Chapter 14 Neurocognitive Disorders ABNORMAL PSYCHOLOGY, SIXTEENTH EDITION James N. Butcher/ Jill M. Hooley/ Susan Mineka Chapter 14 Neurocognitive Disorders © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Brain Impairment in Adults: New DSM-5 The old category of “Delirium, Dementia, and Amnestic and Other Cognitive Disorders” now called “Neurocognitive Disorders.” New subsections based on severity are “delirium, major/mild neurocognitive disorder.” © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

DSM-5’s new Mild Neurocognitive Disorder category is controversial. Diagnostic Issues The Mild Neurocognitive Disorder category provides cause and degree of severity information. DSM-5’s new Mild Neurocognitive Disorder category is controversial. Chapter deals with disorders that arise out of changes in brain structures, function, or chemistry. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Clinical Signs of Brain Damage Damage or destruction of brain tissue may involve wide range of outcomes depending on Nature, location, and extent of neural damage Premorbid competence and personality of individual Individual’s life situation Damage or destruction of brain tissue may involve only limited behavioral deficits or a wide range of psychological impairments © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Diffuse versus Focal Damage Moderate diffuse damage Focal damage Attention is often impaired by moderate diffuse damage (such as damage from moderate oxygen deprivation) Focal damage (such as damage from an injury or stroke) can cause different problems depending on what part of the brain is affected © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Figure 14.2: Brain Structures and Associated Behaviors © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Diffuse versus Focal Damage Some consequences of brain disorders with mainly focal origins commonly appear in context of progressively diffuse damage. How many consequences can you identify? Impairment of memory Impairment of orientation Impairment of learning, comprehension, and judgment Impairment of emotional control or modulation Apathy or emotional blunting Impairment in the initiation of behavior Impairment of controls over matters of propriety and ethical conduct Impairment of receptive and expressive communication Impaired visuospatial ability © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

The Neuropsychology/ Psychopathology Interaction Close link between neuropsychological and psychopathological conditions Psychological disorder not necessarily and completely explained by patient’s brain damage © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Treatments and Outcomes Delirium Treatments and Outcomes Clinical Picture © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Clinical Picture Delirium State of acute brain failure that lies between normal wakefulness and stupor or coma © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Delirium Clinical Picture Has sudden onset and involves fluctuating state of reduced awareness Reflects confusion, disturbed concentration, and cognitive dysfunction Can occur in person of any age, though the elderly and children are at particularly high risk May result from drug intoxication or withdrawal, head injury, or infection © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Figure 14.3: Continuum of Level of Consciousness © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Treatments and Outcomes True medical emergency Often reversible Most often treated by medications, environmental manipulations, and family support Delirium Neuroleptics are most common medication © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Clinical Picture Major Neurocognitive Disorder (Dementia) Not rapidly fluctuating condition Characterized by a decline from a previously attained level of functioning Slow onset and a deteriorating course Caused by over 50 different disorders Most commonly caused by Alzheimer’s disease © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Figure 14.4: Distribution of Dementia by Probable Cause © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Clinical Picture Second most common neurodegenerative disorder Parkinson’s Disease Second most common neurodegenerative disorder Characterized by tremors or rigid movements Primarily caused by loss of dopamine neurons. About 75% eventually show signs of dementia Second most common neurodegenerative disorder after Alzheimer’s disease © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Clinical Picture Huntington’s Disease Rare degenerative disorders of nervous system Chronic, progressive chorea Patients usually develop dementia Chronic, progressive chorea Irregular and involuntary movements that flow randomly from one part of body to another © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Alzheimer’s Disease Alzheimer’s Disease Progressive and fatal neurodegenerative disorder Associated with Alzheimer’s disease. Usually slow but progressively deteriorating course terminating in delirium and death © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Alzheimer’s Disease Risk factors Age Genes Genetic mutations of APP APOE-E4 allele of APOE gene Age is a major risk factor for Alzheimer’s disease, as well as for other forms of dementia such as vascular dementia Genes play a major role in susceptibility to and risk for Alzheimer’s disease Genetic mutations of the APP, presenilin 1, and presenilin 2 genes are implicated The APOE-E4 allele of the APOE gene is also a risk factor © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Neurofibrillary tangles Alzheimer’s Disease Neuropathology Atrophy Plaques Neurofibrillary tangles Characteristic neuropathology Cell loss Plaques (which contain a sticky protein called beta amyloid) Neurofibrillary tangles (which contain an abnormal tau protein) Alzheimer’s disease accounts for most cases of dementia © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Alzheimer’s Disease Disease course Drugs help stop ACh from being broken down and increasing availability to brain Drug treatments include cholinesterase inhibitors such as donepezil and non- cholinesterase inhibitor memantine AD causes destruction of cells that make neurotransmitter important for memory Disease course AD causes destruction of cells that make acetylcholine, neurotransmitter important for memory Drug treatments include cholinesterase inhibitors such as donepezil © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Alzheimer’s Disease Complete the sentence below. Any comprehensive approach to therapeutic intervention must consider the situation of ________. Any comprehensive approach to therapeutic intervention must consider the situation of caregivers. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Dementia from HIV-1 Infection HIV-1 virus can result in destruction of brain cells Neuropsychological features HIV and mild cognitive impairment Rates of full dementia The HIV-1 virus (or a mutant form of it) can itself result in the destruction of brain cells Neuropsychological features include Mild memory difficulties Psychomotor slowing Diminished attention and concentration Around 30% of people infected with the HIV virus show signs of some mild cognitive impairment Rates of full dementia have decreased since the1990s © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Vascular Disease Vascular disease Series of circumscribed cerebral infarcts cumulatively destroy neurons over expanding brain regions © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Amnestic Disorder Amnestic disorder Characteristic feature of amnestic syndrome Causes of amnestic syndrome Treatment techniques The characteristic feature of amnestic syndrome is strikingly disturbed memory Causes of Korsakoff’s syndrome include: Chronic alcohol use Head trauma Stroke A wide range of techniques have been developed to assist the good-prognosis amnestic patient in remembering recent events © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Disorders Involving Head Injury Incidence Common causes Risk by gender and age Traumatic brain injury affects over 2 million people per year in United States Motor vehicle accidents are most common cause Other causes include falls, violent assaults, sports injuries, and war injuries Males are at highest risk © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Head injuries outcomes Clinical Picture Head injuries outcomes Retrograde amnesia Anterograde amnesia Personality changes Phineas Gage survived a massive head injury but suffered from personality changes © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Clinical Picture Head injuries results Retrograde amnesia Anterograde amnesia Personality changes © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Treatments and Outcomes Prompness and further damage Immediate and long-term reeducation and rehabilitation Aftereffects Treatment team often involves wide variety of health professionals Prompt treatment of brain injury can prevent further damage Immediate treatment may need to be supplemented with long-term reeducation and rehabilitation Aftereffects can include headaches, impaired memory, lowered intellectual level, or personality changes, among others Treatment team often involves wide variety of health professionals © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Unresolved Issues Should healthy people use cognitive enhancers? Would you take a drug approved for Alzheimer’s disease if you thought it would help you do better on a test? Should schools and colleges begin to test for these drugs prior to taking major exams? © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.