Cognitive Disorders

Cognitive disorders are mental disorders that develop on the basis of cognitive mental disorder perspective. They represent a loss of memory, mental performance and other cognitive functions compared to baseline (normal individual). Cognitive functions are called the most complex brain functions, with the help of which the process of rational cognition of the world controls and provides meaningful interaction with them, like the perception, analysis and storage of information, sharing it with other people, creation and implementation of actions.

To assess the severity of the cognitive impairment, scientists apply both quantitative neuropsychological techniques and clinical scales, which assess cognitive and other (behavioral, emotional, functional) symptoms of dementia and memory disorders. To determine the stage of the disease, doctors use the Global Deterioration Rating.

The second and third positions of the scale of Global Deterioration Rating correspond to light cognitive impairment, and from fourth to seventh - dementia (ICD-10). At the first stage, there are no subjective or objective symptoms of memory or other cognitive functions. The second stage is a light disorder. There complaints of memory loss, usually of two types: - forgetting where he/she put some things and forgetting names of close friends. In an interview with the patient, memory disorders are not detected. The patient is fully coped with work and home and is adequately alarmed of existing symptoms. The third stage is  light disorders: structurally unstable people, but clinical symptoms are outlined. At least one of the following symptoms: the inability to find his/her way while traveling in an unfamiliar place; the patient's co-workers are aware of his cognitive problems; obvious difficulties in choosing words and forgetfulness of the names of relatives; the patient cannot remember what he had just read, the names of people who he had just met; he cannot find a vital object which he previously put away somewhere; during the neuropsychological testing may show a breach of the serial account. Cognitive disorders can only be objectified by a careful study of higher brain functions. Breaches may affect the work and behavior at home. The patient begins to reject its existing problems, often mild or moderate anxiety.

 In the fourth stage in the mild memory impairment, there are apparent symptoms. The main manifestations are: the patient is not aware of events occurring around him, there is a breaching of the memory of certain events of life, and impaired ability of finding the road, processing the financial transactions, etc. The sixth stage is characterized by severe memory impairment: not always possible to recall the name of a spouse or the person from whom the patient has a total dependence in the daily life. Amnesia is for most of events of life. There is also disorientation in time, having difficulties in counting from 10 to 1, sometimes also from 1 to 10.

Most of the time person needs outside help, but sometimes he/she is able to find the familiar road. Often the "sleep-wake" cycle is broken. Almost always it recalls his/her name intact. Usually the person slightly recognizes familiar people. There are changes in personality and in the emotional state. This state can be accompanied with delusions and hallucinations, for example, the idea that the husband has been replaced; patient can have the conversation with imaginary persons, or with his own reflection in the mirror, compulsion, anxiety, psychomotor agitation, aggression, and cognitive abulia - as a result of the loss of the ability for the purposeful activity.

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During the seventh stage, there is  severe memory impairment: usually, the patient cannot speak. Patient needs help with eating, has urinary incontinence. Basic psychomotor skills are lost, including the skill of walking. The brain is no longer able to control the body.

In neuropsychology, cognitive function (including memory, attention, learning, executive function) can be measured using a set of standardized tests which help to analyze the extent of their malfunction and the localization of brain changes. The localization of the central nervous system dysfunction can be determined with the help of neurocognitive tests. According to Shallice, it should be preceded by an attempt to understand the origin of damage of information processes themselves. Nevertheless, the emergence of new (including computerized) methods of assessment of cognitive functioning (supported by brain imaging using MRI, CT, and others) contributed to the significant progress in this area of science. At the present time, to assess cognitive functions, doctors often use the following tests: Wisconsin Card Sorting Test, Continuous Performance Test and Stroop Test.

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Wisconsin Card Sorting Test (WCST) carries out like this: firstly, stimulus cards are shown to the participant. Participants are not told how to match cards; nevertheless, they show whether the particular match is wrong or right. Mistakes made in this learning process are strictly analyzed to arrive at a score.

The WCST used paper cards and was held with the experimenter on the one side of the desk and on the other side facing the participant. Nevertheless, from the early 1990s, computerized versions of this task have been available. It was the most recent version of Microsoft Windows 4.0. The latter has its advantage of the automatically scoring test, which was extremely complex in its manual version. This test takes 12-20 minutes and generates psychometric scores, including percentages, numbers, and percentiles of achieved categories, errors, trials, and perseverative errors.

Continuous Performance Test

Although tests may vary in terms of the length and type of stimulus used, the basic nature of tests remains the same. Clients are presented with a repetitive, "boring" task and have to maintain their focus over a period of time, in order to respond to targets or inhibit the response to foils. Tests may use numbers, symbols, or even sounds, but the basic task has the same concept.

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The Stroop test (in some sources called the Stroop effect) is a result of the mental (attentional) flexibility and vitality. The effect relates to abilities of most people to read words quicker and more automatically than they are able to name colors. If the word is put in a color which differs from s color it names; for instance, if the word green is displayed in the blue ink  then people have a hard time recognizing the blue ink. In this example, even when people are asked to name a color of the ink, people tend to say the name a word represents.

Cognitive disorders are divided into three groups. There are light, mild and severe cognitive impairments. Historically, problems of cognitive disorders have been studied mainly in the framework of dementia (the term "dementia" refers to the most severe cognitive impairment, leading to the disorder of everyday life). Only later scientists also began to pay attention to less severe disorders.

Mild cognitive impairment is a mono-or polyfunctional cognitive disorder, clearly beyond the age norm, but which does not restrict the autonomy and independence, that is not causing maladjustment in the everyday life. Mild cognitive disorders are usually reflected in individual complaints, and attract the attention of others. They can prevent the most complex forms of intellectual activity. According to studies, the prevalence of mild cognitive impairment in older age reaches 12-17%. Among the neurological patients, the syndrome of the mild cognitive impairment occurs in 44% of cases.

In light cognitive impairment, indicators of psychometric scales may remain within the average age norm or deviate from it slightly, but patients are aware of cognitive decline. Light cognitive disorders reflect in patient's complaints; they do not attract the attention of others, do not cause difficulties in the everyday life, even the most complex forms. Population-based studies of the prevalence of light cognitive impairment have not yet been conducted; however, scientists suggest that their prevalence is not inferior to the prevalence of the mild cognitive impairment.

In the severe cognitive impairment where memory loss is in progress, person may experience significant changes in personality; that is why a sick person requires substantial assistance in the performance of ordinary daily activities. At this stage, a sick person usually forgets about his/her experience or recent events, as well as the environment; not fully remember his own biography, but may give his name; sometimes forgets the name of the spouse or caregiver, but generally can distinguish familiar people from unfamiliar; there are significant changes in personality and behavior, such as suspiciousness and delusions, delusions (for example, the belief that the caregiver is a liar), auditory and visual hallucinations, compulsive repetitive movements, such as hand-wringing or cutting / tearing the pieces of fabric.

The main symptoms and signs of cognitive disorders are change in level of consciousness, irritability, difficulty in thinking with sudden onset, particularly short-term memory, state of awareness which is ranging from hyper vigilance to the stupor or coma; confabulation; impairment in a thought process and cognition; anxiety.

People with cognitive disorders need the specific nursing assessment. First of all, they need psychological support, patient and gentle handling. Sick people should maintain physical activity having physical therapy sessions. The patient cannot be hurried and worried: tremor and other symptoms are getting worse when the person is worried or in a hurry to perform any movement. Usually, warm baths are applied to patients for muscle relaxation. Also, the hospital or caregiver should monitor the regular medication. The effect of drugs with psychopathy is often small. With the help of the medication, doctors can adjust the behavior, reduce incontinence and increase susceptibility to therapy. Psychopathy cannot be cured with drugs. However, it should be noted that, even if the doctor does not see the effect of the drug, the patient can observe significant positive changes. The effect of drugs with psychopathy is often diminishing with time. This may be explained by various factors - tolerance, irregular intake and concurrent use of other medicines. Also, the use of medications depends on the emotional state of the patient and the stage of his disease. However, usually following medicines are taken: Haloperidol (2-6 mg / day), Chlorpromazine (50-200 mg / day), Thioridazine (50-200 mg / day), Tiotixene (4-12 mg / day), Trifluoperazine (4-12 mg / day).

Causes of cognitive disorders are various. Cognitive impairment may be organic or functional. Functional cognitive impairment develops in the absence of direct damage of the brain. Causes of functional cognitive impairment may be fatigue, nervous stress and overload, negative emotions. Functional cognitive disorders develop at any age. They are not dangerous, and always go away or immensely reduce after the removal of causes of malfunction. However, in some cases, functional impairment may require the medical treatment.

Organic cognitive disorders result from the damage of the brain substance in some diseases. Organic cognitive impairment is more common in older people and is usually more stable. However, appropriate treatment in these cases can improve and prevent the further growth of disorders. The most frequent causes of organic cognitive disorders are:

1) Lack of blood supply to the brain: it can cause such diseases as hypertension, cardiovascular disease and stroke. It is necessary to diagnose these diseases and to treat them properly to avoid complications. Particular attention should be given to blood pressure, maintaining the normal blood sugar and cholesterol;

2) Age-related decrease in brain mass (atrophy): this kind of atrophy of the brain leads to more severe cognitive disorders. This pathological condition is called Alzheimer's disease. It is a progressive disease, but rates of growth of cognitive disorders vary considerably. Typically, symptoms grow slowly, and for many years patients retain independence and autonomy. An adequate treatment of this disease is of great importance, as modern methods of treatment can improve the current state of the patient and help to stabilize symptoms for a long term;

3) Other reasons for cognitive disorders: other brain diseases, cardiovascular disease, diseases of internal organs and metabolism, abuse of alcohol or other poisonings.

Main chronic diseases and degenerative brain disorders and cognitive impairments are irreversible, but in cases where the cause of cognitive disorders is systemic metabolic disorders, correction of these malfunction results in the recovery of mental functions. In such cases, one can say about reversible cognitive disorders. Reversible cognitive disorders include dysmetabolic encephalopathy, disorders of higher brain functions in normotensive hydrocephalus and brain tumors (in some cases); the cause of reversible disruption could also be an anxiety-depressive disorder. Up to 5% of cases of the cognitive impairment at the stage of dementia are totally reversible.

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If the patient does not get the treat he or she needs, that can lead to the formation of serious complications, like dental and oral cavity disease, bedsores, malnutrition, hygiene problems, respiratory, eye and skin infections; an instant drug use may cause cardiovascular disease and pancreatic diabetes.

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