cognitive impairment
Jump to navigation
Jump to search
Introduction
Impairment of cognition.
Loss of cognitive function in at least on domain: memory, lanuguage, executive function, visuospatial function or behavior.
Also see cognition, altered mental status, encephalopathy.
Classification
Etiology
acute/subacute
- vascular: stroke
- CNS infections: viral encephalitis
- toxic: acute drug effect (amitriptyline)
- metabolic: hepatic encephalopathy
- inflammatory: cerebral vasculitis
- nutritional: Wernicke-Korsakoff syndrome (thiamine deficiency)
- degenerative:
- delirium superimposed on dementia
- urinary tract infection
- epileptic: seizure, postictal state
- traumatic: acute head injury
- psychiatric: acute psychosis (schizophrenia)
- neoplastic: primary brain tumor (obstructive hydrocephalus)
chronic
- vascular disease
- ischemic stroke, lacunar infarct
- leukoaraiosis
- cerebral amyloid angiopathy
- primary CNS angiitis
- blood-brain barrier breakdown (BBB) is an early marker of cognitive dysfunction in humans independent of beta-amyloid & MAP-tau[11]
- infectious:
- HIV, AIDS dementia complex, possibly latent CMV
- neurosyphilis
- transmissible spongiform encephalopathy
- fungal meningitis
- composite measure of exposure to Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus, & Herpes simplex HSV1 & HSV2 is a risk factor[8]
- toxic:
- chronic drug effect (lithium carbonate)
- heavy drinking in middle-age men[10]
- lead poisoning (plumbism)
- metabolic: hypothyroidism, diabetes mellitus in poor control
- inflammatory: autoimmune meningoencephalitis
- nutritional:
- vitamin B12 deficiency
- consumption of ultra-processed foods[16]
- degenerative:
- epileptic: psychomotor status epilepticus
- traumatic: sequellae of brain trauma
- psychiatric: chronic psychosis (bipolar disorder)
- depression in early adulthood may increase risk for cognitive impairment in midlife[17]
- obstructive sleep apnea may cause cognitive impairment in midlife[18]
- neoplastic: meningeal carcinomatosis (communicating hydrocephalus)[1]
- chronic renal insufficiency[6]
- hearing loss, especially if accompanied by visual impairment[15]
Epidemiology
- up to 30% of community-dwelling adults
- no specific cause found in 24%[14]
Clinical manifestations
- cognitive decline is already evident in middle age (age 45-49)[2]
- functional limitations due to cognitive decline are more common among adults with vision impairment (RR=3)[12]
Radiology
- neuroimaging (all patients)
Complications
- disease interaction(s) of anemia with cognitive impairment
- disease interaction(s) of cancer with cognitive impairment
- disease interaction(s) of visual impairment with cognitive impairment
- disease interaction(s) of olfactory disorder with cognitive impairment
Differential diagnosis
Management
- no evidence support the use of dietary supplements or pharmaceuticals to prevent cognitive decline[3]
- exercise improves cognition in the elderly[4]
- Mediterranean diet in combination with exercise, reduces risk of cognitive impairment & dementia[5]
- low saturated fat intake & high monounsaturated fat intake are beneficial for cognition in elderly women[7]
- USPSTF recommends against routine screening of elderly
- no evidence of improved outcomes[9]
- prognosis:
More general terms
More specific terms
- cognitive impairment in the elderly
- critical illness cognitive impairment (post-ICU cognitive impairment)
- dementia; Alzheimer's disease & related dementias (ADRD)
- executive function impairment in Alzheimer's disease
- lack of awareness
- language impairment in Alzheimer's disease
- learning impairment
- memory impairment
- post-chemotherapy cognitive impairment
- postoperative cognitive impairment
- pre-mild cognitive impairment (preMCI)
Additional terms
- cognition (intelligence)
- cognitive assessment
- differential diagnosis of cognitive impairment
- encephalopathy
- intellectual disability; mental retardation
- prevention of cognitive impairment
References
- ↑ Jump up to: 1.0 1.1 1.2 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 18. American College of Physicians, Philadelphia 2009, 2012, 2018.
- ↑ Jump up to: 2.0 2.1 Singh-Manoux A et al. Timing of onset of cognitive decline: Results from Whitehall II prospective cohort study. BMJ 2012 Jan 5; 344:d7622. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22223828
- ↑ Jump up to: 3.0 3.1 Plassman BL, Williams JW Jr, Burke JR, et al. Systematic review: Factors associated with risk for and possible prevention of cognitive decline in later life. Ann Intern Med Aug 3, 2010; 153(3):182-193 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20547887
- ↑ Jump up to: 4.0 4.1 Jackson AS, Sui X, Hebert JR, et al. Role of lifestyle and aging on the longitudinal change in cardiorespiratory fitness. Arch Intern Med 2009; 169(19):1781-1787 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19858436
- ↑ Jump up to: 5.0 5.1 Scarmeas N et al Physical Activity, Diet, and Risk of Alzheimer Disease JAMA. 2009;302(6):627-637. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19671904 <Internet> http://jama.ama-assn.org/cgi/content/full/302/6/627
Feart C et al Adherence to a Mediterranean Diet, Cognitive Decline, and Risk of Dementia JAMA. 2009;302(6):638-648. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19671905 <Internet> http://mail.google.com/mail/?hl=en&tab=wm#inbox/1230e5270aa617fe
Knopman DS et al Mediterranean Diet and Late-Life Cognitive Impairment A Taste of Benefit JAMA. 2009;302(6):686-687 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19671912 <Internet> http://mail.google.com/mail/?hl=en&tab=wm#inbox/1230e5270aa617fe - ↑ Jump up to: 6.0 6.1 Yaffe K, Ackerson L, Kurella Tamura M, et al. Chronic kidney disease and cognitive function in older adults: findings from the chronic renal insufficiency cohort cognitive study. J Am Geriatr Soc 2010 Feb; 58(2):338-345. Epub 2010 Jan 26. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20374407
- ↑ Jump up to: 7.0 7.1 Okereke OI et al. Dietary fat types and 4-year cognitive change in community- dwelling older women. Ann Neurol 2012 May 17 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22605573 <Internet> http://onlinelibrary.wiley.com/doi/10.1002/ana.23593/abstract;jsessionid=93500A913F6A8B59C680984086D4CD7B.d01t03
- ↑ Jump up to: 8.0 8.1 Katan M et al Infectious burden and cognitive function. The Northern Manhattan Study. Neurology March 26, 2013 vol. 80 no. 13 1209-1215 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23530151 <Internet> http://www.neurology.org/content/80/13/1209.short
Strandberg TE and Alello AE Is the microbe-dementia hypothesis finally ready for a treatment trial? Neurology March 26, 2013 vol. 80 no. 13 1182-1183 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23530150 <Internet> http://www.neurology.org/content/80/13/1182.extract
Prasad KM et al Progressive gray matter loss and changes in cognitive functioning associated with exposure to herpes simplex virus 1 in schizophrenia: A longitudinal study. Am J Psychiatry 2011 Jun 1; PMID: https://www.ncbi.nlm.nih.gov/pubmed/21632649 - ↑ Jump up to: 9.0 9.1 Lin JS et al Screening for Cognitive Impairment in Older Adults: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med. Published online 22 October 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24145578 <Internet> http://annals.org/article.aspx?articleid=1760977
Moyer VA et al Screening for Cognitive Impairment in Older Adults: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. Published online 25 March 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24663815 <Internet> http://annals.org/article.aspx?articleid=1850963 - ↑ Jump up to: 10.0 10.1 Sabia S et al Alcohol consumption and cognitive decline in early old age. Neurology. January 15, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24431298 <Internet> http://www.neurology.org/content/early/2014/01/15/WNL.0000000000000063
- ↑ Jump up to: 11.0 11.1 Nation DA, Sweeney MD, Montagne A et al Blood-brain barrier breakdown is an early biomarker of human cognitive dysfunction. Nature Medicine 2019. Jan 14. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30643288 https://www.nature.com/articles/s41591-018-0297-y
- ↑ Jump up to: 12.0 12.1 Saydah S, Gerzoff RB, Taylor CA, Ehrlich JR, Saaddine J. Vision Impairment and Subjective Cognitive Decline-Related Functional Limitations - United States, 2015-2017. MMWR Morb Mortal Wkly Rep 2019;68:453-457 https://www.cdc.gov/mmwr/volumes/68/wr/mm6820a2.htm
- ↑ Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
- ↑ Jump up to: 14.0 14.1 14.2 14.3 McWhirter L, Ritchie C, Stone J, Carson A. Functional cognitive disorders: A systematic review. Lancet Psychiatry 2019 Nov 12; PMID: https://www.ncbi.nlm.nih.gov/pubmed/31732482 https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30405-5/fulltext
- ↑ Jump up to: 15.0 15.1 Ge S et al. Longitudinal association between hearing loss, vision loss, dual sensory loss, and cognitive decline. J Am Geriatr Soc 2021 Mar; 69:644. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33258497 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.16933
- ↑ Jump up to: 16.0 16.1 Gomes Goncalves N, Vidal Ferreira N, Khandpur N et al JAMA Neurol. 2022 Dec 5. Association Between Consumption of Ultraprocessed Foods and Cognitive Decline. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36469335 https://jamanetwork.com/journals/jamaneurology/fullarticle/2799140
- ↑ Jump up to: 17.0 17.1 Dintica CS, Habes M, Erus G et al Long-term depressive symptoms and midlife brain age. J Affect Disord. 2023 Jan 1;320:436-441 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36202300 https://www.sciencedirect.com/science/article/abs/pii/S0165032722011788
- ↑ Jump up to: 18.0 18.1 Gnoni V, Mesquita M, O'Regan D et al Distinct cognitive changes in male patients with obstructive sleep apnoea without co-morbidities. Front. Sleep, 06 April 2023 https://www.frontiersin.org/articles/10.3389/frsle.2023.1097946/full