Definition

Organic mental disorders or neurocognitive disorders are disorders of mental function due to medical conditions other than psychiatric disorders. Organic mental disorders are a collection of diseases that need to be excluded first before making a psychiatric diagnosis. Broadly speaking, two diseases are classified as organic mental disorders, namely dementia and delirium.

Dementia is a chronic and progressive decline in memory and cognitive function that hinders social interaction. About 60-80% of dementia occurs due to Alzheimer's. The prevalence increases every five years with age. The main symptoms of dementia are memory loss and behavioral changes.

Delirium (acute confusional state) is an acute (duration of hours to days) and fluctuating disturbance of consciousness, perception, and cognitive function. Delirium is found in 30% of serious illnesses. Data from Cipto Mangunkusumo Hospital (RSCM) shows that delirium in the elderly occurs in 88.2% of emergency cases. The main symptoms of delirium are confusion, memory problems, aggression, the flow of speech that cannot be understood and followed, delusions (beliefs that do not match reality and cannot be resolved), and hallucinations.

Causes

Many diseases and conditions can cause organic mental disorders, including:

• Head trauma
  • Bleeding in the brain
  • Bleeding in the head cavity
  • Bleeding in the skull bones which causes pressure on the brain

• Respiratory disorders
  • Low oxygen levels in the blood (hypoxia)
  • High levels of oxygen in the blood (hypercapnia)

• Cardiovascular disease
  • Dementia due to stroke (multi-infarct dementia)
  • Heart infections (endocarditis, myocarditis)
  • Strokes
  • Transient ischemic attack (TIA)

• Degenerative disease
  • Alzheimer's
  • Huntington's disease
  • Multiple sclerosis
  • Hydrocephalus
  • Parkinson's

• Metabolic disorders
  • Kidney illness
  • Liver disease
  • Thyroid disease (hyperthyroid or hypothyroid)
  • Vitamin deficiencies (B1, B12, folate.

• Disorders related to drugs and alcohol
  • Alcohol withdrawal
  • Drug or alcohol intoxication/poisoning
  • Wernicke-Korsakoff syndrome
  • Withdrawal from medications (such as sedatives and corticosteroids)

• Infection
  • Acute and chronic infections
  • Sepsis condition
  • Encephalitis or inflammation of the brain
  • Meningitis or inflammation of the lining of the brain and spinal cord
  • Syphilis

• Cancer complications or chemotherapy side effects
• Prolonged pain can cause delirium

Risk factor

Any condition that causes a person to need prolonged treatment in a hospital. such as post-surgery or being treated in an intensive care unit, can increase the risk of delirium. Other risk factors for delirium are:

• Have a medical condition of the brain, such as dementia, stroke, or Parkinson's disease
• Have ever had an episode of delirium
• Having vision and hearing problems
• Have some other medical conditions
• Using high doses of medication

Meanwhile, dementia has risk factors that can be changed and those that cannot be changed.

• Risk factors that cannot be changed

• • Age, the older you are, the higher the risk of developing dementia. The risk of developing dementia increases at age 65 years and over
  • Family history, having a family history of dementia can increase a person's risk of developing dementia in old age
  • Down syndrome, individuals with Down syndrome can experience Alzheimer's disease at a younger age. This is one of the risk factors for dementia

•  Modifiable risk factors

• • Lifestyle, there is a relationship between low physical activity and an unhealthy diet and an increased risk of dementia
  • Consuming large amounts of alcohol can increase the risk of changes in the brain, which can contribute to increasing the risk of developing dementia.
  • Cardiovascular risks (smoking, high blood pressure, having high cholesterol)
  • Having depression
  • Have diabetes
  • Exposure to air pollution
  • Suffering from head trauma
  • Vitamin deficiency
  • Using drugs that can interfere with memory

Symptoms

In general, the main symptoms of organic mental disorders are:

• Changes in consciousness, confusion
• Can't be calmed down
• Easily offended
• Changes in behavior
• Doesn't remember the people around him
• Rambling

Dementia and delirium can be difficult to differentiate, and a person can even experience both at the same time. Delirium is a frequent complication of patients with dementia. However, experiencing multiple episodes of delirium does not mean the patient has dementia.

The main differences between these two conditions include:

• Time

Delirium occurs over a short period, while dementia symptoms appear slowly over several years.

• Attention or attention

A person with delirium is generally unable to focus or maintain attention. Meanwhile, patients with dementia are generally conscious.

• Fluctuation

A person with delirium may experience symptoms that fluctuate throughout the day. Meanwhile, in dementia, symptoms are generally more constant throughout the day.

Diagnosis

The diagnosis of dementia and delirium is made by a doctor based on the main complaint, physical examination and supporting examinations. To establish delirium, the doctor will refer to the diagnostic criteria by the Guidelines for the Classification and Diagnosis of Mental Disorders III (PPDGJ III), namely:

• Impaired consciousness in the form of inability to focus, maintain and shift attention
• Cognitive and perceptual disorders not related to dementia
• Psychomotor disorders in the form of hypoactivity (reduced activity) or hyperactivity (more active than usual)
• Sleep cycle disorders in the form of insomnia or reverse cycle (sleeping during the day)
• Emotional disorders include anxiety, fear, depression, irritability, apathy and euphoria.

Meanwhile, to confirm dementia, the diagnosis can be strengthened by a Mini-Mental State Examination (MMSE).

Management

Therapy for delirium includes treating the underlying disease. Ensuring the patient's condition is comfortable, nutrition is maintained, hydration is adequate, and management of restless noises needs to be done during treatment.

Dementia requires cognitive rehabilitation to maintain existing functions, ensuring adequate nutrition, providing vitamins, and taking antidementia. If needed, medications such as antipsychotics can help relieve symptoms.

Complications

Delirium occurs in a shorter time than dementia, namely several hours to several weeks. If the medical condition that causes delirium can be treated, the symptoms of delirium will improve. Recovery time will depend on many factors, such as your health condition before the illness and the type of medical condition you are experiencing. Some people with serious medical conditions cannot return to normal as they were before experiencing delirium, resulting in a decline in their health condition, taking longer to recover from surgery, and increasing the risk of death.

Meanwhile, complications from dementia include:

• Poor nutrition. People with dementia often forget to eat or don't eat at all, which affects their nutritional intake. If left alone, they cannot eat or chew at all.
• Pneumonia. Difficulty chewing increases the risk of choking on food, which can cause pneumonia
• Unable to care for yourself
• Death due to long-term infection

Prevention

Delirium can be prevented by avoiding the risk factors above. Placing the patient in a quiet, quiet room can help prevent delirium. Another strategy that can be used is to ensure the patient can sleep peacefully.

The following steps can be taken to prevent dementia, including:

• Doing activities that stimulate the brain, such as playing puzzles, word games
• Exercise and be socially active
• Quit smoking
• Taking vitamins
• Control cardiovascular risk factors
• Overcoming medical conditions experienced
• Eat a healthy diet

When to see a doctor?

Immediately consult a doctor or someone close to you if you experience symptoms of delirium or dementia, such as changes in behavior or memory problems. Treatment of the underlying medical condition causing delirium and dementia can help resolve symptoms.