What is Cognitive Deficits?
Cognition refers to the mental process of gaining knowledge and understanding through thinking, experience, and our senses. This covers a range of advanced mental functions and processes like paying attention, memory, understanding, making decisions, planning, reasoning, judgment, understanding perception, comprehension of language, and visual-spatial skills. Cognitive processes are all about using the knowledge we have and creating new knowledge.
The term “cognitive deficit” refers broadly to a decrease in different cognitive abilities. It’s not unique to any specific disease or condition, but can be a symptom of different underlying conditions. It’s sometimes used interchangeably with “cognitive impairment”. It could be a temporary situation or something that progresses and becomes permanent.
Cognitive disorders, which fall under the larger category of neurocognitive disorders, refer to any condition that significantly reduces an individual’s cognitive functions to the point where they can’t function normally in society without treatment. Alzheimer’s disease is a well-known condition linked to cognitive impairment.
What Causes Cognitive Deficits?
Cognitive deficits, or problems with thinking and learning, can be present from birth or develop later due to certain factors such as brain injury, mental illness, or neurological disorders. While not all older people will have cognitive deficits, the condition is more common in older individuals.
A variety of factors can contribute to cognitive deficits early in life. These can include genetic abnormalities, exposure to drugs before birth, poor nutrition, lead poisoning, newborn jaundice, low blood sugar or thyroid function, prematurity, lack of oxygen, trauma, or child abuse.
In childhood or adolescence, cognitive deficits may develop due to a range of conditions. These could be side effects of cancer treatments, heavy metal poisoning, poor nutrition, metabolic conditions, autism, and diseases of the immune system like systemic lupus erythematosus.
As we get older, conditions such as stroke, delirium, dementia, depression, schizophrenia, chronic alcohol use, substance abuse, brain tumors, vitamin deficiencies, hormonal imbalances, and some chronic diseases could cause cognitive deficits. Certain brain diseases, including Alzheimer’s, Parkinson’s disease, Lewy body dementia, Huntington’s disease, certain HIV-related and prion diseases, are also often associated with cognitive deficits. Certain drugs, like sedatives, tranquilizers, anticholinergics, and glucocorticoids can also cause cognitive deficits. Brain injuries and infections at any age can also contribute to cognitive deficits.
Risk Factors and Frequency for Cognitive Deficits
Cognitive impairment, or difficulties with thinking and memory, can be caused by many things and it’s hard to say exactly how common these issues are. However, we do know that as people age, they’re more likely to suffer from these issues. A major cause of cognitive impairment is Alzheimer’s disease. This disease affects about 5.5 million people in the United States and over 24 million worldwide.
- Alzheimer’s disease is particularly common in African American communities, with rates roughly double that of European Americans.
- The likelihood of getting dementia, another cause of cognitive impairment, doubles every 10 years after the age of 60.
- Specifically, the chance of getting Alzheimer’s disease grows significantly as you get older, from less than 1% per year before 65, to 6% per year after the age of 85.
Signs and Symptoms of Cognitive Deficits
Cognitive impairment is not a disease, but rather a sign of an underlying condition. It’s when a person is having trouble with things like memory, attention, and mental processing. The individual or their caregivers and friends often notice these changes.
The common signs of cognitive impairment include:
- Difficulty recalling information, often repeating the same question or story
- Struggling to learn new things or concentrate
- Vision issues or problems with speaking
- Trouble recognizing familiar people and places
- Feeling overwhelmed in new places or situations
- Confusion or agitation
- Changes in mood or behavior
- Struggling with everyday tasks that were previously easy
Cognitive impairment can fluctuate, and it varies in severity. In its mild form, there might be noticeable changes in cognitive function, but the person can still carry out their daily activities. At its most severe, cognitive impairment, or dementia, can prevent a person from living independently due to difficulties with regular tasks and judgment.
The symptoms of cognitive impairment can accompany other symptoms based on the root cause. People with cognitive impairment due to an infection might have a fever, rash, headache, and nausea among other symptoms. If the cognitive problems are due to a metabolic disorder, the person might also have issues like abdominal pain, nausea, rapid or slow heartbeat, fatigue, and muscle weakness. Other conditions, such as head injuries, stroke, or dementia, could also result in cognitive problems and bring with them symptoms like personality changes, vision issues, imbalance, and seizures.
Delirium is a type of cognitive disorder that develops quickly and causes confusion, disorientation, and inability to process new information. It can also lead to hallucinations and mood swings. Another type of cognitive disorder is neurocognitive disorder, which relates to memory loss and cognitive impairments. It’s commonly seen in older adults. The difference between mild and major neurocognitive disorders lies in the severity of the symptoms. Major neurocognitive disorder, also known as dementia, leads to significant cognitive decline and dependency, whereas in a mild neurocognitive disorder, the individual remains independent.
Testing for Cognitive Deficits
Doctors use a comprehensive approach to evaluate patients, including detailed personal and family history, and clinical exams that assess physical, neurological, and mental status. This helps them understand changes in cognitive functions, self-care abilities, physical symptoms, psychiatric symptoms, and current medication.
Several screening tools help evaluate a patient’s cognitive abilities. The goal is to spot those people who might need a full diagnostic assessment. A common test doctors use is the Mini-Mental State Exam (MMSE). But there are other newer tools particularly suited to primary care settings, such as:
1. General practitioner assessment of cognition (GPCOG)
2. Memory impairment screen (MIS)
3. Montreal cognitive assessment (MoCA)
4. Mini-Cog
5. Memory and executive screening (MES), and more.
Family members and caretakers might be asked to provide information using the Short Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Dementia Severity Rating Scale (DSRS), AD-8, or General Practitioner Assessment of Cognition (GPCOG). If a patient performs poorly on these tests, more in-depth neuropsychological testing could help understand the type and level of impairment.
The suitability of these tools varies depending on the case. For instance, because it tests a broad range of cognitive functions, the Montreal Cognitive Assessment (MOCA) is often used for general screening. In contrast, the Mini-Mental State Examination (MMSE) is more focused on memory testing and is used for patients with Alzheimer’s disease.
A thorough neurological examination is also part of the physical exam. This allows the doctor to gauge how well the brain and nervous system are functioning, which can be helpful in detecting signs of different brain diseases like stroke, Parkinson’s disease, brain tumors, or other medical conditions.
Extra tests might be needed based on the physical symptoms and signs. These could include blood count, thyroid tests, vitamin B12 levels, basic metabolic panel, urine analysis, or liver and kidney function tests to rule out infectious causes and metabolic disorders. Brain imaging like CT scans and MRIs can also be helpful in identifying brain problems like tumors, bleeding, or stroke.
Treatment Options for Cognitive Deficits
Deciding on a treatment for cognitive difficulties often depends on what is causing the problem in the first place. Certain conditions, such as infections, depression, hormonal imbalances, or medication side effects, are curable and may lead to improvement of cognitive issues when treated. In circumstances where cognitive disorders are present, the focus of treatment is typically on enhancing the person’s quality of life and minimizing leftover symptoms.
In the case of mild cognitive impairment, there aren’t any medication treatments. The approach is to improve the individual’s daily functioning. Counseling plays a crucial role in this process. Additional issues such as problems with mobility, falls, vision, and hearing should also be addressed. If sleep apnea is present, a therapy called continuous positive airway pressure (CPAP) may be beneficial. It’s important to note that certain medications, especially some types of antidepressants, may have negative effects on cognitive function in older adults, so these should often be avoided. Adjusting medications in older adults may lead to a significant boost in cognitive function.
When dealing with delirium, figuring out the root cause is vital. Certain medications like antipsychotics or benzodiazepines may alleviate symptoms in some cases. Those suffering from alcohol abuse or malnutrition may benefit from vitamin B supplements. Severe cases might necessitate life support. It’s worth noting that despite being popular, the herbal supplement Ginkgo biloba hasn’t been proven in randomized trials to prevent cognitive decline in those with mild cognitive impairment or regular cognitive function.
Enhancing cognitive health might be helped by physical activity, cognitive training and exercises, good sleep, and relaxation strategies. A Mediterranean diet might be beneficial for individuals with cognitive impairment. Occupational therapy can teach strategies to help reduce the impact of cognitive impairment on daily life. Creating a calm environment, keeping familiar objects around, psychotherapy and providing support for patients and their families can all lead to better understanding and management of the disorder, hence improving the quality of life for everyone involved.
As for Alzheimer’s disease, while there’s no cure, available medications can slow down the worsening of symptoms and improve cognition and behavioral issues. Several types of medications are commonly used in treatment, including cholinesterase inhibitors and a partial N-methyl-d-aspartate antagonist. Accompanying symptoms of Alzheimer’s disease, like depression, hallucinations, and sleep disorders, also need treatment. Certain medications such as antidepressants and antipsychotics are commonly used to manage these symptoms. In cases of mild cognitive decline in normal aging, behavioral and supportive interventions are typically the only requirements.
What else can Cognitive Deficits be?
Cognitive impairment isn’t a disease, but a symptom of different underlying health problems. Here are a few conditions which can lead to cognitive issues:
- Delerium
- Alzheimer’s disease
- Huntington’s disease
- Stroke
- Developmental disorders like Down syndrome
- Brain injury
- Multiple sclerosis
- Parkinson’s disease
- Lewy body dementia
- Meningitis
- HIV/AIDS
- Effects of certain substances like alcohol, drugs, or toxins
- Wernicke-Korsakoff syndrome (a brain disorder caused by a lack of vitamin B1)
What to expect with Cognitive Deficits
The outlook for cognitive deficits, or mental lapses, is tied to their root cause. Some causes, like certain medications, depression, thyroid disorders, and infections, can be fixed. On the other hand, conditions like Alzheimer’s disease can’t be reversed, although the progression can be slowed. Certain causes of cognitive deficits can be life-threatening if not correctly managed.
Patients diagnosed with Alzheimer’s disease typically live about 4 to 8 years after diagnosis, if they’re 65 years or older. Some may live up to 20 years after the first signs of the disease appear.
In some cases, cognitive deficits might be a sign of a severe or potentially deadly condition. Such conditions include brain tumors, stroke, encephalitis, meningitis, traumatic head injury, severe dehydration or heat stroke, kidney failure, sepsis, and spinal cord injury or tumors. Therefore, the outlook for cognitive deficits depends largely on the specific circumstances.
Possible Complications When Diagnosed with Cognitive Deficits
Having cognitive problems can sometimes be a sign of other serious illnesses or conditions. Failing to get treatment in time can lead to serious problems or even permanent harm. Once a diagnosis is made, it’s crucial to follow a proper plan of treatment to prevent potential issues. These can include:
- Delayed growth and development
- Learning disabilities
- Problems with speech and hearing
- Weakness or loss of muscle movement
- Continued cognitive (thinking and memory) problems
- Permanent loss of feeling
- Physical disabilities
- Changes in personality
- Permanent loss of memory
- Loss of independence
- Falls and injuries
- Coma
Preventing Cognitive Deficits
Age is the main reason for a decline in mental functions. Other factors can include a family history of cognitive issues, lack of physical exercise, and illnesses such as Parkinson’s, heart disease, stroke, brain injury, cancers of the brain, substance abuse, exposure to harmful substances, and diabetes. To help lower the risk of these problems, it helps to stay physically active, eat healthily, and maintain good levels of blood pressure, blood sugar, and cholesterol. Some causes of cognitive decline, like infections, medication side effects, depression, and a lack of vitamin B12, can be treated. So, it is important to identify people who show signs of cognitive decline and can get the right healthcare or treatment.
Other factors like high blood pressure, diabetes, high cholesterol, smoking, and obesity are believed to make it harder to remove a protein called amyloid from the brain. This then raises the risk of developing Alzheimer’s disease. The risk becomes even higher if you have a combination of these health issues in your 50s. Therefore, it’s key to keep your blood pressure, sugar, and cholesterol at healthy levels.
Changes to the environment and behavior can also help, particularly with managing behavioral problems. Simple strategies such as reducing noise, redirecting attention, keeping a familiar environment, providing comfort items, ensuring personal comfort, and avoiding arguments can help manage behavioral issues. Regular aerobic exercise and the Mediterranean diet have been found to slow the progression of Alzheimer’s disease.
There are many memory and cognitive function tests online that can give you an idea about possible cognitive issues in a person. However, these are not substitutes for a doctor’s examination and full medical checkup. Before reaching any conclusions and starting treatment options, a consultation with a healthcare professional is necessary. Alzheimer’s disease and other forms of dementia can cause significant upheaval for the patient, as well as their family, friends, and the community. So treatment and management must involve doctors, patients, loved ones, and even policymakers. Policymakers in healthcare should consider policies and initiatives that could provide more support, advance research, and ultimately improve the quality of life for those living with cognitive impairment and their families.