Cognitive Impairment

Cognitive impairment occurs when problems with thought processes occur. It can include loss of higher reasoning, forgetfulness, learning disabilities, concentration difficulties, decreased intelligence, and other reductions in mental functions. Cognitive impairment may be present at birth or can occur at any point in a person’s lifespan.

Some early causes of cognitive impairment include chromosome abnormalities and genetic syndromes, malnutrition, prenatal drug exposure, poisoning due to lead or other heavy metals, hypoglycemia (low blood sugar), neonatal jaundice (high bilirubin levels developing after birth), hypothyroidism (underactive thyroid), complications of prematurity, trauma or child abuse such as shaken baby syndrome, or oxygen deprivation in the womb or during or after birth.

Cognitive impairment that develops in childhood or adolescence can result from many conditions. Examples include side effects of cancer therapy, malnutrition, heavy metal poisoning, autism (abnormal development of communication and social skills), metabolic conditions, and systemic lupus erythematosus (disorder in which the body attacks its own healthy cells and tissues).

With age, other conditions such as stroke, dementia, delirium, brain tumors, chronic alcohol use or abuse, substance abuse, some vitamin deficiencies, and some chronic diseases may cause cognitive impairment. Head injury and infection of the brain or of the covering of the brain and spinal cord (meninges) can cause cognitive impairment at any age.

In some cases, cognitive impairment may be reversible if the underlying cause is identified and treated. Seek immediate medical care (call 911) for the sudden onset of cognitive impairment, especially if it is accompanied by high fever (higher than 101 degrees Fahrenheit), neck stiffness or rigidity, rash, head injury, changes in level of consciousness or alertness, flushing or dry skin, severe nausea and vomiting, fruity breath, or other symptoms that cause you concern. Seek prompt medical care for new onset of cognitive impairment or if existing impairment worsens.

Cognitive impairment may accompany other symptoms, which vary depending on the underlying disease, disorder or condition. Symptoms that frequently affect the brain may also involve other body systems or disorders.

Cognitive impairment may accompany symptoms related to infection including:

• Fever
• Headache
• Malaise or lethargy
• Muscle twitching, spasms or seizures
• Nausea with or without vomiting
• Rash
• Stiff or rigid neck

Cognitive impairment may accompany other symptoms related to metabolic disorders including:

• Abdominal pain

• Abnormal heart rhythm such as rapid heart rate (tachycardia) or slow heart rate (bradycardia)

• Changes in skin

• Confusion or loss of consciousness for even a brief moment

• Difficulty breathing or rapid breathing

• Nausea with or without vomiting

• Fatigue

• Feeling very thirsty

• Frequent urination or decrease in urine output

• Fruity breath

• Muscle weakness

Cognitive impairment may accompany symptoms related to other problems, such as injury, stroke or dementia. These symptoms may include:

• Change in sleep patterns

• Changes in mood, personality or behavior

• Confusion or loss of consciousness for even a brief moment

• Difficulty with memory, thinking, talking, comprehension, writing or reading

• Impaired balance and coordination

• Loss of vision or changes in vision

• Nausea with or without vomiting

• Numbness, weakness or paralysis

• Seizure

• Severe headache

In some cases, cognitive impairment may be a symptom of a life-threatening condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

• Change in level of consciousness or alertness such as passing out or unresponsiveness

• Change in mental status or sudden behavior change such as confusion, delirium, lethargy, hallucinations or delusions

• Garbled or slurred speech or inability to speak

• High fever (higher than 101 degrees Fahrenheit)

• High-pitched, shrill cries in an infant or small child

• Paralysis or inability to move a body part

• Poor feeding, unusual sleepiness, or irritability in a child or infant

• Seizure

• Stiff or rigid neck

• Sudden change in vision, loss of vision, or eye pain

• Trauma to the head

• Worst headache of your life

Cognitive impairment can result from conditions that occur during fetal development, at birth, shortly after birth, or at any point in life. Sometimes, the cause of cognitive impairment cannot be determined, especially in a newborn or small child.

Cognitive impairment may be present at birth and may be genetic or chromosomal or result from complications of pregnancy. Congenital causes of cognitive impairment include:

• Chromosomal abnormalities such as Down syndrome, fragile X syndrome, cri du chat syndrome, Prader-Willi syndrome, and others

• Congenital hypothyroidism (underactive thyroid)

• Genetic abnormalities such as phenylketonuria, Tay-Sachs disease, galactosemia, Hunter syndrome, Hurler syndrome, adrenoleukodystrophy, and others

• Intrauterine growth retardation (poor growth of fetus)

• Prenatal drug or alcohol exposure

• Prenatal infections

Cognitive impairment can also be caused by complications related to delivery including:

• Infection

• Lack of oxygen during labor or birth

• Preterm birth or its complications such as intracranial hemorrhage (uncontrolled bleeding in the brain)

Cognitive impairment can also be caused by conditions that occur after birth or during childhood and adolescence including:

• Autism (abnormal development of communication and social skills)

• Head injury

• Heavy metal poisoning such as lead poisoning

• Infection

• Kidney disease (which includes any type of kidney problem such as kidney stones, kidney failure, and kidney anomalies)

• Malnutrition

• Metabolic conditions

• Neonatal jaundice (yellowing of the skin and whites of the eyes occurring after birth)

• Side effects of cancer therapy

• Systemic lupus erythematosus (a disorder in which the body attacks its own healthy cells and tissues)

Cognitive impairment can also be caused by conditions that occur in adulthood including:

• Alcohol or drug abuse

• Brain or spinal cord injury

• Certain vitamin deficiencies

• Congestive heart failure (deterioration of the heart’s ability to pump blood)

• Dementia

• Infections

• Kidney disease (which includes any type of kidney problem such as kidney stones, kidney failure, and kidney anomalies)

• Liver disease (which includes any type of liver problem such as hepatitis, cirrhosis, and liver failure)

• Medication side effects

In some cases, cognitive impairment may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. These include:

• Brain tumor

• Encephalitis (inflammation and swelling of the brain due to a viral infection or other causes)

• Heat stroke

• Kidney failure

• Meningitis (infection of the membranes that cover the brain and spinal cord)

• Profound dehydration

• Sepsis (severe infection of the bloodstream)

• Spinal cord injury or tumor

• Stroke

• Traumatic head injury

To diagnose your condition, your doctor or licensed health care practitioner will ask you several questions related to your cognitive impairment including:

• When did you first notice symptoms of cognitive impairment?

• What specific symptoms have you noticed?

• Did anything such as an injury or illness precede the symptoms?

• Were there any prenatal complications or complications of birth?

• Do you have any other medical conditions?

• What medications are you taking? Are you taking any new medications?

• Have you taken any street drugs?

• Do you drink alcohol?

Because cognitive impairment can be due to serious diseases, failure to seek treatment can result in serious complications and permanent damage. Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your health care professional design specifically for you to reduce the risk of potential complications including:

• Developmental delays and failure to thrive
• Learning disability
• Paralysis or inability to move a body part
• Permanent cognitive impairment
• Permanent loss of sensation
• Personality changes
• Physical disability