Cognitive Disorders Thomas Bowers, Ph.D. Penn State Harrisburg Add Corporate Logo Here To insert your company logo on this slide From the Insert Menu Select “Picture” Locate your logo file Click OK To resize the logo Click anywhere inside the logo. The boxes that appear outside the logo are known as “resize handles.” Use these to resize the object. If you hold down the shift key before using the resize handles, you will maintain the proportions of the object you wish to resize.

Contributors Samuel Adams, an undergraduate, for assisting in preparing the pages and synopses. Kathy Houseman, laboratory assistant, for helping with the samples. Donna Marie Struck, a graduate assistant in psychology, for taking the photographs. Dr. Jay Towfighi, for providing the neuropathology samples.

Acknowledgements These examples are from the Penn State Hershey Medical Center's Neuropathology Laboratory, Hershey, PA, operated under the direction of Dr. Jay Towfighi.

Cognitive Disorders Two fundamental types –I. Delirium - relatively acute state, due to intoxication, withdrawal, poisoning or similar transient source of impairment of consciousness –II. Dementia - more fixed impairment of memory and other higher cognitive processes

Dementia Multiple sources –1. Deteriorating disorders –2. Disease processes –3. Head injury –4. Vascular disorders –5. Constitutional impairment

Deteriorating Disorders I. Alzheimer’s disease –Remarkably common Farmington study estimates incidence of 11% for those over 85 years of age Progressive atrophy of the cortex, with notable impairment in the hippocampus in particular Diagnosis by exclusion, definitive diagnosis only on autopsy

Deteriorating Disorders I. Alzheimer’s disease –Decrement in recent memory functioning, probably due to problems in consolidation –Recent appreciation of the role of acetylcholine

Example of Alzheimer’s Disease

Deteriorating Disorders II. Pick’s Disease –Relatively rare –Selective atrophy of frontal and temporal regions of the cortex –Unknown cause and etiology

Example of Pick’s Disease

Deteriorating Disorders III. Huntington’s Disease –Subcortical impairment, also eventually impacts on cortical functions –Grimacing, unusual and eccentric presentation, gradual deterioration –Some strong genetic components

Deteriorating Disorders IV. Parkinson’s Disease –Deficiency in dopamine (DA) –Tremors, as pill rolling tremors, akinesia (inability to initiate movement) –Late stages impact on frontal region functions

Disease Processes There is a remarkable array of rare infectious processes which impact on the brain Sources of impairment –1. Encephalopathy –2. Encephalitis

Disease Processes I. Meningitis - Inflammation of the outer lining of the brain –Viral - Most common –Bacterial - much more problematic –Relatively common among children, rarer for adults (and far more serious)

Disease Processes II. Herpes Simplex Encephalitis –Sudden clinical course and presentation –Many early deaths until late 1980s –Now largely effectively treated with antiviral medications (as acyclovir)

Disease Processes III. Neurosyphilis –Now extremely rare –Initial presentation mild, maybe asymptomatic –Later manifestation as severe neurological disorders general paresis - Alzheimer’s like presentation

Disease Processes IV. Lyme encephalopathy - documented memory deficits V. Creutfeld-Jakob Disease - slow viral agent VI. Progressive multifocal leukoencephalopathy - viral demyelinating disorder

Disease Processes VII. HIV and AIDS related dementia complex –Both mild and severe cognitive difficulties could arise –Focus of considerable new research interests

AIDS Dementia Complex

Disease Processes VIII. Chronic Fatigue Syndrome (CFS) –Controversial area –Severe enough to reduce activity more than 50% below premorbid levels –At least six months –Associated low-grade symptoms, memory dampened

Disease Processes VIII. Chronic Fatigue Syndrome (CFS) –Some (but not all) demonstrate Epstein- Barr virus antibodies –Important to rule out other disorders –Often helped by antidepressants and cognitive behavioral therapy for depression –Also display problems in memory and speed of processing not attributable to depression