Cognitive disorder

This article has an unclear citation style. The references used may be made clearer with a different or consistent style of citation and footnoting. (August 2021) (Learn how and when to remove this template message)

Part of a series on
Psychology
Outline History Subfields
show Basic types Abnormal Behavioral genetics Biological Cognitive/Cognitivism Comparative Cross-cultural Cultural Differential Developmental Evolutionary Experimental Mathematical Neuropsychology Personality Positive Quantitative Social
show Applied psychology Applied behavior analysis Clinical Community Consumer Counseling Critical Educational Environmental Ergonomics Forensic Health Humanistic Industrial and organizational Psychometrics Legal Medical Military Music Occupational health Political Religion School Sport Traffic
show Lists Disciplines Organizations Psychologists Psychotherapies Publications Research methods Theories Timeline Topics
Psychology portal
v t

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, attention deficit disorder, schizophrenia and mild and major neurocognitive disorder (previously known as dementia). Cognitive disorders are deficits in cognitive ability (acquired rather than developed) that typically decline over time and may have underlying pathology in the brain. 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, various medical conditions 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. Neurocognitive disorders are diagnosed as mild or major based on the severity of their symptoms. While anxiety disorders, mood disorders, and psychotic disorders can also affect cognitive and memory functions, the DSM-IV-TR does not consider these cognitive disorders because the loss of cognitive function is not the primary (causal) symptom. Additionally, developmental disorders such as autism spectrum disorder are typically developed at birth or early in life instead of 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. Treatments depend on how the disorder began. 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.

Cognitive mental disorder perspective[]

In abnormal psychology, cognitive disorders are mental health disorders that develop based on the 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 essential cognitive functions, i.e., memory processing, perception, problem-solving, and language. This perspective opposes 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 the cognitive disorder perspective is Albert Ellis. In 1962, Ellis proposed that humans develop irrational beliefs/goals about the world creating disorders in cognitive abilities. 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. His model showed that a blending of adverse cognitive functions about the self, the world, and possible selves leads to cognitive mental disorders.

Molecular Genetic Overlap[]

In 2017, the Feinstein Institute for Medical Research at Northwell Health and Hofsta Northwell School of Medicine formed a team of scientists, led by Dr. Todd Lencz. The Feinstein team (known as the Cognitive Genomics Consortium, or COGENT) studied the genes of 35,000 participants and found (for the first time) a genetic overlap between cognitive dysfunction and personality. This finding suggests a genetic predisposition that may exist for cognitive disorders. ^[13]

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 representing a marked deterioration from a previous level of function.” The subsections include delirium and mild and major neurocognitive disorder.

Delirium[]

Delirium develops rapidly over a short period and is characterized by a disturbance in cognition, including 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 fast onset ranging from minutes to hours and sometimes days, but typically only lasts a few hours to weeks. Delirium can also be accompanied by a shift in attention, mood swings, violent or unordinary behaviors, and hallucinations. A preexisting medical condition can cause it. Delirium during a hospital stay can result in a greater risk of complications and long-terms stays.

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. Still known as dementia, the 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. For non-reversible causes of dementia such as age, the slow decline of memory and cognition is lifelong. It can be diagnosed by screening tests such as the Mini-Mental State Examination (MMSE).

Attention deficit disorder (ADD)[]

Attention deficit disorder is a cognitive disorder that may or may not develop with symptoms of hyperactivity. The disorder is characterized by inattention, fidgeting, and impulsiveness. ADD is a chronic disorder (frequently life-long) that affects an estimated 5% of children. There is some suggestion that attention deficit disorder may have some degree of a genetic inheritance, however, its cause is officially unknown. ADD is believed to originate from an abnormality in the neurotransmission of dopamine and noradrenaline. Some risk factors include head injury, parental smoking or drinking, and trauma (emotional or physical). ^[14]

Causes[]

Delirium[]

Delirium can be caused by worsening previous medical conditions, substance abuse or withdrawal, mental illness, severe pain, immobilization, sleep deprivation and hypnosis. Other common causes that may increase the risk of delirium include infections of the urinary tract, skin, stomach, pneumonia, old age, and poor nutrition.

Mild and major neurocognitive disorder[]

Neurocognitive disorders can have numerous causes: genetics, brain trauma, stroke, and heart issues. The leading causes are neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, and Huntington's disease because they affect or deteriorate brain functions. 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.

The neurocognitive disorder may also be caused by brain trauma, including concussions, and traumatic brain injuries, post-traumatic stress, and alcoholism. Referred to as amnesia, and is characterized by damage to essential memory encoding parts of the brain such as the hippocampus. 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. Retrograde amnesia is also caused by damage to the hippocampus, but the memories encoded or being encoded in long-term memory are erased

Attention deficit disorder (ADD)[]

There is some suggestion that attention deficit disorder may have some degree of a genetic inheritance, however, its cause is officially unknown. ADD is believed originate from an abnormality in the neurotransmission of dopamine and noradrenaline. Some risk factors include head injury, parental smoking or drinking, and trauma (emotional or physical). ^[14]

Treatment[]

Delirium

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

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.

Studies suggest that diets with high Omega 3 content, low in saturated fats and sugars, and regular exercise can increase brain plasticity. 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.

In some cases, Amnesia may be cured through time. Treatments for amnesia include cognitive therapy, (for mild to moderate memory loss), the treatment of underlying medical conditions, treatment for underlying psychiatric illnesses (including substance abuse disorders). ^[11]

Attention deficit disorder Treatment for attention deficit disorder will not cure the dysfunction, however behavioral therapy, counseling and stimulant medication may allow for more productive and easier functioning.

Cognition-based interventions for healthy older people and people with mild cognitive impairment[]

Current evidence suggests that cognition-based interventions do improve mental performance (i.e. memory, executive function, attention, and speed) in older adults and people with mild cognitive impairment.^[1] Especially, immediate and delayed verbal recall resulted in higher performance gains from memory training.

References[]

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. 1 2 3 4 5 6 Guerrero, Anthony (2008). Problem-Based Behavioral Science of Medicine. New York: Springer. pp. 367–79.
4. 1 2 3 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. 1 2 3 Torpy, Janet (2010). "Dementia". The Journal of the American Medical Association. 304 (7): 1972. doi:10.1001/jama.304.17.1972. PMID 21045107.
6. 1 2 3 4 5 6 Cicerelli, Saundra. Psychology. Upper Saddle River: Pearson Prentice Hal.
7. 1 2 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. Mandal, D. A. (2019, June 5). Treatment of amnesia. News. https://www.news-medical.net/health/Treatment-of-amnesia.aspx.
12.  ↑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
13. Feinstein Institute genetic discovery provides new insight into cognitive disorders. (2017, January 18). US Official News.
14. Block, R. W., MD, Macdonald, N. E., PhD, & Piotrowski, N. A., PhD. (2021). Attention deficit hyperactivity disorder (ADHD). Magill’s Medical Guide (Online Edition). 

References[]