Cognitive Disorder

Cognitive disorders affect how the brain processes information, impacting memory, thinking, language, and judgment. While these changes can be concerning, understanding what causes them and how they can be managed is an important first step toward maintaining quality of life.

Table of contents

• What Is a Cognitive Disorder?
• Signs and Symptoms
• Types of Cognitive Disorders
• What Causes Cognitive Disorders?
• How Are Cognitive Disorders Diagnosed?
• Treatment and Management
• Can Cognitive Disorders Be Prevented?
• Living With Cognitive Impairment

What Is a Cognitive Disorder?

Cognition is the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses. It encompasses various aspects of high-level intellectual functions and processes such as attention, memory, knowledge, decision-making, planning, reasoning, judgment, perception, comprehension, language, and visuospatial function^[4].

A cognitive disorder occurs when there is a decline in thinking, memory, or other mental abilities that affects daily functioning. Cognitive impairment is when you have problems remembering things, concentrating, making decisions, and solving problems^[3]. Cognitive impairment is a symptom, not an illness itself. It can be caused by many different conditions^[3].

Cognitive disorders are defined as any disorder that significantly impairs the cognitive functions of an individual to the point where normal functioning in society is impossible without treatment^[4]. These disorders represent a bigger entity that is part of neurocognitive disorders, as classified in medical diagnostic systems^[4].

Cognitive impairment can range from mild to severe. Sometimes, cognitive impairment can get better^[3]. Cognitive impairment is more common in older people, but not every older person has cognitive impairment. It is not a normal sign of aging^[3].

Signs and Symptoms

If you have a cognitive impairment, you may notice problems with remembering things, thinking, planning and organizing things, controlling your emotions, and communicating with other people^[3].

The symptoms of cognitive impairment are more serious than the memory issues that are expected as people get older. The brain, like the rest of the body, changes with age. Many people notice they become more forgetful as they age. It may take longer to think of a word or to recall a person’s name. But if concerns with memory go beyond what’s expected, the symptoms may be due to cognitive impairment^[1].

Specific symptoms that people with cognitive disorders may experience include:

• Forgetting things more often
• Missing appointments or social events
• Losing their train of thought^[1]
• Difficulty finding the right words to say
• Misplacing items more often than usual
• Becoming easily distracted or losing focus
• Falling behind on bill payments^[5]
• Trouble completing tasks that used to be easy
• Trouble staying organized, planning, or multitasking^[14]

Cognitive symptoms can make you feel exhausted, overwhelmed, stressed, anxious, depressed, or sad^[6]. In some cases, you may have trouble with movement or your sense of smell along with cognitive changes^[5].

Types of Cognitive Disorders

Neurocognitive disorders are grouped into three main categories^[2]:

Delirium is a condition that occurs suddenly and can be a sign of a serious medical problem^[2]. It involves severe, short-term loss of brain function^[2].

Mild neurocognitive disorder (also called mild cognitive impairment) is a noticeable decline in memory and thinking. It’s a stage that happens between typical thinking and dementia^[5]. People with mild cognitive impairment experience some decreased mental function, but are able to stay independent and do daily tasks^[2]. The condition causes memory loss and trouble with language and judgment, but it doesn’t affect daily activities^[1].

There are two types of mild cognitive impairment. Amnestic MCI mostly affects memory—you might forget important information that you used to be able to remember. Non-amnestic MCI mostly affects thinking—you may have trouble with judgment, making decisions, or completing complex tasks^[5].

Major neurocognitive disorder (also called dementia) involves decreased mental function and loss of ability to do daily tasks^[2]. This is a more severe decline in mental functioning that affects your daily life. You may need assistance or supportive care^[5].

What Causes Cognitive Disorders?

There is no single cause of cognitive impairment. Many factors can cause problems with memory and thinking^[15]. Cognitive deficits may be present from birth or caused later by environmental factors such as brain injury, mental illness, or neurological disorders^[4].

The most common causes of cognitive impairment include delirium, dementia, and depression^[3].

Parts of your brain that help with memory and thinking may have damage or structural changes. These include your hippocampus, temporal lobes, parietal lobe, and other connected regions. These brain changes may make it harder to remember things, think clearly, or focus as well as before^[5].

Mild cognitive impairment may be an early stage of certain conditions that get worse over time and affect how your brain works, including:

• Alzheimer’s disease
• Frontotemporal dementia
• Lewy body dementia
• Parkinson’s disease
• Vascular dementia^[5]

Some of the early causes of cognitive deficit include chromosome abnormalities or genetic syndromes, prenatal drug exposure, malnutrition, poisoning due to lead or other heavy metals, neonatal jaundice, hypoglycemia, hypothyroidism, prematurity, hypoxia, trauma, or child abuse^[4].

In childhood or adolescence, cognitive deficit may develop as a result of side effects of cancer therapy, heavy metal poisoning, malnutrition, metabolic conditions, autism, and immune conditions like systemic lupus erythematosus^[4].

Other causes of cognitive impairment include:

• Brain injury
• COVID-19
• Drug use
• Intellectual disability
• Side effects from medicines
• Stroke^[3]
• Brain conditions such as traumatic brain injury and normal pressure hydrocephalus
• Chronic conditions like diabetes, COPD, and osteoarthritis
• Heart and blood vessel issues like high blood pressure, high cholesterol, and stroke
• Infections like urinary tract infections and HIV
• Mental health conditions like anxiety and depression
• Metabolic and nutritional issues like hypothyroidism, vitamin B12 deficiency, and dehydration
• Sleep conditions like obstructive sleep apnea^[5]

Cognitive impairment may be a side effect of taking certain medications, including antihistamines, antidepressants, blood pressure medications, antiseizure medications, benzodiazepines, muscle relaxants, and opiates^[5].

Risk Factors

Anyone can develop cognitive impairment. But you may be more at risk if you:

• Are above age 65
• Have a biological family history of dementia
• Have the APOE-ε4 (APOE4) gene variant, which increases your risk of Alzheimer’s disease^[5]

Not every elderly person will have a cognitive deficit, but cognitive deficit is more common in the elderly^[4]. Estimates suggest that roughly 10% to 20% of people over age 65 have mild cognitive impairment, with the risk increasing as someone gets older^[15].

How Are Cognitive Disorders Diagnosed?

To work out if you have cognitive impairment, your doctor may ask you about your symptoms and general health. They may also ask questions to test your memory, concentration, and understanding^[3].

A scale that doctors often use is called the Mini-Mental State Examination (MMSE)^[3]. Other brief tests include the Short Test of Mental Status and the Montreal Cognitive Assessment (MoCA). More detailed testing may show to what degree memory has changed and reveal the types of memory most affected and whether other mental skills are affected^[8].

Your doctor may also want to know if it’s okay to ask your family or loved ones some questions. This is because people close to you may have noticed changes in your behavior over time^[3]. A healthcare professional may confirm issues related to memory, planning, following instructions, or making decisions with a family member or close friend^[8].

To find the cause of your cognitive impairment, your doctor may also arrange blood tests and a brain CT scan^[3]. Your doctor may also organize a pharmacy review, also known as a Home Medicines Review, where a pharmacist looks at all the medicines that you take to check if any of your medicines or combinations of medicines could be causing your symptoms^[3].

As part of a physical exam, a healthcare professional may test how well your brain and nervous system works. These tests can help look for conditions that affect memory and other mental abilities. The neurological exam may test reflexes, eye movements, and walking and balance^[8].

Treatment and Management

Your treatment will depend on what is causing your cognitive impairment^[3]. Treatment depends on the underlying condition. Many conditions are treated mainly with rehabilitation and supportive care to help the person with activities lost due to areas where brain function is affected^[2].

There is no specific medication for mild cognitive impairment at this time^[11]. In some cases, memory and thinking problems may be caused by conditions that are treatable. For example, a bad reaction to medication, emotional problems, drinking too much alcohol, blood clots or tumors in the brain, or a head injury can all cause serious memory problems that can be resolved with treatment^[15].

Medicines may be needed to reduce aggressive behaviors that can occur with some conditions^[2]. A healthcare provider can help you manage any underlying causes or symptoms^[5].

Non-Drug Interventions

There are a number of lifestyle modifications that have been shown to help individuals with cognitive impairment^[11]. If you are having problems with memory, you can:

• Make a daily to-do list
• Use planners and reminder notes
• Keep items in the same place
• Try memory techniques, such as making up a rhyme, to help you remember things
• Ensure you are getting enough sleep to feel rested^[6]

If you are having difficulty speaking, you can talk to your healthcare provider about seeing a speech therapist, try to control your breathing as you speak, and write down and rehearse what you want to say before speaking to better organize your thoughts^[6].

If you are having difficulty understanding, ask others to speak slowly and in short sentences, and focus on other forms of communication—such as hand and body gestures—to supply context clues in a conversation^[6].

If you are having problems concentrating, prioritize tasks and do the most important ones first, ideally when you are most rested. Focus on doing one thing at a time, try to stay calm and not stress, ensure you are getting enough sleep to feel rested, and avoid drinking caffeine before bed^[6].

Can Cognitive Disorders Be Prevented?

Lifestyle measures can help to prevent cognitive impairment^[3]. Although there are no guarantees when it comes to preventing memory loss or dementia, some activities might help^[20].

Research identifies several risk factors that, if effectively addressed, could lead to a significant reduction in dementia cases. This reduction can mean either preventing dementia or delaying its onset, allowing individuals to enjoy more productive years^[22].

Steps to Reduce Risk

Manage vascular and metabolic risk factors. If you have high blood pressure or type 2 diabetes, work with your healthcare provider to manage these conditions. Hypertension and type 2 diabetes during mid-life are strongly associated with increased risk of dementia^[22].

Be physically active every day. Physical activity raises blood flow to the whole body, including the brain. This might help keep your memory sharp^[20]. Aim to get 150 or more minutes per week of moderate intensity physical activity. If you are sedentary, start with physical activity that can be incorporated into your lifestyle^[22].

Prioritize quality sleep. If you are getting insufficient or poor-quality sleep, aim to get seven to eight hours of sleep daily, including naps^[22]. Many studies suggest that not getting enough sleep is associated with increased risks of cognitive impairment and dementia^[22]. If you suffer from sleep apnea or other sleep disorders, talk to your doctor^[22].

Eat a brain-healthy diet. Eat a brain-healthy diet that includes high levels of vegetables, fruits, beans, nuts, and whole grains, while limiting intake of high-fat dairy products, red meat, fried foods, and processed foods^[22].

Stay mentally active. Activities that engage your mind help keep your brain in shape. And those activities might help prevent some memory loss. Do crossword puzzles, read, play games, learn to play a musical instrument, try a new hobby, or volunteer at a local school or with a community group^[20]. To stimulate your brain, it’s important to engage in new and novel things^[24].

Spend time with others. Social interaction helps ward off depression and stress, both of which can contribute to memory loss^[20]. There’s nothing more cognitively stimulating than having to engage with other people^[24].

Living With Cognitive Impairment

Mild cognitive impairment isn’t always permanent. In some cases, symptoms may improve^[5]. However, mild cognitive impairment raises the risk of developing dementia caused by Alzheimer’s disease or other conditions^[1]. Estimates suggest that roughly one to two out of 10 people age 65 or older with mild cognitive impairment develop dementia over a one-year period. However, in many cases, the symptoms stay the same or even improve^[15].

Some disorders are short-term and reversible. But many are long-term or get worse over time^[2].

Coming to terms with changes to your cognitive abilities can be tough. It’s normal to feel a range of emotions with this diagnosis^[5].

Making Everyday Tasks Easier

Many people with early-stage cognitive impairment continue to manage their everyday activities. But it’s important to look ahead to a time when performing daily tasks will be harder. The sooner you adopt new strategies to help you cope with changes, the more time you will have to adjust to them^[18].

Try to keep a routine, such as bathing, dressing, and eating at the same time each day. Help the person write down to-do lists, appointments, and events in a notebook or calendar. Plan activities that the person enjoys and try to do them at the same time each day^[23].

Write down to-do lists, appointments, and events in a notebook or calendar. You can also keep track of activities with computer software or a smartphone app. Some people have an area in their home, such as an entryway table or bench, where they store important items or organize the things they need each day^[18].

Setting up automated payments is an easy way to pay your bills correctly and on time without having to write checks. Also consider asking someone you trust to help you pay bills^[18].

When to See Your Doctor

See your doctor if you, or someone you know, shows signs of cognitive impairment^[3]. Contact your healthcare provider if you have been diagnosed with cognitive impairment and you are uncertain about the exact disorder, if you have symptoms of this condition, or if your symptoms become worse^[2].

If you have this condition, it’s important to see a doctor or specialist regularly to help monitor changes in memory and thinking over time^[15].