Your first question may be “What does Cognitive Functioning mean? Cognitive functioning includes all of the following: Orientation to Person, Place, Time and Situation, Attention Span and Concentration, Memory, General Intelligence, Abstract Thinking, Insight and Judgment, and Perception and Coordination. Two ways of testing a person’s abstract thinking is by proverbs and similarities, such as what does it mean “a stitch in time saves nine?” Or what are the similarities between a cat and a mouse. Judgment is defined as the ability to compare and evaluate ideas, and choices, to understand their relationships, and to draw appropriate conclusions.
As we age, we do sustain some degree of cognitive functioning loss. There are many theories on why our brains’ age normally from such hypotheses as there are physical changes occurring in the human brain resulting in loss of neurons and neural connections, to memory lapses occurring due to the overabundance of memories stored in our brain from the many years of living experiences and the time it takes the brain to sort out the correct response. It is diseases like Alzheimer’s and strokes and brain injuries due to alcoholism and accidents that are the major contributors toward moderate and severe cognitive functioning loss.
Most people are not as concerned with why cognitive functioning is lost as much as how will it affect them and their being able to live independently and handle all their business affairs. Like sunburn, cognitive functioning occurs in degrees. With first degree (minor) cognitive functioning loss, there are episodes of forgetting what you are saying in the middle of a conversation or walking into a room for something and then saying to yourself why am I here. With third degree (severe) cognitive functioning loss, the person becomes only a shell of his former self, losing his orientation to who he is, where he is at, unable to care for himself and has no interest in his surroundings.
Let us examine the different degrees of memory loss:
Minor Cognitive Functioning Loss:
A. May appear to be “absentminded.” Forgetting such basics as an anniversary or the names of friends.
a. Compensates with increasingly rigid schedules and routines.
b. Notepads, calendars, speed dial loaded with all important phone numbers.
B. Decreased efficiency in absorbing and retaining new information.
C. Learning is slower and requires greater effort, but this is only evident in comparison with past learning capabilities.
D. Tends to speak mostly about past events. This occurs as result of the individual seeing himself as vital and active when he was younger. Most memories from the past are pleasant and bring a sense of ‘well-being.” Current events are more centered on illnesses, loss of friends and family, and so forth.
E. Has difficulty concentrating or staying focused on a task, such as paying bills, in the midst of distractions, such as grandchildren playing their boom box loudly in the same room.
F. This group is able to live independently, handle their own finances and maintain their own households. With reminder cues, they are able to keep track of their appointments, important phone numbers, and so forth.
Moderate Cognitive Functioning Loss:
A. Difficulty remembering events of the recent past, such as what the doctor told him three days ago about changes in diet to reduce his blood pressure, but has accurate and detailed recall of learning and events in the past, such as his first car and what he got paid on his first job.
a. Attempts to compensate for memory loss become more difficult. This leads to increased rigidity and compulsiveness, such as always eating dinner at 5 PM-not one minute earlier or later.
B. Thinking becomes more slowed and less effective. The individual finds it more and more difficult to solve even the simplest of problems, such as there is no milk for breakfast tomorrow. In the past, the individual would have just gone to the grocery store or would have planned on a breakfast that did not require milk. In the present situation, the individual with moderate memory loss becomes quite distraught and immobilized over trying to find a solution for no milk for breakfast.
C. Has greater difficulty keeping attention focused on the task at hand, such as cooking dinner. Wife puts the food in the frying pan. Lights the burners at the correct temperature and then walks into the living room where the TV is playing an old movie. She sits down and completely forgets about the dinner she is cooking until the smoke alarm goes off.
D. Has difficulty telling what day of the month it is or what year it is. When asked the date, the person may respond June 23, 1989. Or if asked who the president is, he may respond Bill Clinton or Ronald Reagan.
E. There is an initial loss of orientation to place. Unable to identify unfamiliar locations. The person may have lived in Chicago all his life and had travelled around the city several times during his lifetime, but now only recalls areas that are familiar to him-his neighborhood, places he visits often and so forth.
F. Difficulty identifying unfamiliar people. He knows people that he sees on an everyday basis, such as his wife, children, grandchildren, friends, neighbors and so forth. But cannot remember people that he met in the past but has not seen often like fellow co-workers. He has great difficulty remembering names– even of his wife and children.
G. Has increased difficulty in seeing similarities and differences in similar objects, such as a child and a “small person.” Becomes very concrete in thinking. If asked to explain the proverb, “people who live in glass houses should not throw stones,” he would answer, “Don’t throw stones at glass houses.”
H. Overlooks the obvious. Judgment becomes impaired and increasingly unreliable. Individual is driving down the wrong way on a one way street, and does not realize it despite several drivers honking their horns and saying, “You idiot, you are going the wrong way.”
I. Behavior becomes increasingly inappropriate which is often reflected in:
a. Deterioration of grooming and personal hygiene-does not comb hair, does not brush teeth or use deodorant, wears dirty clothes, etc.
b. Deterioration of eating habits and manners-begins eating with his hands, spilling food and drink all over himself, etc.
c. Decreased ability to manage financial affairs.
J. Wide changes in mood.
c. Wide mood swings between depression and euphoria within a short time span without any reason for the change in mood.
e. Diffuse physical complaints-constipation, knee pain
K. Diminished Vitality. The essence of the person greatly disappears. You will commonly hear “Jack is not like he use to be. He was so full of life.”
L. People with moderate memory loss require supervision of their daily activities, financial and personal affairs. These individuals can live at home but under direct supervision of a family member, caregiver, etc. or placed in an assisted living environment.
Severe Cognitive Functioning Loss:
A. Includes all the changes listed in Moderate Memory Loss plus.
B. Memory loss extends further and further into the remote past until all memory is totally lost. (This occurs with Alzheimer’s disease.)
C. No sense of time. There is no past, present or future.
D. Increased difficulty identifying familiar surroundings. He does not recognize his home or his neighborhood.
E. Does not remember current location where he lives (even though he has lived there 50 years) or his address.
F. Does not remember other people’s relationships to him, such as his wife, children, etc.
G. Has difficulty remembering his own name or identifying who he is.
H. Unable to care for himself.
I. Has no interest in the environment or his surroundings.
J. Tends to be suspicious of others and their intentions.
K. Is negative about any requests made of him. His answer (if he can speak) to everything is “No.” Or he just pulls away.
L. People with severe memory loss require constant 24 hours supervision in a special facility which provides care for individuals with dementia.
I am a retired master’s prepared nurse with a vast scope of experiences in the areas of mental and geriatric nursing. I have held clinical specialist positions in as well as administrative positions in which I developed programs for acute and long term clients on social skills, reality orientation, etc.