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ESSENTIALS OF DIAGNOSIS

  • Transient or permanent brain dysfunction with alterations in awareness or attention.

  • Cognitive impairment to varying degrees.

  • Impaired recall and recent memory, inability to focus attention and problems in perceptual processing, often with psychotic ideation.

  • Random psychomotor activity such as stereotypy.

  • Emotional disorders frequently present: depression, anxiety, irritability.

  • Behavioral disturbances: impulse control, sexual acting-out, attention deficits, aggression, and exhibitionism.

GENERAL CONSIDERATIONS

The organic problem may be a primary brain disorder or a secondary manifestation of some general disorder. All of the cognitive disorders show some degree of impaired thinking depending on the site of involvement, the rate of onset and progression, and the duration of the underlying brain lesion. Emotional disturbances (eg, depression) are often present as significant comorbidities. The behavioral disturbances tend to be more common with chronicity, more directly related to the underlying personality or central nervous system vulnerability to drug side effects, and not necessarily correlated with cognitive dysfunction.

The causes of cognitive disorders are listed in Table 25–11.

Table 25–11.Etiology of delirium and other cognitive disorders.

CLINICAL FINDINGS

The many manifestations include problems with orientation, short or fluctuating attention span, loss of recent memory and recall, impaired judgment, emotional lability, lack of initiative, impaired impulse control, inability to reason through problems, depression (worse in mild to moderate types), confabulation (not limited to alcohol organic brain syndrome), constriction of intellectual functions, visual and auditory hallucinations, and delusions. Physical ...

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