Overview - Cognitive Impairment Disorders

DISORDERS:

There is no easy way to cover all of the aspects of these brain dysfunctions, although I believe it is informative to at least cover the basics. Therefore, here is an overview from, diagnosis of the disorders using the most recent DSM, to attempting to examine possible treatments.

DIAGNOSING BRAIN DYSFUNCTIONS - The most recent edition of the "diagnostic dictionary", the DSM, is the DSM-lV, which does contain a section on cognitive disorders. The diagnosis of the disorders included are based on essential features, or symptoms but do include information concerning conditions that have possibly been chemically induced (for example, substance-induced mood disorder). The ability to asses brain damage and brain function has improved greatly in recent years, due to a few tools. Tools such as neuroimaging techniques, positron emission tomography (PET) scans, magnetic resonance imaging (MRI), and computerized axial tomography (CT) scans provide ways of viewing the living brain.

There are also tests that are used to asses the client such as the Mini Mental State Exam (MMSE). It contains eleven items and has a possible score of 30 points. It is a quick way to examine for gross cognitive impairment. There are questions regarding the following:

Diagnosis of the location of the damage is not always as simple, because of two reasons. For one, each person's brain is somewhat different, and two, many brain functions do not occur in just one area of the brain. Most often there are many parts of the brain operating to complete the one task.

DELIRIUM - Delirium refers to reduced level of consciousness or ability to focus, sustain, and shift attention. It can also include cognitive changes such as memory or language deficits, disorientation, or perceptual disturbances such as hallucinations. Delirium usually has a rapid onset over hours or days, it also tend to fluctuate during the course of the day. Often it is a signal of the onset of a serious mental condition, although it is viewed as temporary and reversible, for some patients it has lead to comas and even death. Delirium can be caused by any number of things, such as: burn victims, pre-existing brain damage, drug-dependent patients experiencing withdrawal, heart surgery patients, people with AIDS and many others. Numerous medications, toxic substances, and head injuries also can cause delirium, although, these people usually are incoherant or disoriented for only a few days and then return to notrmal consciousness.

AMNESTIC DISORDERS - Amnesia refers to impairment of short or long-term memory. The hippocampus, amygdala, and other temporal structures are usually affected with this disorder, by medical conditions or injuries to the head. The memory dysfunctioning is primarily noticed when, trying to learn new information, or trying to recall previous information. This disorder usually gets diagnosed when the inability to recall or learn new infromation becomes impairs their functioning lives, that is when they seek out the diagnosis.

DEMENTIA - Dementia refers to general, multiple, cognitive deficits reflecting a decline in previously higher levels of functioning; it is also acquired, unlike other diseases that one can be inborn. To be diagnosed with dementia, patients must meet with at least one of four criteria:

Often those with dementia will preservate, or repeat ideas, come back to the same theme, or have difficulty switching topics appropriately. These people make very poor judgements in planning and cannot usually function independently. This is a disorder that frequently afflicts those with old age, about 30 percent of individuals over eighty have it, and about 2 to 4 percent of persons aged sixty-five or younger also do. There are some forms of dementia that are partielly reversible, about 10 to 20 percent of patients, but sadly, most of the time it is permanent and progressive.

TREATMENTS - Most of the treatments for these disorders are beyond my understanding, although I have heard of a few for helping, not treating, Alzheimer's and Parkinson's syptoms. At this time there ae investigations into the drug tancrine, that possibly can improve the brain functioning of patients with Alzheimer's dementia; it is thought to repair the cholinergic deficiency that results from cell damage. There has also been investigation in the area of implanting healthy dopamine-producing brain cells, to improve the motor functioning of patients with Parkinson's. A lot of other treatments are used to deal with the psychological distress that goes along with the disorders. There are medications to ease moods, such as anti-depressants, which also work to subside some symptoms. In addition to medications, there are also behavioral change programs, to cope with problem beaviors, such as, aggressiveness, wandering, and incontinence. The procedures are based on simple learning procedures that alter the environment. Such behavior programs can also improve, say, personal hygiene, by making the tools more accessible, creating larger handles and such. Reward systems are also used to fuel the process.

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