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Cognitive disorder

Most common mental disorders affect cognitive functions, mainly memory processing, perception and problem solving. The most direct cognitive disorders are amnesia, dementia and delirium. Others include anxiety disorders such as phobias, panic disorders, obsessive-compulsive disorder, generalized anxiety disorder and post-traumatic stress disorder. Mood disorders such as depression and bipolar disorder are also cognitive mental disorders. Psychotic disorders such as schizophrenia and delusional disorder are also classified as cognitive mental disorders.

Cognition is the brain’s ability to retain and use information. A cognitive disorder refers to any medical condition that affects how the brain processes and stores information. It can result in memory loss, faulty perceptions or a combination of both. Cognitive disorders can be genetic, environmental, or caused by an injury.

Types of Cognitive Disorders

Cognitive disorders affect mental processes such as the capacity learn, remember, perceive and solve problems. At it's basic the cognitive function is information processing and may be broken into three categories; Delirium, Dementia and Amnesia. Statistically the older the client is, the more likely they are going to establish cognitive disorder falling into such an example categories. The majority are going to be attentive to Alzheimers disease, mainly because it affects around 4 million people in the country alone. Alzheimers is definitely a dementia cognitive disorder.

Cognitive Disorder Types

Although cognitive disorders are of this particular aging process and will eventually manifest usually in an era of over 80, mild cognitive disorder (MCI) can occur in younger patients. Anyone display cognitive disorder symptoms who don't impair their minds significantly, and this occurs at an age not normally involving cognitive disorders, there're clinically determined to have mild cognitive disorder.

Many studies instructed to confirm if MCI is correctly diagnosed will confirm proof memory impairment while other cognitive functions respond normally. To find out no strategy to MCI, the link which has an increased opportunity of Alzheimer's developing later in life can prompt pre-emptive measures for alzhiemers in MCI patients.

Delirium is actually a cognitive processing disorder which can manifest itself as being a difficulty in processing new information, as well as a difficulty with situational awareness. Delirium are usually categorized into two separate diagnosis.

Firstly, Hypoactive delirium show up patients who exhibit deficiencies in energy and who're generally unresponsive. Secondly, Hyperactive Delirium symptoms include aggressive behavior and hostility.

It's possible for starters patient to showcase symptoms of both kinds delirium in the lifetime of the cognitive disorder, of which this is known as Mixed Delirium. There isn't any known cause for delirium although some studies have shown the it is typically triggered by stress, alcohol or medication. Delirium can be a temporary cognitive disorder, yet, in severe cases it can certainly develop into an instance of dementia.

Patients with partial or total forgetfulness and with additional difficulty in learning new information are displaying signs and symptoms of Dementia, an incurable cognitive disorder. Although dementia could happen at all ages, it is usually at their peak inside the elderly.

Dementia may be a genetic disorder which can also be triggered

by severe trauma say for example stroke, heart valve issues and brain trauma. Alzheimers disease is easily the most common version of dementia and affects almost 10% of one's elderly over 85 yrs . old regardless sex.

Amnestic disorder is really a cognitive disorder that will spark a difficulty with information retention, particularly lasting memory.

There are specific several types of amnesia which may impact the memory function in another way. Usually of those that have an amnestic disorder will recall the personal history and identity, but experience difficulty for some other tasks of the memory function. Retrograde Amnesia will result in an issue with recalling events and knowledge from ahead of start of the disorder.

Anterograde amnesia describes a problem where it's difficult for ones patient to sit and learn new information or recall new memories. Amnesia is linked to go trauma and extended drug use.

If a cognitive disorder may just be caused by direct physiological effect of the general medical problem which does not fall cleanly into one of the three categories above, it is known as Cognitive Disorder NOS (Not Otherwise Specified). These cases for example can establish quite challenging for both carers and physicians when trying to buy a means to fix a real cognitive disorder.

1.

cog·ni·tionNoun/kägˈniSHən/

1. The mental action or process of acquiring knowledge and understanding through thought, experience, and the senses.

Definition:

Cognition is a term referring to the mental processes involved in gaining knowledge and comprehension, including thinking, knowing, remembering, judging and problem-solving. These are higher-level functions of the brain and encompass language, imagination, perception and planning.

Memory disorder

Memory can be defined as an organism's ability to encode, retain, and recall information. Disorders of memory can range from mild to severe, yet are all a result of damage to neuroanatomical structures; either in part or in full. This damage hinders the storage, retention and recollection of memories. Memory disorders can be progressive, including Alzheimer's disease, or they can be immediate including disorders resulting from head injury.

Memory disorders in alphabetical order

Agnosia

Agnosia is the inability to recognize certain objects, persons or sounds, yet there are many more specific diagnoses of agnosia. Agnosia is typically caused by damage to the brain (most commonly in the occipital or parietal lobes) or from a neurological disorder. Treatments vary depending on the location and cause of the damage. Recovery is possible depending on the severity of the disorder and the severity of the damage to the brain. [1] Some examples of specific types of Agnosia include: Visual Agnosia, Auditory Agnosia, Prosopagnosia, Somatosensory agnosia, Simultanagnosia, Apraxia, Associative Agnosia, etc.

Alzheimer's disease

Alzheimer's disease (AD) is a progressive, degenerative and fatal brain disease, in which cell to cell connections in the brain are lost. As a result, the death of brain cells occur, therefore giving Alzheimer's disease the title as the most common form of dementia. In the entire world, approximately 1-5% of the population is affected by Alzheimer's disease. It is estimated that 500,000 Canadians currently suffer from Alzheimer’s disease or a related dementia. It is the most significant cause of disability among individuals aged 65 and above. Women are disproportionately the victims of Alzheimer’s disease, with evidence suggesting that women with AD display more severe cognitive impairment relative to age-matched males with AD, as well as a more rapid rate of cognitive decline.

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PET scan of a healthy brain - Image courtesy of US National Institute on Aging Alzheimer's Disease Education and Referral Center

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PET scan of brain with AD - Image courtesy of US National Institute on Aging Alzheimer's Disease Education and Referral Center

Amnesia

Amnesia is an abnormal mental state in which memory and learning are affected out of all proportion to other cognitive functions in an otherwise alert and responsive patient. [5] There are two forms of amnesia: Anterograde amnesia and retrograde amnesia, that show hippocampal or medial temporal lobe damage. Anterograde amnesics show difficulty in the learning and retention of information encountered after brain damage. Retrograde Amnesics generally have memories spared about personal experiences or context independent semantic information. [6]

Brain injury

∑ PET scan of brain with AD - Image courtesy of US <a href=National Institute on Aging Alzheimer's Disease Education and Referral Center Amnesia Amnesia is an abnormal mental state in which memory and learning are affected out of all proportion to other cognitive functions in an otherwise alert and responsive patient. There are two forms of amnesia: Anterograde amnesia and retrograde amnesia , that show hippocampal or medial temporal lobe damage. Anterograde amnesics show difficulty in the learning and retention of information encountered after brain damage. Retrograde Amnesics generally have memories spared about personal experiences or context independent semantic information. Brain injury Causes of TBI Traumatic brain injury often occurs from damages to the brain caused by an outside force, and may lead to cases of amnesia depending on the severity of the injury. Head injury can give rise to either transient or persisting amnesia. Occasionally, post-traumatic amnesia (PTA) may exist without any retrograde amnesia (RA), but this is often more common in cases of penetrating lesions. Damage to the frontal or anterior temporal regions have been described to be associated with disproportionate RA. Studies have " id="pdf-obj-4-32" src="pdf-obj-4-32.jpg">

Causes of TBI

Traumatic brain injury often occurs from damages to the brain caused by an outside force, and may lead to cases of amnesia depending on the severity of the injury. Head injury can give rise to either transient or persisting amnesia. Occasionally, post-traumatic amnesia (PTA) may exist without any retrograde amnesia (RA), but this is often more common in cases of penetrating lesions. Damage to the frontal or anterior temporal regions have been described to be associated with disproportionate RA. Studies have

illustrated that during PTA, head injury patients showed accelerated forgetting of learned information. On the other hand, after PTA, forgetting rates were normal.

In some cases, individuals have reported having a particularly vivid memory for images or sounds occurring immediately before the injury, on regaining consciousness, or during a lucid interval between the injury and the onset of PTA. As a result, recent controversy has emerged about whether severe head injury and amnesia exclude the possibility of post-traumatic stress disorder (PTSD) symptoms. In a study carried out by McMillan (1996), patients reported ‘windows’ of experience, in which emotional disturbance was sufficient to cause PTSD. These 'windows' involved recall of events close to impact (when RA was brief), of distressing events soon after the accident (when PTA was short), or of 'islands' of memory (e.g. hearing the screaming of others).

Brain injuries can also be the result of a stroke as the resulting lack of oxygen can cause damage to the location of the cerebrovascular accident (CVA). The effects of a CVA in the left and right hemispheres of the brain include short-term memory impairment, and difficulty acquiring and retaining new information.

Dementia

Dementia refers to a large class of disorders characterized by the progressive deterioration of thinking ability and memory as the brain becomes damaged. Dementia can be categorized as reversible (e.g. thyroid disease) or irreversible (e.g. Alzheimer's disease). [12] Currently, there are more than 35 million people with dementia worldwide. It is estimated that within 20 years, worldwide prevalence will increase twofold. By 2050, this number is expected to increase to 115 million. Overall, dementia incidence is similar for men and women. However, after 90 years of age dementia incidence declines in men but not in women. [13]

Hyperthymestic Syndrome

Hyperthymestic Syndrome causes an individual to have an extremely detailed autobiographical memory. Patients with this disorder are able to recall events from every day of their lives (with the exception of memories before age five and days that were uneventful). This disorder is very rare with only a few confirmed cases. [14]

Huntington’s Disease

Huntington's Disease is an inherited progressive disorder of the brain that leads to uncontrolled movements, emotional instability, and loss of intellectual faculties." [15] Because of the inheritability of Huntinton's each child born to a parent with Huntington's has a 50% chance of inheriting the disease, leading to a prevalence of almost 1 in 10,000 Canadians (0.01%). [16] The first signs of Huntington's Disease are generally subtle; suffers commonly note tics and twitching as well as unexplained fluctuations of mood. Clumsiness, depression and irritability are noted. What begins as a slurring and slowing

of speech eventually leads to difficulty communicating and confinement to a wheelchair or bed. [15]

Parkinson's disease

Parkinson's disease (PD) is a neurodegenerative disease. Movement is normally controlled by dopamine; a chemical that carries signals between the nerves in the brain. When cells that normally produce dopamine die off the symptoms of Parkinson’s appear. The most common symptoms include: tremors, slowness, stiffness, impaired balance, rigidity of the muscles, and fatigue. As the disease progresses, non-motor symptoms may also appear, such as depression, difficulty swallowing, sexual problems or cognitive changes. [17] According to studies done in London and in Sicily, 1 in 1000 elderly citizens will be diagnosed with Parkinson's [18] , although this can vary regionally and affect a large range of age groups. [19] Cognitive impairment is common in PD. Specific parkinsonian symptoms, bradykinesia and rigidity, have been shown to be associated with decline of cognitive function. The underlying neuropathological disturbance in PD involves selective deterioration of subcortical structures, and the executive dysfunction in PD, especially in processes that involve working memory. This has been shown to be related to decreased activation in the basal ganglia and frontal cortex. Elgh, Domellof, Linder, Edstrom, Stenlund, & Forsgren (2009) studied cognitive function in early Parkinson's disease and found that PD patients performed significantly worse than healthy controls in attention, episodic memory, category fluency, psychomotor function, visuospatial function and in several measures of executive function. Patients also exhibited greater difficulty with free recall that required a preserved executive function than with cued recall and recognition in tests of episodic memory. [20]

Wernicke-Korsakoff’s Syndrome

Wernicke-Korsakoff syndrome (WKS) is a severe neurological disorder caused by thiamine (vitamin B 1 ) deficiency, and is usually associated with chronic excessive alcohol consumption. It is characterized clinically by oculomotor abnormalities, cerebellar dysfunction and an altered mental state. Korsakoff's syndrome is also characterized by profound amnesia, disorientation and frequent confabulation (making up or inventing information to compensate for poor memory). [21][22] A survey published in 1995 indicated that there was no connection to the national average amount of alcohol ingested by a country in correlation to a range of prevalence within 0 and 2.5%. [23] Symptoms of Wernicke-Korsakoff Syndrome include confusion, amnesia, and impaired short-term memory. WKS also tends to impair the person’s ability to learn new information or tasks. In addition, individuals often appear apathetic and inattentive and some may experience agitation. WKS symptoms may be long-lasting or permanent and its distinction is separate from acute affects of alcohol consumption and from periods of alcohol withdrawal. [21]

Mild cognitive impairment

Mild cognitive impairment (MCI, also known as incipient dementia, or isolated memory impairment) is a diagnosis given to individuals who have cognitive impairments beyond that expected for their age and education, but that do not interfere significantly with their daily activities. [1] It is considered to be the boundary or transitional stage between normal aging and dementia. Although MCI can present with a variety of symptoms, when memory loss is the predominant symptom it is termed "amnestic MCI" and is frequently seen as a risk factor for Alzheimer's disease. [2]

Studies suggest that these individuals tend to progress to probable Alzheimer’s disease at a rate of approximately 10% to 15% per year. [2] Additionally, when individuals have impairments in domains other than memory it is classified as non-amnestic single- or multiple-domain MCI and these individuals are believed to be more likely to convert to other dementias (i.e. dementia with Lewy bodies). [3]

Diagnosis

The diagnosis of MCI requires considerable clinical judgement, [2] and as such a comprehensive clinical assessment including clinical observation, neuroimaging, blood tests and neuropsychological testing are best in order to rule out an alternate diagnosis. A similar assessment is usually given for diagnosis of Alzheimer's disease.

MCI is diagnosed when there is: [4]

  • 1. Evidence of memory impairment

  • 2. Preservation of general cognitive and functional abilities

  • 3. Absence of diagnosed dementia

Treatment

There is no proven treatment or therapy for mild cognitive impairment. As MCI may represent a prodromal state to clinical Alzheimer’s disease, treatments proposed for Alzheimer’s disease, such as antioxidants and cholinesterase inhibitors, may be useful. However, several potential treatments are still under investigations. [2] Two drugs used to treat Alzheimer's disease have been assessed for their ability to treat MCI or prevent progress of towards full Alzheimer's disease. Rivastigmine failed to stop or slow progression to Alzheimer's disease or on cognitive function for individuals with mild cognitive impairment, [8] and donepezil showed only minor, short-term benefits and was associated with significant side effects. [9]

In a two-year randomized trial of 168 people with MCI given either high-dose vitamins or placebo, vitamins cut the rate of brain shrinkage by up to half. The vitamins were the three B vitamins folic acid, vitamin B6, and vitamin B12, which inhibit production of the

amino acid homocysteine. High blood levels of homocysteine are associated with increased risk of dementia and cardiovascular disease. [10][citation needed]

Role

Occupational therapists (OTs) help people of all ages to improve their ability to perform tasks in their daily living and working environments. They work with individuals who have conditions that are mentally, physically, developmentally, socially or emotionally disabling. They also help them to develop, recover, or maintain daily living and work skills. Occupational therapists help clients not only to improve their basic motor functions and reasoning abilities, but also to compensate for permanent loss of function. Occupational therapists assist clients in performing activities of all types, ranging from using a computer to caring for daily needs such as dressing, cooking, and eating. Physical exercises may be used to increase strength and dexterity, while other activities may be chosen to improve visual acuity and the ability to discern patterns. For example, a client with short-term memory loss might be encouraged to make lists to aid recall, and a person with coordination problems might be assigned exercises to improve hand-eye coordination. Occupational therapists also use computer programs to help clients improve decision-making, abstract-reasoning, problem solving, and perceptual skills, as well as memory, sequencing, and coordination —- all of which are important for independent living. Occupational therapists are often skilled in psychological strategies such as cognitive behavioural therapy and Acceptance and Commitment Therapy, and may use cognitive therapy especially when introducing people to new strategies for carrying out daily activities such as activity pacing or using effective communication strategies.

Mental health

Occupational therapists also work with people who have mental health problems and learning disabilities. In this work, therapists choose activities that help people learn to engage in and cope with daily life. Activities include time management skills, budgeting, shopping, homemaking, and the use of public transportation. Occupational therapists also may work with individuals who are dealing with alcoholism, drug abuse, depression, eating disorders, or stress-related disorders. The ultimate aim would be to help people to engage in a personally satisfying and socially adaptive range of occupations.

Assessment

Assessing and recording a client’s activities and progress is an important part of an occupational therapist’s job. Accurate records are essential for evaluating clients, for billing, and for reporting to physicians and other health care providers.

Thorough and accurate assessment ensures that Occupational Therapists select appropriate and effective interventions for their clients. Assessment in Occupational Therapy is complex and multifaceted, and is an essential component of the Occupational Therapy Process. Assessment occurs at the beginning of the Process (providing the

foundation for effective treatment), at the end (evaluation). Reassessment also occurs throughout intervention

Occupational Therapy’s Role in

Adult Cognitive Disorders

Cognition includes processes such as orientation, attention, perception, problem solving, memory, judgment, language, reasoning, and planning. It is essential for taking in information, synthesizing it, and using it to affect behavior. Therefore, a cognitive deficit will have at least some impact on function. Cognitive disorders may be caused by traumatic brain injury (TBI), infection, tumors, stroke, dementias such as Alzheimer’s disease, or existing congenital conditions. Cognitive disorders are a growing problem in the United States. The incidence among older adults is accelerating as people are living longer and as demographics shift toward an aging population. In 2010, it was estimated that 5.3 million people in the U.S. had Alzheimer’s disease and an additional 3.7 to 5.3 million people had other types of dementia, 1 most of whom were over 65 years of age. Among younger adults, cognitive impairment is often caused by injury. It is difficult to find statistics for the total number of adults with cognitive impairment, but from 2002 to 2006 TBI alone accounted for almost 750,000 annual injuries of people between the ages of 15 and 64.2

Occupational Therapy’s Role in Cognitive

RehabilitationOccupational therapists are experts at determining how cognitive deficits can impact everyday activities, social interactions, and routines. Their knowledge about neurology and neuroanatomy helps them understand the impact of the brain disorder on deficits, administer appropriate tests and measures to identify the extent of functional loss, and determine the extent to which deficits are likely to be remediated or circumvented. Occupational therapists have the skills to assess the cognitive aspects of functional activities and design an intervention plan, from acute care to community reintegration. There is significant evidence that the brain has considerable neuroplasticity, or the capacity to redirect pathways and

relearn skills, even many years after damage has occurred.3 Occupational therapy practitioners facilitate this process through the use and modification of motivating daily activities and adaptation of the client’s environments.

Where Do Occupational Therapy Practitioners Provide Cognitive Rehabilitation?Occupational

therapy services for cognitive impairment are provided in a number of settings. Acute Care: Typically for individuals with sudden onset, such as stroke or TBI. • Evaluation of performance ability for safety and independence in self-care activities • Preparatory activities to facilitate balance and stability • Family and caregiver education • Home program may be developed, with client/caregiver training as needed

Rehabilitation Center or Skilled Nursing Facility:

Follow up to acute care interventions when incident is severe.

• Intensive, daily therapy to improve all aspects of function • Intervention to address attention, problem solving, and perceptual deficits, and to manage impulsive behaviorIntervention initially to address basic activities of daily living (ADLs) such as eating, bathing, dressing, grooming, and sequencing tasks. If basic skills are achieved, progression to more difficult tasks may include:

• preparing meals; • managing medication; • balancing a checkbook/paying bills; • organizing daily routines; • doing laundry and light housekeeping; • responding to an emergency situation, using the telephone, and engaging in socially appropriate behavior; and • preparing for community re-entry, driving, and workplace assessment as appropriate for the client's level of progress.

Outpatient/Home Health Services or Community Re- Integration Day Programs

• Adapt remediation/compensatory strategies as required to support performance in the person’s home, workplace, etc. • Carry-over of cognitive strategies in different environments (workplace, place of worship, grocery store, etc.) contexts. When the cognitive disorder has a gradual onset and degenerative course, as is the case with most dementias, the client will usually be seen at home or in a setting with supervision, such as adult day care, an assisted living facility, an outpatient clinic, or a nursing home. Intervention often revolves around educating caregivers, adapting the environment, setting up compensatory strategies, and reorganizing and simplifying tasks. These approaches allow the individual to engage in familiar activities to maintain quality of life. Progressive cognitive disorders worsen over time, but with appropriate treatment, clients can remain independent in self-care and other activities well into the disease process. Conclusion Occupational therapy practitioners serve a vital role for adults with cognitive impairment to facilitate new brain pathways and improve functional skills through adapting activities and retraining. Enabling individuals to participate more fully in self-care, work, leisure, and community activities enhances quality of life while reducing the burden on caregivers and societal resources.

Psychiatry

Psychiatry is the medical specialty devoted to the study and treatment of mental disorders.

A medical doctor specializing in psychiatry is a psychiatrist.

Psychiatric assessment typically starts with a mental status examination and the compilation of a case history. Psychological tests and physical examinations may be conducted. Psychiatric treatment applies a variety of modalities, including psychoactive medication, psychotherapy and a wide range of other techniques. Treatment may be delivered on an inpatient or outpatient basis, depending on the severity of functional impairment