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Diagnosis   

Cognitive disorders

In sever cognitive impairment no useful history will be obtainable from the patient so you will have to depend on an informant.

A whole host illnesses can cause cognitive impairment. It is often necessary to evaluate  to evaluate a patients cognitive function.

Dementia

• Syndrome due to disease of the brain

• Usually of a chronic or progressive nature

• Consciousness is not clouded

• Disturbance of multiple higher cortical functions...

- memory - thinking - orientation - comprehension

- calculation - learning capacity - language - judgement

Delirium

• Non-specific organic cerebral syndrome

• Duration is variable and the degree of severity ranges from mild to very severe

• Disturbances of...

- consciousness - attention - perception - thinking

- memory - psychomotor behaviour - emotion - sleep-wake schedule

- 'Have you found yourself forgetting things?' (establish onset, duration, degree)

- 'Do you ever get confused or disorientated?'

- 'Do you have trouble understanding what people say to you?'

- 'Do you have trouble finding the right words to say?'

...have any of these symptoms been getting gradually worse over months?'

- 'Have you seen, heard or felt anything that other people told you didn’t exist?'

Administer the cognitive exam

Other questions: -

- 'Have you noticed a change in your sense of smell?' (lost early in some dementias)

- 'Have you had any incontinence?'

- 'Has there been a change in personality?'

[You may have to obtain answers from relatives, carers, nurses]