Delirium, Dementia &

Amnestic Cognitive Disorders

Scott Rower
9/20/06
Cognitive Disorders In General
 Brain dysfunction  cognitive deficits
 Cognitive Functions
 Memory, attention, perception & thinking
 Develop later in life
Delirium – What Is It?

 A syndrome of disturbances in
consciousness accompanied by
symptomatic manifestations of early
brain dysfunction
 (which can not be better explained by dementia)
Delirium – Main Symptoms
 Confusion
 Disorientation
 Cognitive Changes
 Memory
dysfunction,
perceptual
dysfunction
Types of Delirium
 Delirium Due to a Medical Condition
 Delirium Due to Substance
Intoxication
 Delirium Due to Substance
Withdrawal
 Delirium Due to Multiple Etiologies
 Delirium Not Otherwise Specified
What are other possible effects?
 Emotional disturbances
 Tremors
 Autonomic hyperactivity
 Reversal of night-day sleep-wake
cycle
 Extreme shifts in psycho-motor
activity
Who is at risk?
What Is The Course?
 Begins abruptly
 Fast recovery
 Dependant on i.d. & attention
 Complete recovery is common
Differential Diagnosis
 Dementia
 Substance intoxication & withdrawal
 Schizophrenia, Schizophreniform
 Malingering & Factitious Disorder
But Scott, Are There Other Causes?
 Severe medical  Severe lack of food
illness or water
 Severe mental  Sleep deprivation
illness  Excess stress
 Fever
 Poisoning
 Brain Injury
Key Diagnostic Point
 Disturbance of consciousness
 Change in cognition
Dementia – What Is It?

 A gradual deterioration of the brain

functioning that affects judgment,
memory, language & other advanced
cognitive processes
Dementia – Main Symptoms
 All cognitive function becomes
affected
 Memory impairment
 Cognitive disturbance(s)
 Agnosia, Aphasia, Apraxia, Executive
Functioning
Types of Dementia
 Dementia of the Alzheimer’s Type
 Vascular Dementia
 Dementia Due to Other General
Medical Conditions
 Substance-Induced Persisting
Dementia
 Dementia Due to Multiple Etiologies
 Dementia Not Otherwise Specified
Cortical Vs. Subcortical Dementia
Characteristic Cortical Subcortical

Language
Aphasia No aphasia

Memory Impaired recall; normal

Recall & recognition impaired or less impaired
recognition
Visuospatial Skills
Impaired Impaired

Mood Less severe depression & More severe depression

anxiety & anxiety
Coordination Normal until late in
Impaired
progression
What Are Other Possible Side Effects?
 Emotional changes
 Irrational beliefs, depression, agitation,
aggression, apathy
Who Is At Risk?
 Big surprise – the elderly
 Ages 75 – 79  2.3%
 80 – 84  4.6%
 85 & Older  8.5%
What Is The Course?
 Continued cognitive deterioration
 Death

Sad, I know
Differential Diagnosis
 Delirium
 Schizophrenia
 MDD
 Age-Related Cognitive Decline
What Are The Causes of Dementia
 Brain trauma
 Infectious disease
 Toxic substances
 Diseases
 Multiple genes
The Alzheimer’s Brain
What Is The Treatment?
 Biological treatment
 Psychosocial treatment
Prevention
 Estrogen replacement therapy
 Treatment of hypertension?
 Nonsteroidal anti-inflammatory
drugs?
Key Diagnostic Point
 Memory impairment
 At least one major cognitive
disturbance
Amnestic Disorder – What Is It?

 Loss of memory w/o loss of high-level

cognitive functions
 Inability to transfer information into long
term memory
What Are The Main Symptoms?
 Inability to learn new info or recall
previously learned info
 Issues with social and occupational
functioning
What is the course?
 Variable
 Acute onset
 Subtle onset
 Due to head trauma is largely variable
 Greatest after injury, improvement until
about 2 years
What Are The Types
of Amnestic Disorder?
 Based on etiology
 Amnestic disorder due to general
medical condition
 Substance-induced persisting amnestic
disorder
 Amnestic disorder not otherwise
specified
Differential Diagnosis
 Repetition of sequential string of info
a good test
 Unimpaired  amnestic disorder
 Impaired  delirium
 Any cognitive impairment?
 Direct effect of a medical condition or
substance abuse?
Key Diagnostic Point
 Distinguishing feature is memory
impairment without other cognitive
deficits
Amnestic Disorder In The Media
 Oliver Sacks’ –
The Man Who
Mistook His Wife
for a Hat
 Dory from Finding
Nemo
 Memento
Making A Diagnosis
 2 tiered process
 1 – recognition that symptoms are
consistent w/ a DSM disorder
 2 – Search for underlying physiological
asuse
Making A Diagnosis
 To delineate which cognitive disorder
 Does the patient have disturbances of
consciousness?
 Does the patient have an impairment of
cognition?
 What is the temporal basis of the
patient’s disturbance?