Cognitive Disorders and Neurological Disorders

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Cognitive Disorders and Neurological Disorders

• Assessment Diagnosis
• SW 593

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Introduction

• Etiology related to physiological processes which
  are due to general medical conditions.
• Some specific diagnoses are related to the use of
  one or more substances or exposure to a toxic
  agent.
• The hallmark of delirium is a disturbance in
  consciousness (awareness of ones environment
  and/or capacity to focus and direct ones
  attention).

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Delirium

• Other disturbances in cognitive functioning
  (language disturbance, disorientation, memory
  deficits) may be present as well.
• This condition develops over a relatively short
  period of time, and the intensity of symptoms
  fluctuates in the course of a day.

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Delirium

• Some of the most common risk factors for delirium
  include
• Use of a general anesthetic
• Multiple medications
• A history of drug/alcohol abuse
• Sensory loss
• Social isolation
• Unfamiliar environments
• Sleep deprivation
• Central nervous system disorders metabolic and
  cardiopulmonary disorders.

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Dementia

• The prominent symptoms for Dementia include
• Memory impairment
• Other cognitive disturbances (language
  disturbances apraxia, agnosia and/or
  disturbances in executive functioning
• Most dementias develop slowly and display a
  steadily deteriorating course.
• Symptoms are directly related to the portion of
  the brain that is being affected.

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Dementia

• Dementia of the Alzheimers type impairment is
  focused in the parietal and temporal portions of
  the brain, which are central to memory function.

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Amnestic Disorders

• Characterized by memory impairment in the
  relative absence of other cognitive problems.
• The most common medical conditions related to
  Amnestic disorders are a variety of brain traumas
  or diseases that damage the midbrain structures
  of maxillary bodies, hippocampus, and fornix.

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Mental disorders due to a General Medical
Condition

• Two specific disorders
• Catatonic Disorder describes clients who show
  significant disruptions in motor activity,
  extreme negativism, or mutism, oddities of
  voluntary movement, and/or mirroring behaviors.
• Personality change clients who display negative
  and persistent changes to their previous
  personality pattern.
• These changes are usually associated with a
  variety of neurological, metabolic, or autoimmune
  disorders.

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• In all of the above diagnoses, the general
  medical condition should be listed on Axis III.

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Assessment

• When a practitioner conducts assessments related
  to these disorders, a crucial component is a
  thorough medical workup.
• Prognosis for these medical conditions is
  determined by whether or not the underlying
  medical situation can be remedied.
• Primary focus of assessment with these mental
  disorders is on cognitive functioning.

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Cultural Considerations

• A vast majority of persons with these conditions
  are the elderly of our society.
• Regardless, of age, most individuals with these
  disorders are in need of assistance and
  considerable care giving.
• Research indicates that family members provide
  80 of the informal care that older persons and
  individuals with chronic disabilities receive.

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Cultural Considerations

• Caring for a person with a cognitive disorder can
  be an exhausting activity and there is ample
  evidence to suggest that cultural variations
  exist among different ethnic groups within our
  society in terms of the norms, values, and
  beliefs associated with care giving for family
  members.
• Traditionally, African American, Asian/Pacific
  Islander, and Hispanic families have held strong
  beliefs about maintaining care giving
  responsibilities within the family unit.

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Cultural Considerations

• Ethnic minority families are often seen as
  under-utilizing resources available to them in
  the community.
• As practitioners, be aware to culturally diverse
  philosophies of care giving.
• All families may require support in coping with
  the stress of care giving, the type and degree of
  support may vary across cultures.

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Cultural Considerations

• Being able to establish a culturally sensitive
  relationship with the client and family will more
  likely lead to a successful long-term outcome in
  caring for the individual with the disability.

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Social Support Systems

• It should be evident that clients with these
  disorders require assistance to maintain
  functioning.
• This dependency may become so pronounced that
  institutionalization becomes necessary.
• Both the provision of assistance and the decision
  making about appropriate placement and care can
  cause substantial amounts of stress.

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Social Support Systems

• Along with these demands, care givers are
  typically grieving various losses associated with
  the clients deterioration.
• This accumulated physical, emotional, financial,
  and social stress is commonly referred to as care
  giver burden.
• Female care givers experienced the greatest
  amount of loneliness and depression, with wives
  experiencing more loneliness than daughters.

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Social Support Systems

• Husbands also experienced loneliness but at lower
  levels than those of the female care givers.