Cognitive Disorders

Definition

• Cognitive disorders are characterized by the disruption of thinking, memory, processing, and problem solving.
• Types of cognitive disorders include: delirium, dementia, and memory loss disorders (amnesia or dissociative fugue).

Risk Factors

1. Physiological changes such as neurological, metabolic, and cardiovascular disease.
2. Cognitive changes
3. Family genetics
4. Infections
5. Tumors
6. Sleep disorders
7. Substance abuse
8. Drug intoxications and withdrawals

Signs and Symptoms

1. Irritability; mood most frequently seen in organic brain disorder.
2. Change in level of consciousness.
3. Difficulty thinking with sudden onset.
4. State of awareness ranging from hyper vigilance to stupor or coma.
5. Impairment in cognition and thought process, particularly short-term memory.
6. Anxiety
7. Confabulation

Therapeutic Nursing Management

1. The nurse plays a primary role in providing a safe environment for the client and others.
2. Exogenous stimuli in the environment can intensify the client’s level of orientation.
3. Cognitive changes may often include a period of confusion or forgetfulness.
4. The nurse may encourage family members to bring photographs or familiar items as strategy to orient the client.
5. Psychological treatment may focus more on the family to offer them support during this stressful time.
6. Cognitive changes affect the family and care providers. Cognitive decline often means a change in the family roles and activities of daily living.
7. Pharmacologic therapy is implemented to reduce or alleviate the associated symptoms such as antianxiety medications, antidepressants, and antipsychotics.

Nursing Interventions

1. Determine the cause and treatment of the underlying causes.
2. Remain with the client, monitoring behavior, providing reorientation and assurance.
3. Provide a room with a low level of visual and auditory stimuli.
4. Provide palliative care with the focus on nutritional support.
5. Reinforce orientation to time, place, and person.
6. Establish a routine.
7. Client protection may be required.
8. Have client wear an identification bracelet, in case she or he gets lost.
9. The client should not be left alone at home
10. Break test into small steps, giving one instruction at a time.