Conditions That Affect Cognition
There are many different things which affect how well we think. Anyone who has had a few bad nights of sleep can attest that many factors affect are ability to think clearly and quickly. Sleep, illness, stress, grief, and major life changes may all lead to some temporary difficulty with a person’s ability to think as clearly as they are used to. In isolation such experiences are no cause for concern. However, when such experiences continue outside of extenuating circumstances, then that may mean something else is going on. Below is a brief overview of some common conditions which may impact a person’s thinking.
Traumatic Brain Injury
Traumatic brain injury is an acute injury that can impact cognition in both temporary and long-term ways. While definitions of traumatic brain injury vary, a broad definition is any hit to the head that results in some noticeable change in consciousness, whether that is dizziness, confusion, or a complete loss of consciousness. Traumatic brain injury is generally rated as mild, moderate, or severe depending on the degree of change in consciousness, length of time a person is unconscious, and impacts on memory for before and after the injury. Sustaining a mild traumatic brain injury, what we usually refer to as a concussion, is not uncommon and may happen in minor car accidents, sports injuries, or other common accidents.
For most people, they will recover quickly (within a few weeks) from cognitive impacts of a mild traumatic brain injury. However, in the immediate aftermath people may notice problems with memory, attention, focus, and speed of thinking. It is often recommended that people with a mild head injury take it mentally easy for a few weeks to allow the brain time to fully recover. You may imagine it like taking a solid hit to any part of your body—slip and hit your knee hard enough and there may be soreness or bruising for a few days that mean you need to limp or let that leg rest. However, hopefully you are soon back to normal functioning as the area heals, just like a head injury.
For individuals who have experiences a moderate or severe head injury, generally diagnosed when there is a period of unconsciousness ranging from a few hours to days, cognitive impacts may remain for a long time after. The difficulties a person experiences may vary depending on what kind of head injury was sustained, where they were hit, and other factors. Testing may help identify strengths and weaknesses, as well as track recovery over time. This may be helpful for an individual who may need certain school or workplace accommodations during acute and chronic recovery.
Dementia
Dementias are a class of medical diagnosis that refer to sustained and generally progressive changes in memory and other thinking skills over time. Alzheimer’s Disease is the most well-known and common kind of dementia. It often impacts people in their 60s and beyond, though age of onset varies depending on personal factors. Alzheimer’s Disease occurs when a certain kind of protein begins to buildup in the brain and interferes with normal communication among various brain systems. Common concerns include problems with short term memory and language skills.
Other kinds of dementia, however, can also impact thinking. Vascular dementia is the second most common form, occurring when there is a disruption to blood flow in the brain. This may be due to a major cerebrovascular event, such as stroke, or long-term vascular such as diabetes, high blood pressure, high cholesterol, and other chronic health problems. Many people with this kind of dementia will have difficulty with planning, judgment, and memory. However, in the case of a specific injury such as stroke, the area of the brain impacted by the condition will also play a role in the kinds of impairments seen.
Lewy Body, Frontotemporal, and Parkisonian dementias are also possible diagnostic considerations. Each of these has different subtypes and presentations, impacting areas such as speech, behavior, judgment, movement, and memory. Evaluation alongside a thorough medical workup is the best way to determine what the underlying cause is. Sometimes, multiple conditions may be present, resulting in a diagnosis of mixed dementia. Other times, it may not be possible to fully determine which kind of dementia is present, though there are treatment recommendations to help manage the symptoms.
Unfortunately, there is no current “cure” for dementia in its various forms. Treatment often focuses on medication to manage symptoms, as well as making environmental and behavioral changes to help protect the impacted individual and encourage safe independence as much as possible.
Delirium
Delirium is another condition worth noting, though rarely is it cause for a cognitive evaluation. Delirium is generally considered a short-term and reversible condition that mimics dementia. There is generally an underlying problem that causes a change, with most common culprits being an infection, dehydration, or problematic medication interactions. This sometimes occurs when an older adult, who has been functioning well on their own, displays a sudden and unexpected change in cognitive ability. They may become forgetful, scared, confused, or disoriented very rapidly, which can cause alarm for the family. An urgent medical evaluation is always the right course in such circumstances in order to ensure effective treatment of the condition and rule-out of other dangerous health issues such as stroke. Fortunately, treating the underlying causes, such as receiving fluids or treating the infection, will usually return the person to their prior level of functioning.