1. Chapter 14 Neurocognitive Disorders
ABNORMAL PSYCHOLOGY, SIXTEENTH EDITION James N. Butcher/ Jill M. Hooley/ Susan Mineka
Chapter 14
Neurocognitive Disorders
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2. 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.”
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3. 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.
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4. 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
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5. 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
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6. Figure 14.2: Brain Structures and Associated Behaviors
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7. 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
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8. The Neuropsychology/ Psychopathology Interaction
Close link between neuropsychological and psychopathological conditions
Psychological disorder not necessarily and completely explained by patient’s brain damage
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9. Treatments and Outcomes
Delirium
Treatments and Outcomes
Clinical Picture
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10. Clinical Picture
Delirium
State of acute brain failure that lies between normal wakefulness and stupor or coma
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11. 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
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12. Figure 14.3: Continuum of Level of Consciousness
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13. Treatments and Outcomes
True medical emergency
Often reversible
Most often treated by medications, environmental manipulations, and family support
Delirium
Neuroleptics are most common medication
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14. 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
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15. Figure 14.4: Distribution of Dementia by Probable Cause
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16. 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
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17. 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
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18. 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
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19. 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
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20. 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
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21. 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
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22. 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.
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23. 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
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24. Vascular Disease
Vascular disease
Series of circumscribed cerebral infarcts cumulatively destroy neurons over expanding brain regions
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25. 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
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26. 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
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27. 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
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28. Clinical Picture
Head injuries results
Retrograde amnesia
Anterograde amnesia
Personality changes
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29. 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
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30. 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?
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