Cognative Loss In Dementia Essay

4536 words - 19 pages


When the Mind Falters:
Cognitive Losses
in Dementia




Joel Streim, MD
Associate Professor of Psychiatry
Director, Geriatric Psychiatry Fellowship Program
University of Pennsylvania
VISN 4 Mental Illness Research Education and Clinical Center
Philadelphia VA Medical Center

Delaware Valley Geriatric Education Center

The goal of this module is to teach direct staff about the
syndrome of dementia and its clinical effects on residents. It
focuses on the ways that the symptoms of dementia affect
persons’ functional ability and behavior.
We begin with an overview of the symptoms of cognitive
We continue with a description of the causes, ...view middle of the document...

• Link specific cognitive impairments with the disabilities they cause.
Losing cognitive skills means losing the ability to do the things that depend
on them, like using a comb or knowing what clothes to put on.
• Give examples of cognitive impairments and disabilities.
• Describe what to do when there is an acute change in cognitive or
functional status.
Those who care most directly for residents may be the first to notice a change
in cognitive skill that requires a change in the care plan to maintain the wellbeing of the individual.



What is dementia?
What do we see in
these persons?
Memory loss or amnesia, together with
decline in these other cognitive functions:
Use of language, or aphasia
Visual-spatial function, or perceptual
Recognition, or agnosia
Motor coordination, or apraxia
Performing sequential tasks, or executive
Delaware Valley Geriatric Education Center

Dementia interferes with daily functioning and behavior in many ways.
The hallmark of dementia is loss of memory function, or amnesia. The
person experiences forgetfulness, inability to remember old information or
learn new content. Several other areas of mental function may be impaired in
1. Impaired use of language and speech or aphasia Aphasia leads to
difficulty in both understanding speech and/or expressing oneself in words.
People with aphasia may have difficulty following verbal directions and may
seem bewildered. They typically have trouble finding words to express
themselves. In some cases, persons know what they want to say, but can’t get
the words out. They may use the wrong word, or substitute a nonsense word.
2. Visual-spatial function may also be affected, leading to perceptual
confusion. Affected persons may have problems with depth perception; or they
may lose their sense of direction, getting lost frequently.
3. Loss of ability to recognize familiar objects or agnosia. Persons with
agnosia may see an object, but cannot recognize what it is or what it is used for.
4. Loss of ability to carry out motor tasks or apraxia. This include manual
apraxia (e.g., inability to button a button, zip a zipper, remove the lid of a jar),
oral apraxia (e.g., inability to chew efficiently), or gait apraxia (difficulty
coordinating walking movements).
5. Executive dysfunction results in impaired ability to perform a sequence of
motor tasks (such as those involved in cooking a meal or brushing one’s


What causes dementia?


Alzheimer’s disease (AD) is the most
common cause; AD causes degeneration
and death of brain cells.



Many other medical or neurologic
conditions can cause dementia.

Delaware Valley Geriatric Education Center

Dementia is a syndrome, characterized by worsening cognitive
impairment. It can be caused by a wide variety of underlying medical
and neurological conditions that affect how the brain functions. When

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