Cognitive Impairment
Cognitive Impairment is a topic covered in the Johns Hopkins Psychiatry Guide.
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DEFINITION
- Cognitive impairment refers to deficits in neurocognitive domains.
- Deficits can be defined as a difference from baseline, difference from age and education matched controls, or difference from the level of other neurocognitive domains in an individual (e.g., a deficit in complex attention with all other domains intact).
- Cognitive impairment can be classified into three severity levels: Mild (difficulty with instrumental activities of daily living), Moderate (difficulty with basic activities of daily living), and Severe (fully dependent on caregivers).
- Cognitive impairment can present with or without behavioral disturbance.
- The neurocognitive deficits cannot solely occur within an episode of delirium.
- The neurocognitive domains are as follows[3]:
- Complex attention (sustained attention, divided attention, selective attention, processing speed)
- Example deficits: difficulty with multiple stimuli, easily distracted, unable to perform mental calculations
- Executive function (planning, decision making, working memory, responding to feedback/error correction, overriding habits/inhibition, mental flexibility)
- Example deficits: unable to do complex projects, extra effort required to organize, difficulty switching between tasks, problems with impulse control, lacks motivation
- Learning and memory (short-term memory, long-term memory, episodic memory, semantic memory)
- Example deficits: repeats self in conversation, requires frequent reminders, difficulty recalling events that occurred in recent and/or distant past
- Language (expressive language and receptive language)
- Example deficits: impaired word finding (e.g., using general phrases ("that thing on your foot") rather than the name of an object ("shoe"), trouble with names of family members, grammatical errors
- Perceptual-motor (visual perception, visuo-constructional, perceptual-motor, praxis)
- Example deficits: trouble with previous familiar activities, trouble navigating familiar environments, trouble with spatial tasks
- Social cognition (recognition of emotions, theory of mind)
- Example deficits: behavior out of acceptable social range, insensitivity to social standards, makes decisions without regard to safety
- Complex attention (sustained attention, divided attention, selective attention, processing speed)
- When talking about global declines in cognition, two phrases are commonly used: dementia and delirium. Defined simply,
- Dementia: global cognitive decline in the presence of a clear sensorium
- Delirium: global cognitive decline in the setting of a clouded sensorium
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DEFINITION
- Cognitive impairment refers to deficits in neurocognitive domains.
- Deficits can be defined as a difference from baseline, difference from age and education matched controls, or difference from the level of other neurocognitive domains in an individual (e.g., a deficit in complex attention with all other domains intact).
- Cognitive impairment can be classified into three severity levels: Mild (difficulty with instrumental activities of daily living), Moderate (difficulty with basic activities of daily living), and Severe (fully dependent on caregivers).
- Cognitive impairment can present with or without behavioral disturbance.
- The neurocognitive deficits cannot solely occur within an episode of delirium.
- The neurocognitive domains are as follows[3]:
- Complex attention (sustained attention, divided attention, selective attention, processing speed)
- Example deficits: difficulty with multiple stimuli, easily distracted, unable to perform mental calculations
- Executive function (planning, decision making, working memory, responding to feedback/error correction, overriding habits/inhibition, mental flexibility)
- Example deficits: unable to do complex projects, extra effort required to organize, difficulty switching between tasks, problems with impulse control, lacks motivation
- Learning and memory (short-term memory, long-term memory, episodic memory, semantic memory)
- Example deficits: repeats self in conversation, requires frequent reminders, difficulty recalling events that occurred in recent and/or distant past
- Language (expressive language and receptive language)
- Example deficits: impaired word finding (e.g., using general phrases ("that thing on your foot") rather than the name of an object ("shoe"), trouble with names of family members, grammatical errors
- Perceptual-motor (visual perception, visuo-constructional, perceptual-motor, praxis)
- Example deficits: trouble with previous familiar activities, trouble navigating familiar environments, trouble with spatial tasks
- Social cognition (recognition of emotions, theory of mind)
- Example deficits: behavior out of acceptable social range, insensitivity to social standards, makes decisions without regard to safety
- Complex attention (sustained attention, divided attention, selective attention, processing speed)
- When talking about global declines in cognition, two phrases are commonly used: dementia and delirium. Defined simply,
- Dementia: global cognitive decline in the presence of a clear sensorium
- Delirium: global cognitive decline in the setting of a clouded sensorium
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Last updated: May 13, 2022
Citation
Richey, Lisa N, and Matthew E Peters. "Cognitive Impairment." Johns Hopkins Psychiatry Guide, 2022. Johns Hopkins Guides, www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Psychiatry_Guide/787027/all/Cognitive_Impairment.
Richey LN, Peters ME. Cognitive Impairment. Johns Hopkins Psychiatry Guide. 2022. https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Psychiatry_Guide/787027/all/Cognitive_Impairment. Accessed March 26, 2023.
Richey, L. N., & Peters, M. E. (2022). Cognitive Impairment. In Johns Hopkins Psychiatry Guide https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Psychiatry_Guide/787027/all/Cognitive_Impairment
Richey LN, Peters ME. Cognitive Impairment [Internet]. In: Johns Hopkins Psychiatry Guide. ; 2022. [cited 2023 March 26]. Available from: https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Psychiatry_Guide/787027/all/Cognitive_Impairment.
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