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Cognitive & Learning Disorders
medical conditions

Cognitive & Learning Disorders

Explore the available health information, treatment context, and integrative evidence for Cognitive & Learning Disorders.

Background
  • Cognitive function, also called cognitive performance or cognition, refers to the ability of an individual to think, process, and store information in order to solve problems. Humans are the only organisms capable of cognition.
  • Cognitive disorders are characterized by delirium, dementia, and/or amnesia. Delirium is a term used to describe a confused mental state in which a patient has difficulty processing and interpreting information. Dementia is the loss of mental ability that is so severe that it interferes with daily functioning. Amnesia may cause difficulty remembering previously learned information. Patients with cognitive disorders may experience one or more of these symptoms.
  • Treatment for cognitive disorders depends on the underlying cause. Most disorders are incurable and some may have devastating effects. For instance, Alzheimer's disease eventually leads to complete cognitive impairment. Treatment may help delay progression of such disorders. Other disorders, such as age-associated memory impairment (AAMI) may only cause mild symptoms.
  • Cognitive learning disabilities occur when individuals have difficulty interpreting or processing what they see or hear. There is a gap between the patient's intelligence and his/her ability to perform. Patients may have difficulties with spoken and written language, self-control, coordination, and/or attention. As a result, patients may have a hard time with schoolwork or performing tasks at work.
  • Patients with cognitive learning disabilities are often able to live normal, healthy lives. There are many ways for patients to cope with their disabilities. Special education and adaptive skills training has been shown to improve patients' work and school performances. Patients who are diagnosed and treated promptly are often able to go to college and support themselves.
Signs and Symptoms
  • General: The signs and symptoms of cognitive disorders and cognitive learning disabilities vary, depending on the type and severity of the condition. Some patients may live normal, healthy lives and are barely affected by the disorder. Other may have severe disabilities that limit their abilities to function independently.
  • Age-associated memory impairment (AAMI): Age-associated memory impairment (AAMI) causes mild forgetfulness in patients who are 50 years old or older.
  • Alzheimer's disease: Symptoms of Alzheimer's disease (AD) typically develop in patients who are 65 years old and older. However, a less common form of AD, known as early-onset AD, may develop in patients who are 30-40 years old. The youngest patient to be diagnosed with AD was 29 years old.
  • At first, symptoms may be mistaken for normal forgetfulness. However, overtime, the patient loses all cognitive functioning.
  • Mild symptoms may include memory impairment, confusion, difficulty learning and remembering new information, difficulty with daily tasks, mood swings, restlessness, and depression. In most cases, the patient is still able to do most activities, such as driving a car. However, the patient may get lost going to familiar places.
  • Moderate symptoms may include forgetting old facts, continually repeating stories, and/or asking the same questions repeatedly. The individual may make up stories to fill memory gaps. Patients have difficulty performing everyday tasks, such as keeping a checkbook, shopping for groceries, or following written notes. Patients may need help performing daily activities. Other symptoms may include agitation, restlessness, repetitive movement, paranoia, delusions, and hallucinations. Deficiencies in intellect and reasoning, along with a lack of concern for appearance, hygiene, and sleep, become more noticeable.
  • In the advanced stage of AD, damage to the brain's nerve cells is widespread. At this point, full-time care is typically required. The patient is generally bedridden. For friends, family, and caregivers, this can be the most difficult stage. Individuals with severe Alzheimer's disease may have difficulty walking, and they often suffer complications from other illnesses such as pneumonia. Signs of severe Alzheimer's disease may include groaning, screaming, mumbling, or speaking incoherently. They refuse to eat and may inappropriately cry out. Individuals with severe or advanced symptoms fail to recognize the faces of family members or caregivers. Apraxia (inability to perform physical tasks such as dressing or eating) and aphasia (loss of ability in comprehension of spoken or written language) are seen. They have great difficulty with all essential activities of daily life.
  • Multi-infarct disease: Memory impairment is often the first symptom to be noticed. An individual with dementia may be unable to remember ordinary information, such as his/her birth date, phone number, and address. Patients may be unable to recognize friends and family members. There is a progressive decline in cognitive function, including decision making, judgment, orientation in time and space, problem solving, and verbal communication. Behavioral changes may be seen in eating, dressing, and using the bathroom. Dementia patients may be unable to dress without help and may become incontinent or lose the ability to control urine flow. Normal interests, such as hobbies and social groups, are abandoned. They are unable to perform routine activities, such as driving, grocery shopping, and housecleaning. Individuals with dementia also experience changes in personality, such as inappropriate responses and lack of emotional control.
  • Trauma may cause prolonged or permanent changes in cognition, memory, emotions, or behavior.
  • Niacin deficiency-induced dementia: Patients with Niacin deficiency-induced dementia may suffer from the same symptoms as patients with multi-infarct disease.
  • In addition, niacin deficiency may cause symptoms that affect other parts of the body. Other symptoms, unrelated to dementia, may include skin lesions, inflammation of the tongue, reddening of the tongue, pain in the mouth, increased salivation, ulcerations in the mouth, burning in the throat, swelling in the abdomen, abdominal pain, constipation, diarrhea, nausea, and vomiting.
  • Learning disabilities: Cognitive learning disabilities vary from mild to severe. There are several different types of learning disabilities, including dyslexia, dysgraphia, dyscalculia, dyspraxia, and auditory perceptual deficit.
  • Dyslexia occurs when patients have difficulty translating written images into meaningful language. Patients may be unable to recognize written letters or words. Some may be reading at grade levels far below average.
  • Dysgraphia occurs when patients have difficulty writing letters within a defined space. Patients may take longer to write and have extremely poor handwriting that is almost illegible.
  • Dyscalculia occurs when patients have difficulty doing arithmetic and understanding mathematical concepts.
  • Patients with dyspraxia have poor motor control of large movements. Patients may have poor balance, poor posture, lack of rhythm when dancing, poor hand-eye coordination, and clumsy movement.
  • Visual perceptual deficit occurs when patients have difficulty processing visual information. Although nothing may be wrong with their eyesight, patients may have difficulty identifying an object from a background of other objects or they may not see things in the proper order.
  • Auditory perceptual deficit occurs when patients have difficulty processing auditory information. Although nothing may be wrong with their hearing, the brain does not interpret sounds properly. As a result, patients may have difficulty understanding and remembering things that are said. They may have difficulty distinguishing between similar sounds or hearing one sound over background noise.
  • Intellectual disability (mental retardation): Patients with mild intellectual disabilities have intelligence quotients (IQs) of 52-69. From birth to age six, patients are able to develop social and communication skills, but motor coordination is slightly impaired. By late adolescence, patients are able to learn until about a six-grade level. They are generally able to learn appropriate social skills. Adults are usually able to work and support themselves. Some patients may need help during times of social or financial stress.
  • Patients with moderate intellectual disabilities have IQs of 36-51. Children younger than six years old are able talk or communicate with others, but social awareness is generally poor. The patient's motor coordination is typically fair. Adolescents are able to learn some occupational and social skills. They may be able to learn how to travel alone in familiar places. Adults may be able to support themselves with a job. They usually require guidance and assistance during mild social or financial stress.
  • Patients with severe intellectual disabilities have IQs of 20-35. Young children can say a few words, but their speech is limited. Motor coordination is generally poor. Adolescents can usually talk or communicate with others. They are able to learn simple habits. Adults typically require lifelong assistance and guidance with daily activities.
  • Patients with profound intellectual disabilities have IQs of 19 or lower. Children younger than six years old have very little motor coordination and may require nursing care. Adolescents typically have limited motor and communication skills. Adults usually require lifelong nursing care.
Diagnosis
  • Age-associated memory impairment (AAMI): There are currently no tests to diagnose age-associated memory impairment (AAMI). However, if symptoms of forgetfulness worsen over time, patients should be tested for Alzheimer's disease (AD) or other cognitive disorders.
  • Alzheimer's disease: The earliest reported Alzheimer's disease diagnosis purportedly occurred in a 29-year-old patient. However, most patients are diagnosed with the condition when they are older than 65 years of age. There is no one test to diagnose Alzheimer's disease (AD). Typically, doctors start the diagnostic process by ruling out other diseases and conditions, such as brain injury or stroke, which may also cause memory loss.
  • A Mental Status Evaluation (MSE) screens memory, problem-solving abilities, attention spans, counting skills, and language skills. Questions such as "what day is it today?" or "who is the president of the United States?" may be asked. Recall tests are another example. Doctors may list familiar objects and then ask a person to repeat them immediately and again five minutes later. The Clock Drawing Test, the Mini-Mental State Examination (MMSE), and the Functional Assessment Staging (FAST) are commonly used mental status evaluation tools for determining if AD is present. On the tests, the final score helps confirm a diagnosis of AD
  • Brain scans may also be used to take pictures of the brain. Images of the brain are then analyzed for changes in function and structure of the brain that are associated with AD. Researchers have performed studies to determine if these brain scans may help predict a person's risk of developing the condition.
  • Multi-infarct dementia: The American Psychiatric Association has established two generally accepted criteria for the diagnosis of dementia: (1) a decline in recent and past memory and (2) impairment of one or more of the following functions: language (aphasia or the misuse of words or inability to remember and use words correctly); motor activity (apraxia or unable to perform motor activities even though physical ability remains intact); recognition (agnosia or unable to recognize objects, even though sensory function is intact); and executive function (unable to plan, organize, and think abstractly). Symptoms often develop gradually and show a progressive deterioration in function.
  • Once dementia is diagnosed, brain scans may be performed to detect possible abnormalities in the brain.
  • Niacin deficiency-induced dementia: If a patient meets the diagnostic criteria for dementia, additional tests are performed to determine the cause. A blood test is performed to determine if a niacin deficiency is the cause. Patients with dementia that is caused by niacin deficiency will have low levels of niacin in the blood. Healthy individuals typically have 2.4-6.1 milligrams of niacin per deciliter of blood.
  • Learning disabilities: Prompt diagnosis and early treatment of learning disabilities has been shown to improve a patient's long-term prognosis. In order to diagnose a learning disability, a specialist will administer several tests, which may involve writing, speaking, and listening. These tests are designed to measure the patient's strengths and weaknesses. In addition, the specialist will interview the patient and family members about medical history and problems that are being encountered.
  • Intellectual disability (mental retardation): Even though intellectual disability (mental retardation) is an irreversible condition, early diagnosis and prompt treatment has been shown to help improve patients' long-term prognoses.
  • Doctors diagnose intellectual disability after a medical history, physical examination, and intellectual quotient (IQ) test. If a patient does not show signs of adaptive behavior and scores well below average on the IQ test, then a positive diagnosis is made. To measure the patient's adaptive behavior professionals will compare what the patient can do to other children of his or her age. Many skills, including daily living skills (e.g. getting dressed, feeding oneself, and using the bathroom), communication skills (understanding what is being said and being able to respond), and social skills are important to adaptive behavior.
  • Patients with mild intellectual disabilities have intelligence quotients (IQs) of 52-69. Patients with moderate intellectual disabilities have IQs of 36-51. Patients with severe intellectual disabilities have IQs of 20-35. Patients with profound intellectual disabilities have IQs of 19 or lower.
Complications
  • Depression: Depression is common in patients with Alzheimer's disease (AD), especially during the earlier stages when they may be aware of losing mental functions. Depression may be treated with medications called antidepressants.
  • Falls and their complications: Individuals who suffer from dementia may become disoriented, increasing their risk of falls. Falls can lead to bone fractures that require hospitalization, medications, and surgery. Falls may also lead to an increase in the severity of AD symptoms, such as confusion and agitation. In addition, falls are a common cause of serious head injuries, such as brain hemorrhage (bleeding in the brain). Long-term immobilization after surgery and hospitalization may increase the risk of a pulmonary embolism (blood clot in the lungs), which can be life-threatening.
  • Infections: In severe and advanced dementia, individuals may lose all ability to care for themselves. This can make them more prone to additional health problems including pneumonia, which is an infection of the lungs and respiratory system. The individual may have difficulty swallowing food and liquids, which may cause them to inhale some of what they eat and drink into their airways and lungs, which may lead to pneumonia.
  • Urinary incontinence: Patients with severe or advanced dementia may develop urinary incontinence or the loss of bladder control that causes urine leakage. These patients may require the placement of a urinary catheter, which increases the risk of urinary tract infections (UTIs). UTIs can lead to more serious, life-threatening infections, such as pyelonephritis (bacterial infection of the kidney).
Treatment
  • Cholinesterase inhibitors: The U.S. Food and Drug Administration (FDA) has approved cholinesterase inhibitors for the treatment of Alzheimer's disease (AD). These drugs are also used to treat other types of permanent dementia, including multi-infarct dementia. Cholinesterase inhibitors increase the amount of a neurotransmitter, called acetylcholine, throughout the body. Acetylcholine is a chemical that carries messages between the nerves and muscles, and it appears to be involved in learning and memory. Patients with AD have low levels of acetylcholine. Commonly prescribed medications include donepezil (Aricept®), rivastigmine (Exelon®), and galantamine (Razadyne®). About half of the people who take cholinesterase inhibitors experience a modest improvement in cognitive symptoms, such as memory.
  • Side effects are common and may include diarrhea, dizziness, drowsiness, fatigue, nausea, and vomiting. These side effects may cause some patients to discontinue medications. Individuals with liver disease, peptic ulcer disease, chronic obstructive pulmonary disease (COPD), and slow heart rate should not take these drugs.
  • Memantine: Memantine (Namenda®) is a drug approved by the FDA for treatment of moderate to severe Alzheimer's disease. Memantine is also used to treat other types of permanent dementia, including multi-infarct dementia. Memantine, an NMDA (N-methyl-D-aspartate) receptor antagonist, is the first AD drug of its kind that has been approved in the United States. It appears to work by regulating the activity of glutamate, which is one of the brain's specialized messenger chemicals involved in information processing, storage, and retrieval. Glutamate plays an essential role in learning and memory. Excess glutamate, on the other hand, may lead to disruption and death of brain cells. Memantine may protect cells against excess glutamate by partially blocking NMDA receptors. Side effects include headache, constipation, confusion, and dizziness.
  • Nicotinamide supplements: Patients who develop dementia as a result of niacin deficiency receive nicotinamide supplements (e.g. Advicor®, Niacor®, or Niaspan®). Since the supplement is made from niacin, it helps the patient return to normal niacin levels in the body. Nicotinamide supplements effectively cures dementia in these patients.
  • Long-term care: An individual with dementia may need monitoring and assistance at home or in an institution. Options include in-home care, boarding homes, adult daycare, and convalescent or long-term care facilities (nursing homes).
  • Visiting nurses, volunteer services, homemakers, adult protective services, and other community resources may help a family care for a patient with dementia. In some communities, support groups may be available. Family counseling may also help relatives of the patient cope with homecare and the debilitating effects of cognitive disorders.
  • The patient should be surrounded with familiar objects and people. Leaving the lights on at night may help reduce or prevent episodes of disorientation. Patients should follow simple schedules that are easy to remember.
  • Behavior modification may be beneficial in patients who exhibit unacceptable or dangerous behavior. This type of therapy involves rewarding appropriate behaviors and ignoring inappropriate ones (when it is safe to do so). Reality orientation is a technique in which caretakers take every opportunity to orientate the patient, such as reminding the patient where they are and what time of day it is. Reality orientation with repeated reinforcement of environmental and other cues may also help reduce disorientation.
  • Patients who are diagnosed with a progressive form of dementia, such as AD, should seek legal advice before they are unable to make decisions about medical care and end-of-life issues.
Prevention
  • Mental fitness: Maintaining mental fitness may delay onset of dementia. Some researchers believe that lifelong mental exercises and learning may promote the growth of additional synapses, the connections between neurons, and delay the onset of dementia. Other researchers argue that advanced education gives a person more experience with the types of memory and thinking tests used to measure dementia. Doing crossword puzzles, reading books, and increasing social activities are recommended by healthcare providers.
  • Lifestyle: Lifestyle habits that can reduce the risk for head injury include using seat belts, wearing a helmet when riding bicycles and motorcycles, and wearing protective headgear when playing contact sports. Avoiding substance abuse and addiction can reduce the risk for dementia resulting from disease, vitamin deficiency, seizure, and head injury. Safer sex practices can help prevent human immunodeficiency virus (HIV) and syphilis infection, reducing the risk for acquired immunodeficiency syndrome (AIDS) dementia complex and neurosyphilis dementia. The risk for dementia as a result of other metabolic or toxic conditions can be reduced by receiving prompt medical attention at the first sign of illness (such as fever, pain, swelling, heat, confusion, or other impairment of cognitive function).
  • Heart health: Some of the most recent research indicates that taking steps to improve cardiovascular (heart) health, such as losing weight, exercising, and controlling high blood pressure and high cholesterol, may also help prevent dementia and Alzheimer's disease. A clinical study found that individuals with mild to severe Alzheimer's disease placed on a simple exercise program (one hour, twice a week) had a significantly slower cognitive decline than those on routine medical care.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): Several clinical studies have reported that the NSAIDs ibuprofen (Advil® or Motrin®), naproxen sodium (Aleve®), and indomethacin (Indocin®, a prescription drug) may reduce the risk of developing Alzheimer's disease. This may be because inflammation appears to play a role in Alzheimer's. Because NSAIDs can cause stomach and intestinal bleeding and kidney problems, clinical trials need to be completed before it is clear whether individuals should take NSAIDs solely to prevent Alzheimer's. Patients should not take NSAIDs regularly unless they consult their healthcare providers.
  • Statin drugs: Statin drugs are used to lower cholesterol levels. They include atorvastatin (Lipitor®) and simvastatin (Zocor®). Recent studies have reported that statin drugs may reduce the risk of Alzheimer's disease. More studies are being done to determine exactly what role, if any, statins may have in Alzheimer's prevention. Researchers believe that statins help improve blood flow to the brain by decreasing particles in the blood such as cholesterol and triglycerides.
  • Selective estrogen receptor molecule (SERM): A drug called a selective estrogen receptor molecule (SERM, including raloxifene or Evista®) is used to protect against the bone loss associated with osteoporosis. It also appears to lower the risk of developing mild cognitive impairment, a memory disorder that often precedes Alzheimer's. The mechanism is unknown.
References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

  • Alzheimer's Association. . Accessed May 17, 2009.
  • American Psychiatric Association. . Accessed May 17, 2009.
  • Cummings JL. Treatment of Alzheimer's disease: the role of symptomatic agents in an era of disease-modifying therapies. Rev Neurol Dis. 2007 Spring;4(2):57-62. . View Abstract
  • Gillette Guyonnet S, Abellan Van Kan G, Andrieu S, et al. IANA Task Force on Nutrition and Cognitive Decline with Aging. J Nutr Health Aging. 2007;11(2):132-152. . View Abstract
  • Napryeyenko O, Borzenko I. GINDEM-NP Study Group. Ginkgo biloba special extract in dementia with neuropsychiatric features. A randomised, placebo-controlled, double-blind clinical trial. Arzneimittelforschung. 2007;57(1):4-11. . View Abstract
  • National Alliance on Mental Illnesses (NIMI). . Accessed May 17, 2009.
  • National Institute of Mental Health (NIMH). . Accessed May 17, 2009.
  • Natural Standard: The Authority on Integrative Medicine. . Copyright © 2009. Accessed May 17, 2009.
  • Rolland Y, Pillard F, Klapouszczak A, et al. Exercise program for nursing home residents with Alzheimer's disease: a 1-year randomized, controlled trial. J Am Geriatr Soc. 2007;55(2):158-65. . View Abstract
  • Stella F, Banzato CE, Gasparetto Se EV, et al. Risk factors for vascular dementia in elderly psychiatric outpatients with preserved cognitive functions. J Neurol Sci. 2007; [Epub ahead of print]. . View Abstract