|Year : 2016 | Volume
| Issue : 1 | Page : 1-2
TS Sathyanarayana Rao1, Abhinav Tandon2
1 Department of Psychiatry, JSS Medical College and Hospital, JSS University, Mysore, Karnataka, India
2 Assistant Editor, Indian Journal of Psychiatry and Consultant Neuropsychiatrist, Allahabad, Uttar Pradesh, India
|Date of Web Publication||6-May-2016|
T S Sathyanarayana Rao
Department of Psychiatry, JSS Medical College and Hospital, JSS University, Mysore, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sathyanarayana Rao T S, Tandon A. Cognition. J Geriatr Ment Health 2016;3:1-2
The word cognition has originated from the use of the word "cognito" (translated from Greek: "Gnosis") by Latin philosophers, which translates as knowledge (French: Connaissance, Italian: Conoscenza, German: Erkenntnis) as per the Western Philosophy.  Cognition in a much broader sense means information processing; a high level of processing of specific information including thinking, memory, perception, motivation, skilled movements, and language. The specific functions of cognition that are accessible for assessment are orientation, attention, skill learning, problem-solving, thinking abstractly, reasoning, judgment, and perception; it also includes processes of memory, mathematical ability, control over primitive reactions and behavior, language use and comprehension, and praxis.  Cognitive deficits may affect any of the above-mentioned processes including inability to respond to information quickly, think critically, plan, organize and solve problems, and initiate speech.  With increasing age, cognitive impairment sets in, and hence cognition becomes all the more important with advancing age. ,
All degenerative disorders begin insidiously and gradually progress; hence, early detection when symptoms are at a minimum would go a long way in the secondary prevention of dementia. Mild cognitive impairment (MCI) refers to newly acquired deficits in cognitive functioning (which are more severe than expected for that age and educational background), which are not currently leading to socio-occupational disruption. MCI has been proposed as a transition between normal, age-associated cognitive change, and early dementia.  The criteria for the nomenclature of MCI have been precisely described by the American Academy of Neurology. Prevalence rates of MCI vary from 3% to 59% with approximately 8-15% cases converting into dementia; hence highlighting the need for neuropsychological tests, neuroimaging, and other biological markers.  Indian studies have reported the relative proportion of Alzheimer's disease between 41% and 65% and the proportion of vascular dementia between 22% and 58%. , In a study done in Varanasi district, in North India, Alzheimer's dementia was found to be the most common (55%), followed by vascular dementia (30%), Alzheimer's was reported to be common in both sexes, whereas vascular dementia was predominant in male subjects. Illiteracy, age, and undernutrition were reported to be the most important risk factors. 
Behavioral disturbances are an integral part of the symptomatology of individuals suffering from dementia; hence contributing adversely to the quality of life of patients and caregivers. Delusions and paranoid ideations ("People are stealing things," "One's house is not one's own," "Spouse (caregiver) is an imposter"), hallucinations, activity disturbances (purposeless wandering), aggressive symptoms, diurnal rhythm disturbances, affective (particularly depression: Rate ~ 0-87%),  and anxiety symptoms have been reported to be common. 
Among neuropsychiatric disorders, dementia and major depression account for one-quarter and one-sixth of all disability-adjusted life years, respectively.  Around 1.5 million people are affected by dementia in India currently, and this number is likely to increase by 300% in the next four decades.  Development of services for older people with mental health problems, in low- and middle-income countries such as India in resource-limited settings, is likely to remain a huge public health challenge;  hence, caregiver support becomes all the more important.  Imparting adequate skills to identify neuropsychiatric problems (especially in the elderly), at undergraduate medical education level is a must. Next is a dire need to integrate geriatric mental health care with primary care. Primary care needs to encompass long-term support and chronic disease management.  Currently, the family members are the primary caretakers for the elderly. Such care is associated with significant emotional and financial burden. Care of elderly people at home, especially those with disabling symptoms is likely to become increasingly difficult in the future; families are undergoing transition from joint to nuclear setups; hence, younger women who are usually responsible for taking care of elderly, are increasingly likely to work outside their homes.  The next level of care to be prioritized would be respite care, both in day centers and (for longer periods) in residential or nursing homes. Much needs to be done in this regard by the concerning governments. 
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