Chapter 15 - Cognitive Disorders I.Delirium Acute, temporary impairment in perception & cognition Fluctuating course

Symptoms 1.Disturbance in consciousness - perseveration - emotional changes - hallucinations & paranoid delusions Capgras syndrome

2.Change in cognition - ST memory 3.Lasts short period of time 4.Caused by a general medical condition OR substance intoxication/withdrawal OR multiple etiologies

To diagnose - Mental Status Exam Treatment - antipsychotics - treat general medical condition - time - reassurance

II.Dementia - gradual deterioration in perception & cognition Description - multiple cognitive deficits 1.Memory impairment - trouble learning new information (Anterograde amnesia) - trouble recalling known information (Retrograde amnesia)

2.At least one of: aphasia (impaired language) apraxia (impaired movement) agnosia (can’t name/recognize objects) disturbance in executive functioning 3.Social/occupational impairment 4.Decline from previous functioning

Types of dementias Alzheimer’s Brain atrophy Tangles & plaques

Only diagnosed by autopsy Many mimicking conditions Slightly more in women

Vascular dementia Brain damage (blocked/damaged blood vessels) Dx: neurological exam, CT/MRI Many strokes Onset typically abrupt Stepwise but fluctuating course Rapid change in fx Individual variability Men

Parkinson’s disease Slow, progressive deterioration Psychomotor: tremors, rigidity, instability Dementia present in 20-60% Decreased DA

Huntington’s disease Progressive impairment in cognition, emotion, movement Single dominant gene Dx usually in 40s Onset: insidious personality change Movement: fidgeting (“chorea”) Cognitive: memory, executive fx, judgment Sometimes disorganized speech & psychosis Men & women

Pick’s disease Degeneration primarily in frontal & temporal lobes Memory impairment later Primitive reflexes With progression, either apathy or agitation Onset usually in 50s or 60s

Other Head trauma (e.g., pugilistic) HIV General medical conditions Substances

Possible causes (mostly re Alzheimer’s) Genes Concordance in first-degree relatives Dominant trait 3+ chromosomes (21, 14, 19) Some genes are deterministic Some increase susceptibility Genes cause buildup of amyloid protein into plaques & plaques cause cell death

Environmental exacerbations Cigarette smoking Alcohol Repeated head trauma Diabetes Strokes Aluminum? Viruses (Creutzfeldt-Jakob disease)

Buckner (2005) – brain’s default state (when daydreaming, etc.) Same area active in Alzheimers Young adults can shift to concentration mode If Alzheimer’s, instead of shifting areas, default areas become more active

Same posterior & cortical regions show plaques in Alzheimer’s

Treatments Cannot yet regenerate brain cells Compensation by other brain areas

Thus treatment = 1.Prevent exacerbating conditions 2.Stop brain damage from progressing - GDNF to restore neurons - implant fetal brain tissue - prevent strokes (e.g., aspirin, no smoking) - enhance cognitive abilities

3.Help person & caregiver cope - treat depression in both - memory aids - well lit environment - loose, easy clothing - labels on clothes - familiar schedules

III.Amnestic Disorder Description Anterograde amnesia Retrograde amnesia No other serious cognitive impairment Impairment in function Decline from previous function

Confabulation - making up information to fill gaps Can be transient (< 1 month) Or chronic (> 1 month)

Etiology head trauma, drugs Treatment Memory aids Treat other conditions