate effectively is crucial for accurate assessment and diagnosis.
Assess communication by observing the patient's general appearance, including hygiene, and considering their vocabulary and understanding of what is being said.

Observing the Patient

Take note of the patient's ability to follow directions, whether they speak easily and naturally, and their expressive language.
Consider the patient's receptive language, including their ability to understand what is being said, and any potential disorders related to brain injury or illness.

Assessing the Patient's Level of Orientation

Assess the patient's level of orientation to person, place, time, and situation.
Consider whether the patient is fully conscious and alert, and oriented to self, location, time, and situation.
Reduced or varying consciousness may be due to hypoglycemia, stroke, seizure, delirium, or organic brain disease.

Assessing the Patient's Perceptions and Thinking Abilities

Note whether the patient's statements are aware of reality and can be explained by their level of cognitive development or sociocultural factors.
Patients who are aware of reality may have frequent symptoms of psychological disorders.
Children may have difficulty explaining their perceptions and thinking due to their level of cognitive development.

Assessing the Patient's Decision-Making Ability

Ask the patient about a personal situation that requires good judgment to determine their ability to consider options and make decisions.
Consider whether the patient's options and decisions make sense, taking into account their level of cognitive development and potential psychological disorders.

Assessing the Patient's Communication

Consider the patient's vocabulary and whether they understand what you are saying.
Be aware of the patient's expressive and receptive language abilities.
Don't assume all patients are native English speakers; some may require assistance from an interpreter.

Assessing the Patient's Level of Orientation

Assess the patient's orientation to person, place, time, and situation.
A fully conscious and alert patient is oriented to self, location, time, and situation.
Reduced or varying consciousness may be due to hypoglycemia, stroke, seizure, delirium, or organic brain disease.
Modify questions for children according to their developmental level.

Assessing the Patient's Memory

Assess the patient's memory by asking about their name, birth date, and address.
Inability to recall events from one's past may be suggestive of dementia, especially Alzheimer's disease.
In Alzheimer's disease, loss of short-term memory typically precedes loss of long-term memory.
Alterations in memory in children may suggest a problem with learning or intellectual function.

Assessing the Patient's Computational Ability

Assess the patient's ability to perform simple arithmetic calculations.
Inability to perform calculations may be suggestive of brain disease or cognitive developmental stages.
Patient's responses may be negatively affected by language barriers, cognitive developmental stages, or cognitive ability.

Assessing the Patient's Perceptions and Thinking Abilities

Note whether the patient's statements are aware of reality.
Patients who are unaware of reality may have psychological disorders.
Assess the patient's ability to think abstractly and make logical judgments.
Be aware of the patient's thought process and content.

Cognitive Development Stages

Sensorimotor Stage (Birth to 2 years): Infants use motor and sensory capabilities to explore the physical environment, learning through trial and error, developing a sense of "self" and "other", and understanding object permanence.

Key Developments in Sensorimotor Stage

Development of behavioral schemes that produce images or mental schemes
Sense of self and other emerges
Understanding of object permanence

Preoperational Stage (2-7 years)

Characteristics: Thought is egocentric, children cannot adopt the perspectives of others, and use symbols (images and language) to explore their environment.
Developments: Children participate in imaginative play, recognize that others don't see the world the same way they do, and begin to develop social skills.

Concrete Operational Stage (7-11 years)

Characteristics: Children acquire cognitive operations or mental schemes to think about concrete (observable) problems.
Developments: Children are no longer fooled by appearances, and understand the basic properties of objects and events, and relations among them.

Formal Operational Stage (11 years and beyond)

Characteristics: Thought is systematic and abstract, and no longer limited to the concrete or observable.
Developments: Children engage in systematic, deductive reasoning, and ponder hypothetical issues, and are proficient at inferring motives.

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Description

Explore the mental processes of cognition, including perception, attention, memory, and problem solving, and learn how it's defined by social and cultural norms.

Normal Cognition

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Questions and Answers

Cognition is the complex set of mental processes by which individuals acquire, store, retrieve, and use ______.

Cognition primarily involves activities that are controlled by the ______ hemispheres.

A definition of normal cognition depends on social and cultural ______ and the environment in which the individual operates.

The desired and most basic consequences of normal cognition are to obtain a level of ______ and adaptation.

Normal cognition enables individuals to function effectively as a ______ being.

What is the primary function of normal cognition in terms of social interaction?

Which of the following is NOT a direct consequence of normal cognition?

What is the primary characteristic of normal cognition in terms of information processing?

How does normal cognition vary across different cultures and environments?

What is the ultimate goal of normal cognition in terms of individual development?

Perception refers to an interpretation of ______ or inputs that takes place in the brain.

External stimuli or inputs include touch, taste, vision, hearing, and ______.

Internal stimuli include proprioceptive sensations that contribute to ______ function and spatial awareness.

Orientation is a component of normal perception that includes four basic elements: person, place, time, and ______.

Orientation to person is the ability to correctly identify one’s own ______.

What is the primary function of external stimuli in perception?

Which of the following is an example of internal stimuli?

What is the purpose of orientation to time in normal perception?

Which of the following is NOT a component of normal perception?

What is the primary role of proprioceptive sensations in perception?

The reticular activating system (RAS), thalamus, and frontal cortex are the structures that are primarily involved in ______ and attention.

The neurotransmitters dopamine and ______ both play a major role in regulating attention.

Individual ______ depends on the ability to attend and focus.

Attention refers to the brain’s ability to remain ______ and aware while selectively prioritizing concentration on a stimulus.

Variations in attention span are typical among healthy individuals and may be impacted by ______, genetics, biological rhythms, culture, and other environmental factors.

What is the primary function of the structures involved in arousal and attention?

What is the significance of a change in an individual's level of awareness and attention span?

What is the primary role of dopamine in regulating attention?

What is the primary factor that influences variations in attention span among healthy individuals?

What is the primary consequence of impaired attention in terms of individual safety?

Memory refers to the process by which individuals retain, store, and retrieve information gained from previous ______.

Sensory ______ refers to the earliest stage of memory, in which visual input and auditory information are retained for less than a few seconds.

Short-term ______ refers to the active processing and manipulation of information in conscious awareness.

Long-term ______ is used to describe the final sequence or destination of information that can be stored indefinitely.

Declarative memories are those that are explicit and can be consciously accessed; they are distinguished as semantic (storing ______ and verbal information) and episodic (composed of personal experiences).

What is the primary function of short-term memory?

What is the primary characteristic of declarative memories?

What is the primary limitation of short-term memory?

What is the primary role of working memory?

What is the primary difference between declarative and nondeclarative memories?

Memory plays a significant role in communication and ______.

Social cognition is the ability to process and apply ______ information accurately and effectively.

Motor coordination refers to the planning, organizing, and execution of complex ______ tasks.

Cognitive function and motor coordination are carried out by shared ______ pathways in the brain.

Individuals with intact cognition exhibit normal variations in ______ function and coordination.

What is the primary function of social cognition?

Which brain regions are responsible for cognitive function and motor coordination?

What is the characteristic of motor function in individuals with intact cognition?

What is the role of memory in communication and social cognition?

What is the primary characteristic of individuals with impaired motor function?

Executive function is an umbrella term that is used to describe the mental skills involved in planning and executing complex ______.

Intellectual function is a general term used to describe the mental capacity of an individual in relation to learning, reasoning, and ______.

Adaptive behavior refers to a set of practical skills people need to function in their everyday ______.

Cognition largely depends on brain and ______ system functioning.

The three categories of adaptive behavior are conceptual skills, social skills, and ______ skills.

What is the primary purpose of executive function in cognitive processes?

Which of the following is NOT a category of adaptive behavior?

What is the primary role of the limbic system in cognition?

What is the primary function of the cerebral cortex in cognition?

What is the primary characteristic of intelligence quotient (IQ) scores?

Research demonstrates that genetic makeup accounts for as much as 80% of the ______ in cognition found in the general population.

Different genes can be linked to particular components of ______ function, such as attention in working memory in healthy adults.

The pathophysiology of these conditions is generally related to conditions causing abnormalities in the ______ and function of the brain.

Perceptual disturbances may be a function of structural and physiologic ______ abnormalities in several areas of the cerebral cortex.

Illogical thinking may be the result of ______ lobe dysfunction and dopamine imbalance.

What percentage of variations in cognition found in the general population can be attributed to genetic makeup?

What is the primary pathophysiological mechanism underlying alterations in cognitive function?

What is the primary cognitive component affected in individuals with frontal lobe dysfunction and dopamine imbalance?

Which of the following brain regions is responsible for perceptual processing?

What is the primary consequence of dysregulation of one or more of the key components of normal cognition?

Confusion is a general term used to describe increased difficulty in thinking clearly, making judgments, and focusing ______.

Disorientation is an element of confusion in which the individual is unable to correctly identify one or more of the following: person, place, ______, and situation.

Delusions are rigid, false beliefs—for example, believing that members of a healthcare team are actually government ______ assigned to gather information that will be used to harm the patient or others.

Hallucinations are sensory experiences that do not represent reality, such as hearing, seeing, feeling, or smelling things that are not actually ______.

Types of hallucinations include auditory, in which an individual hears voices or sounds that are not there; visual, in which an individual sees things that are not there or sees distortions of things that are ______.

What is the primary difference between disorientation and delusions?