Cognitive Disorders

Delirium
Delirium is a state of confusion that has sudden onset and can fluctuate (change rapidly).  It is very common and most often seen in hospital settings.  Delirium itself is not a disease, but rather a set of symptoms (syndrome) from an underlying disease or problem.

Symptoms
Since delirium may occur in very many grades of severity, all symptoms may occur with varying degrees of intensity. Delirium usually involves:

• Sudden onset
• Fluctuating course
• Attention deficits and decreased awareness of the environment
• Cognitive deficits (impairment in problem-solving or memory)
• Generalized disorganization of behavior
• Altered sleep-wake cycle and changes in arousal
• Psychotic features (such as hallucinations and delusions)

Causes
It is often caused by:

• disease process outside the brain (infection, pneumonia, critical illness)
• drug effects or withdrawal or
• metabolic, circulatory, and neurological impairments

The treatment of delirium requires treatment of the underlying causes. In some cases, temporary or symptomatic treatments are used to comfort patients or to allow better patient management.  The duration of delirium is typically affected by the underlying cause.

Dementia
Dementia is a serious loss of cognitive (thinking) ability, beyond what might be expected from normal aging. This affects many areas of functioning and interferes with day to day living. Although dementia is far more common in the geriatric (senior) population, it may occur at any stage of adulthood.

Symptoms
Although some dementia is reversible, most dementias will usually progress and the symptoms will worsen over time.  Initially, it usually involves difficulty with:

• memory
• attention
• language and
• problem-solving

Dementia itself is not a disease, but rather a set of symptoms (syndrome) from an underlying disease or problem.  Sometimes dementia symptoms are reversible, but more often, dementia results in a long-term decline due to a disease that is progressive and incurable.

Causes
In the elderly population, a large majority of cases of dementia are caused by:

• Alzheimer’s Disease
• Vascular Dementia (such as strokes)
• Mixed Dementia (both Alzheimer’s and Vascular dementia) and
• Dementia with Lewy Bodies

Treatment
There are no cures for the progressive illnesses that cause dementia (as listed above).  There are some medications to help treat symptoms of dementia (such as Aricept and Memantine).  Cognitive and behavioral interventions, psycho-social interventions, and education can be beneficial.  Education and emotional support to the caregiver  is of great importance as well.

Excerpts from DSM-IV and Wikipedia