Aging-Related and Cognitive Disorders Chapter 12 © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

NATURE OF COGNITIVE DISORDERS Injuries to the brain including brain trauma, disease, or exposure to toxic substances including drugs DSM-IV diagnoses include: Delirium Dementia Amnesia Brain’s functioning affects our abilities to think, remember, and pay attention. In DSM-IV-TR, this set of disorders is titled delirium, dementia, amnestic, and other cognitive disorders. Symptoms: Mood disorders Personality disorders © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Delirium A temporary state in which individuals experience a clouding of consciousness Unaware of what is happening around them Unable to focus or pay attention Core of the disorder involves an acute state of confusion, impairment in cognitive processing that affects memory, orientation, executive functioning, ability to use language, visual perception, and learning. © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Delirium Develops for a variety of reasons Substance intoxication Substance withdrawal Head injury High fever Vitamin deficiency People of any age can experience delirium, common among medically or psychiatrically hospitalized older adult patients. © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Delirium Causes Tests and treatment Infection Central nervous system disorder Metabolic disorders Tests and treatment Delirium Rating Scale-Revised Pharmacological approach Haloperidol and respiridone Apart from the cognitive symptoms of inattention and memory loss, individuals experiencing delirium have hallucinations, delusions, abnormalities in sleep-wake cycles, changes in mood, and movement abnormalities. The advantage of using Delirium Rating Scale-Revised is that although designed for psychiatrists, other professionals and researchers can also use it. Pharmacological approach administers antipsychotics. Standard approach uses haloperidol, but clinicians may use “off-label” antipsychotics such as respiridone. © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Amnestic Disorder Cognitive disorders involve inability to: Recall previously learned information Register new memories © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Categories of Amnestic Disorder Amnestic disorders due to medical conditions Chronic Transient Substance-induced persisting amnestic disorders Those due to medical conditions can be chronic (lasting a month or more) or transient (temporary). Such medical conditions include head trauma, loss of oxygen, herpes simplex. Substance-induced – Memory impairment © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Substances That Induce Amnestic Disorder Medications Illicit drugs Lead Mercury Insecticides Industrial solvents The most common cause: Chronic alcohol use Memory loss must persist over time for the clinician to assign the diagnosis of amnestic disorder. © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Traumatic Brain Injury (TBI) Damage to the brain caused by exposure to trauma Post-concussion syndrome: Constellation of physical, emotional, and cognitive symptoms persists from weeks to years In older adults, falls are the most common cause of TBIs. People undergoing mild TBI may experience a related condition known as post-concussion syndrome (PCS). © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Dementia Involves generalized progressive deficits in a person’s memory Learning of new information Ability to communicate Judgment Motor coordination © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Table 12.2 - Symptoms of Dementia © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Alzheimer’s Disease Progressive and gradual cognitive deficits due to severe cerebral atrophy © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Stages of Alzheimer’s Disease Not Alzheimer Early-stage Middle-stage Late-stage © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Figure 12.3 - Charting the Course of Healthy Aging, MCI, and AD Mild cognitive impairment (MCI): A condition in which an individual suffers some memory problems but does not show symptoms of dementia. © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Dementia Caused by Conditions Other than Alzheimer’s Disease Physical conditions and toxins Infectious diseases can cause the changes that occur with dementia Infectious diseases Neurosyphilis Encephalitis Tuberculosis Meningitis Localized infections in the brain Anoxia Exposure to certain drugs and environmental toxins Nutritional deficiencies Anoxia can have severe effects on many brain functions, because neurons quickly die if they are deprived of oxygen. Exposure to certain drugs and environmental toxins can cause brain damage and result in a condition called substance-induced persisting dementia. People who are severely undernourished are prone to develop a deficiency of folate, a critical nutrient, which can lead to progressive cerebral atrophy. © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Figure 12.4 – Other Diseases that can Cause Dementia © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

VARIOUS DEMENTIAS Pick’s disease Parkinson's disease Pick's disease: Affects the frontal and temporal lobes of the cerebral cortex and can cause dementia. Parkinson's disease: Degeneration of neurons in subcortical structures that control motor movements. © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Parkinson’s Disease Symptoms Hands, ankles, or head may shake involuntarily Akinesia: Muscular rigidity, difficulty initiating movement Bradykinesia: General slowing of motor activity Loss of fine motor coordination Slowed, shuffling gait Difficulty starting or stopping movement like walking Signs of cognitive deterioration Expressionless and speech becomes stilted © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

VARIOUS DEMENTIAS Lewy body dementia Frontotemporal dementias Huntington’s disease Creutzfeldt-Jakob disease Vascular dementia Lewy body dementia: Similar to Alzheimer's disease with progressive loss of memory, language, calculation, and reasoning, as well as other higher mental functions. Diagnosed when Lewy bodies are found more diffusely throughout the brain. Frontotemporal dementias: Involve the frontotemporal area of the brain. Reflected in personality changes such as apathy, lack of inhibition, obsessiveness, or loss of judgment. Motivation and communication are lost. Huntington's disease: Hereditary condition causing dementia that involves a widespread deterioration of the subcortical brain structures and parts of the frontal cortex that control motor movements. Creutzfeldt-Jakob disease: A neurological disease transmitted from animals to humans that leads to dementia and death resulting from abnormal protein accumulations in the brain. Vascular dementia: Resulting from a vascular disease that causes deprivation of the blood supply to the brain. Multi-infarct dementia: Caused by transient attacks in which blood flow to the brain is interrupted by a clogged or burst artery. © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Pseudodementia False dementia, symptoms caused by depression that mimic those apparent in early stages of Alzheimer's People with depression are anxious, have difficulty sleeping, show disturbed appetite patterns, and experience suicidal thoughts, low self-esteem, guilt, and lack of motivation. People with pseudodementia are likely to have a history of prior depressive episodes that may have been undiagnosed. © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Diagnosis of Alzheimer’s Disease Brain imaging techniques Neuropsychological testing NINCDS/ADRDA guidelines Mini-Mental State Examination The diagnosis of Alzheimer’s disease based on the NINCDS/ADRDA criteria involves thorough medical and neuropsychological screenings. Continued improvement of MRI has resulted in a virtual explosion of studies on the diagnosis of Alzheimer’s disease through brain imaging. Clinicians convened to revise the 1984 NINCDS/ADRDA Guidelines. Goal was to develop diagnostic criteria not dependent on the expensive and potentially invasive brain scans used in research. The clinical tool that clinicians most commonly use for diagnosing Alzheimer’s disease is a specialized form of the mental status examination, which we call the Mini-Mental State Examination. © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

ALZHEIMER’S DEMENTIA Biological features Neurofibrillary tangles Amyloid plaques Risk factors for Alzheimer's disease: Cigarette smoking Obesity Lack of physical exercise Neurofibrillary tangles: Material within the cell bodies of neurons becomes filled with densely packed, twisted protein microfibrils, or tiny strands. Tau: A protein that normally helps maintain the internal support structure of the axons. Amyloid plaques: Clusters of dead or dying neurons become mixed together with fragments of protein molecules. Two main implications of research documenting the behavioral risk factors for Alzheimer’s disease: People can reduce their risk of Alzheimer’s disease by taking advantage of behaviors that contribute to its development. Risk factors increase the likelihood of an individual developing cerebrovascular disease, depression, and other causes of dementia. © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Figure 12.5 - Neurofibrillary Tangle © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Figure 12.6 - Development of Amyloid Plaques Secretases: Enzymes that trim part of the APP remaining outside the neuron so that it is flush with the neuron’s outer membrane. © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Table 12.5 - Mechanism of Action and Side Effects of Alzheimer’s Medications © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

ALZHEIMER’S TREATMENT Behavioral strategies Target both patient and caregiver to: Increase patient independence Eliminate wandering and aggression Provide social support for caregivers © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Biopsychosocial Perspective No viable treatment for Alzheimer’s disease Computer networks - Innovative, high-technology methods for reducing the stress placed on caregivers Traditional approach – Emotional support Cognitive-behavioral © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

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