Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 14 Cognitive Disorders and Life-Span Issues

Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 14 Delirium Characterized by disorientation, recent memory loss, and a clouding of consciousness.

Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 14 DSM-IV-TR Criteria for Delirium Disturbance of consciousness, such as reduced clarity of awareness of the environment, with reduced ability to focus, sustain or shift attention. Change in cognition (such as memory deficit, disorientation, language disturbance) or development of a perceptual disturbance that is not accounted for by a dementia Disturbance that develops over a short period of time and tends to fluctuate during the course of the day Evidence that the disturbance is caused by the direct physiological consequences of a medical condition.

Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 14 Causes of Delirium There are many causes of delirium. For most patients, an underlying medical, surgical, chemical, or neurological problem causes the delirium. Delirium can be caused by Stroke High Fever HIV Infection Drug Intoxication or Withdrawal Fluid and Electrolyte Imbalances Illicit Drugs Toxic Substances

Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 14 Symptoms of Dementia Memory impairment Aphasia (language disturbance) Apraxia (inability to carry out motor activities despite intact motor function) Agnosia (failure to recognize or identify objects despite intact sensory functioning) Disturbance in executive functioning

Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 14 Leading Causes of Dementia

Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 14 Social and Behavioral Changes – Disorderliness, suspiciousness, argumentativeness, disruptiveness, and anxiousness – Apathy, lack of concern for others – Uncharacteristic lewdness, inattention to personal appearance or hygiene – Intrusiveness, pervasive profanity, talking loudly – Risk taking, poor impulse control, increase alcohol use Symptoms of Frontal Lobe Injury

Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 14 Affective Changes – Apathy, indifference, shallowness – Lability of affect, irritability, mania – Inability to control rage and violent behavior Intellectual Changes – Reduced capacity to use language, symbols, logic – Reduced ability to use mathematics, to calculate, process abstract information, or reason – Diminished ability to focus, concentrate, be oriented in time and place Symptoms of Frontal Lobe Injury, continued

Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 14 Major Regions of the Brain Affected by Alzheimer's

Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 14 Treatments for Dementia Medications – Cholinesterase inhibitors (e.g., Donepezil), which help prevent the breakdown of the neurotransmitter acetylcholine – Memantine, a newly approved drug, regulates the activity of glutamate – Drugs that increase dopamine (for Parkinson’s) – In all cases, drugs do not work for all patients and have only temporary effects. Antioxidants Behavior therapies

Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 14 Amnesia Unlike dementia and delirium, in amnesic disorders only memory is affected. – Anterograde amnesia – impaired in the ability to learn new information – Retrograde amnesia – impaired in the ability to recall previously learned information