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

2. “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)

4. 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

8. 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)

9. 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

16. 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.

17. 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

18. Substance releted causes
- alcohol use disorder
- neurotoxns
-benzodiazepines

19. 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

20. 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)