Cognitive disorder

Cognitive disorders (CDs), also known as neurocognitive disorders (NCDs), are a category of mental health disorders that primarily affect cognitive abilities including learning, memory, perception, and problem solving. Neurocognitive disorders include delirium and mild and major neurocognitive disorder (previously known as dementia). They are defined by deficits in cognitive ability that are acquired (as opposed to developmental), typically represent decline, and may have an underlying brain pathology.[1] The DSM-5 defines six key domains of cognitive function: executive function, learning and memory, perceptual-motor function, language, complex attention, and social cognition.

Although Alzheimer's disease accounts for the majority of cases of neurocognitive disorders, there are various medical conditions that affect mental functions such as memory, thinking, and the ability to reason, including frontotemporal degeneration, Huntington’s disease, Lewy body disease, traumatic brain injury (TBI), Parkinson’s disease, prion disease, and dementia/neurocognitive issues due to HIV infection.[2] Neurocognitive disorders are diagnosed as mild and major based on the severity of their symptoms. While anxiety disorders, mood disorders, and psychotic disorders can also have an effect on cognitive and memory functions, the DSM-IV-TR does not consider these cognitive disorders, because loss of cognitive function is not the primary (causal) symptom.[3] Additionally, developmental disorders such as autism spectrum disorder are typically developed at birth or early in life as opposed to the acquired nature of neurocognitive disorders.

Causes vary between the different types of disorders but most include damage to the memory portions of the brain.[4][5][6] Treatments depend on how the disorder is caused. Medication and therapies are the most common treatments; however, for some types of disorders such as certain types of amnesia, treatments can suppress the symptoms but there is currently no cure.[5][6]

Cognitive mental disorder perspective

In abnormal psychology, cognitive disorders are mental disorders that develop on the basis of cognitive mental disorder perspective. The cognitive mental disorder perspective is the theory that psychological disorders originate from an interruption, whether short or long, in our basic cognitive functions, i.e. memory processing, perception, problem solving and language. This perspective takes opposition to the psychodynamic mental disorder perspective, behavioral mental disorder perspective, sociocultural mental disorder perspective, interpersonal mental disorder perspective and neurological/biological mental disorder perspective. One pioneer of cognitive disorder perspective is Albert Ellis. In 1962, Ellis proposed that humans develop irrational beliefs/goals about the world; and therefore, create disorders in cognitive abilities.[7] Another pioneer of the cognitive disorder perspective is Aaron Beck. In 1967, Beck designed what is known as the "cognitive model" for emotional disorders, mainly depression.[7] His model showed that a blending of negative cognitive functions about the self, the world, and possible selves lead to cognitive mental disorders.

Classifications

The previous edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) included a section entitled "Delirium, Dementia and Amnestic and Other Cognitive Disorders," which was revised in DSM-5 to the broader "Neurocognitive Disorders." Neurocognitive disorders are described as those with “a significant impairment of cognition or memory that represents a marked deterioration from a previous level of function”.[3] The subsections include delirium and mild and major neurocognitive disorder.

Delirium

Delirium develops rapidly over a short period of time and is characterized by a disturbance in cognition, manifested by confusion, excitement, disorientation, and a clouding of consciousness. Hallucinations and illusions are common, and some individuals may experience acute onset change of consciousness. It is a disorder that makes situational awareness and processing new information very difficult for those diagnosed. It usually has a high rate of onset ranging from minutes to hours and sometimes days, but it does not last for very long, only a few hours to weeks.[3] Delirium can also be accompanied by a shift in attention, mood swings, violent or unordinary behaviors, and hallucinations. It can be caused by a preexisting medical condition.[4] Delirium during a hospital stay can result in a longer stay and more risk of complications and long terms stays.[8]

Mild and major neurocognitive disorder

Mild and major neurocognitive disorders are usually associated with but not restricted to the elderly. Unlike delirium, conditions under these disorders develop slowly and are characterized by memory loss. In addition to memory loss and cognitive impairment, other symptoms include aphasia, apraxia, agnosia, loss of abstract thought, behavioral/personality changes, and impaired judgment. There may also be behavioral disturbances including psychosis, mood, and agitation.

Mild and major neurocognitive disorders are differentiated based on the severity of their symptoms. Also still known as dementia, major neurocognitive disorder is characterized by significant cognitive decline and interference with independence, while mild neurocognitive disorder is characterized by moderate cognitive decline and does not interfere with independence. To be diagnosed, it must not be due to delirium or other mental disorder. They are also usually accompanied by another cognitive dysfunction.[3] For non-reversible causes of dementia such as age, the slow decline of memory and cognition is lifelong.[3] It can be diagnosed by screening tests such as the Mini Mental State Examination (MMSE).[3]

Causes

Delirium

Delirium can be caused by the worsening of previous medical conditions, substance abuse or withdrawal, mental illness, severe pain, immobilization, sleep deprivation and hypnosis.[4]

Other common causes that may increase the risk of delirium include infections of urinary tract, skin and stomach, pneumonia, old age, and poor nutrition.[9]

Mild and major neurocognitive disorder

Neurocognitive disorders can have numerous causes: genetics, brain trauma, stroke, and heart issues. The main causes are neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, and Huntington's disease because they affect or deteriorate brain functions.[5] Other diseases and conditions that cause NCDs include vascular dementia, frontotemporal degeneration, Lewy body disease, prion disease, normal pressure hydrocephalus, and dementia/neurocognitive issues due to HIV infection. They may also include dementia due to substance abuse or exposure to toxins.

Neurocognitive disorder may also be caused by brain trauma, including concussions and traumatic brain injuries, as well as post-traumatic stress and alcoholism. This is referred to as amnesia, and is characterized by damage to major memory encoding parts of the brain such as the hippocampus.[6] Difficulty creating recent term memories is called anterograde amnesia and is caused by damage to the hippocampus part of the brain, which is a major part of the memory process.[6] Retrograde amnesia is also caused by damage to the hippocampus, but the memories that were encoded or in the process of being encoded in long term memory are erased[6]

Treatment

Delirium

Before delirium treatment, the cause must be established. Medication such as antipsychotics or benzodiazepines can help reduce the symptoms for some cases. For alcohol or malnourished cases, vitamin B supplements are recommended and for extreme cases, life-support can be used.[4]

Mild and major neurocognitive disorder

There is no cure for neurocognitive disorder or the diseases that cause it. Antidepressants, antipsychotics, and other medications that treat memory loss and behavioral symptoms are available and may help to treat the diseases. Ongoing psychotherapy and psychosocial support for patients and families are usually necessary for clear understanding and proper management of the disorder and to maintain a better quality of life for everyone involved. Speech therapy has been shown to help with language impairment, therefore improving long term development and academic outcome.[10]

Studies suggest that diets with high Omega 3 content, low in saturated fats and sugars, along with regular exercise can increase the level of brain plasticity.[11] Other studies have shown that mental exercise such a newly developed “computerized brain training programs” can also help build and maintain targeted specific areas of the brain. These studies have been very successful for those diagnosed with schizophrenia and can improve fluid intelligence, the ability to adapt and deal with new problems or challenges the first time encountered, and in young people, it can still be effective in later life.[6]

A person with amnesia may slowly be able to recall their memories or work with an occupational therapist to learn new information to replace what was lost, or to use intact memories as a basis for taking in new information. If it is caused by an underlying cause such as Alzheimer's disease or infections, the cause may be treated but the amnesia may not be.

See also

• List of cognitive disorders

Notes

1. Rosen, Allyson. "Neurocognitive Disorders of the DSM-5" (PDF). stanford.edu. Retrieved 2 October 2017.
2. Simpson JR (2014). "DSM-5 and neurocognitive disorders". J. Am. Acad. Psychiatry Law. 42 (2): 159–64. PMID 24986342.
3. Guerrero, Anthony (2008). Problem-Based Behavioral Science of Medicine. New York: Springer. pp. 367–79.
4. Torpy, Janet (2008). "Delirium". The Journal of the American Medical Association. 300 (19): 2936. doi:10.1001/jama.300.24.2936. PMID 19109124.
5. Torpy, Janet (2010). "Dementia". The Journal of the American Medical Association. 304 (7): 1972. doi:10.1001/jama.304.17.1972. PMID 21045107.
6. Cicerelli, Saundra. Psychology. Upper Saddle River: Pearson Prentice Hal.
7. Alloy, et al., 2005
8. McGohan (2005). "Clinical Updates. Delirium". The Journal of Continuing Education in Nursing. 36 (3): 102–103. doi:10.3928/0022-0124-20050501-05. PMID 16022028.
9. "MayoClinic's Review". MayoClinic.
10. Ullrich, Dieter; Ullrich, Katja; Marten, Magret (September 2014). "A longitudinal assessment of early childhood education with integrated speech therapy for children with significant language impairment in Germany: Longitudinal assessment of early childhood education with integrated speech therapy". International Journal of Language & Communication Disorders. 49 (5): 558–566. doi:10.1111/1460-6984.12092. PMID 24939594.
11. Gomez-Pinilla, Fernando (2011). "The Combined Effects of Exercise and Foods in Preventing Neurological and Cognitive Disorders". Preventive Medicine. 52: S75–S80. doi:10.1016/j.ypmed.2011.01.023. PMC 3258093. PMID 21281667.

References

Alloy, Lauren; John Riskind; Margaret Manos (October 2005). Abnormal Psychology. McGraw Hill. pp. 88–89. ISBN 0-07-242298-X.