Yard. Doç.Dr. N. Berfu AKBAŞ COGNITIVE AND MENTAL DISORDERS DUE TO A GENERAL MEDICAL CONDITION (DGMC ) Yard. Doç.Dr. N. Berfu AKBAŞ

“Clinically significant deficit in cognition and memory that represents a significant change from a previous level of functioning” DELIRIUM DEMENTIA NEUROCOGNITIVE DISORDERS DUE TO ANOTHER MEDİCAL CONDITION (AMNESTIC DISORDER)

DELIRIUM Disturbance of consciousness and a change in cognition with sudden onset. Abnormalities of mood, perception, behaviour, tremor, nystagmus, incoordination, urinary incontinance “It’s a syndrome, not a disease!” Other names: acute confusional state, acute brain syndrome, metabolic encephalopathy, toxic psychosis, acute brain failure

Important to recognize; %90 postcardiotomy %40-50 after hip fracture surgery %30 AIDS %20 after severe burns %15-20 in general medical wards Advanced age ( >65-%30-40) 1 year mortality %50 ( poor prognostic sign)

Etiology: CNS disease ( epilepsy, brain trauma, infections, neoplasms, vascular disorders) Systemic Diseases ( arrhytmias, hypoglycemia, hypoxia, hepatic-uremic encephalopathies, endocrine dysfunction, fever, sepsis) Post-operative states Drugs and poisons Electrolyte imbalance of any cause

Traumatic, infection, infarction, hypoxia AMNESTIC DISORDERS Usually damage to the diencephalic and middle temporal lobe structures( mamillary bodies, hippocampus) Commonly bilateral Traumatic, infection, infarction, hypoxia Transient amnestic disorder; pathology in the vertebrobasilar system, acute intoxications, seizures.

MAJOR CAUSES Thiamine Deficiency ( Korsakoff Syndr.) Hypoglıcemia Primary Brain Conditions -seizures - head trauma - cerebral tumors - Cerebrovascular diseases - encephalitis - hypoxia - transient global amnesia - electroconvulsive therapy - multiple sclerosis

Substance releted causes - alcohol use disorder - neurotoxns -benzodiazepines

Clinical Features Short term and recent memory impaired Orientation is seldom lost Remote memory fine Immediate memory not impaired Episodic memory impaired Semantic memory intact No language problems No praxis or function problems

DEMENTIAS Impairment in intellectual functioning in 1)memory 2)cognition; language, personality, judgement, abstraction, information synthesis… %50-Alzheimer type, %25 multi-infarct SUBCORTICAL D: basal ganglia, thalamus, brain stem ( movement disorders ) memory defects are delayed CORTICAL D: memory, language, agnosia, apraxia- Alzheimer D. MIXED D: Multi-infarct D., Lewy body Disease( psychotic and Parkinsonian features)