Johns Hopkins Psychiatry Guide

Cognitive Impairment

Matthew E. Peters, M.D., Peter V. Rabins, M.D., Ph.D.
Cognitive Impairment is a topic covered in the Johns Hopkins Psychiatry Guide.

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DEFINITION

  • Cognitive impairment (CI) refers to unexpected deficits in neurocognitive domains (NCDs).
    • Unexpected can mean different from baseline, different from age-matched controls, or different from the level of other NCDs in an individual (e.g., a deficit in complex attention with all other NCDs intact).
  • The NCDs are as follows[1]:
    • 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, social gatherings reported as taxing
    • Learning and memory (immediate memory, recent memory, very long-term memory)
      • Example deficits: repeats self in conversation, can’t keep a shopping list, requires frequent reminders
    • Language (expressive language and receptive language)
      • Example deficits: 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, gnosis)
      • 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
  • 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: January 29, 2017