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Developmental and Cognitive Disorders
Chapter 13 Developmental and Cognitive Disorders
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Nature of Developmental Psychopathology: An Overview
Normal vs. abnormal development Developmental psychopathology Study of how disorders arise and change with time Disruption of early skills can affect later development
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Nature of Developmental Psychopathology: An Overview
Developmental disorders Diagnosed first in infancy, childhood, or adolescence Attention deficit hyperactivity disorder (ADHD) Learning disorders Autism Mental retardation Technology Tip: The American Academy of Child and Adolescent Psychiatry homepage provides information for children and their families (including research, education, and treatment) on many childhood disorders.
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Attention Deficit Hyperactivity Disorder (ADHD)
Nature of ADHD Central features – inattention, overactivity, and impulsivity Associated with numerous impairments Behavioral Cognitive Social and academic problems Technology Tip: Attention Deficit Disorder. This site contains a wealth of scholarly information and links related to ADHD.
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Attention Deficit Hyperactivity Disorder (ADHD)
DSM-IV-TR symptom types Inattentive type Hyperactive type Impulsive type
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ADHD: Facts and Statistics
Prevalence Occurs in 3% - 7% of school-aged children Symptoms are usually present around age three or four Children with ADHD have problems as adults Gender differences Boys outnumber girls 3:1 Cultural factors Probability of ADHD diagnosis Greatest in the United States
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The Causes of ADHD: Biological Contributions
Genetic contributions ADHD seems to run in families DAT1 - gene have been implicated
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The Causes of ADHD: Biological Contributions
Neurobiological contributions Smaller brain volume Inactivity of the frontal cortex and basal ganglia Abnormal frontal lobe development and functioning
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The Causes of ADHD: Biological Contributions (continued)
The role of toxins No evidence that allergens and food additives are causes Maternal smoking increases risk
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The Causes of ADHD: Psychosocial Contributions
Psychosocial factors Can influence the nature of ADHD ADHD children are often viewed negatively by others Constant negative feedback from peers and adults Peer rejection and resulting social isolation Such factors foster low self-esteem Technology Tip: Attention Deficit Hyperactivity Disorder (NIMH). This NIMH web site provides a wealth of information and resources related to ADHD.
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Biological Treatment of ADHD
Goal of biological treatments To reduce impulsivity and hyperactivity and to improve attention Stimulant medications Reduce core symptoms in 70% of cases Examples include Ritalin, Dexedrine
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Biological Treatment of ADHD
Other medications with more limited efficacy Imipramine and clonidine (antihypertensive) Designer drugs Effects of medications Improve compliance and decrease negative behaviors Do not affect learning and academic performance Benefits are not lasting following discontinuation
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Behavioral and Combined Treatment of ADHD
Behavioral treatment Reinforcement programs To increase appropriate behaviors Decrease inappropriate behaviors May also involve parent training Combined bio-psycho-social treatments Are highly recommended Superior to medication or behavioral treatments alone Technology Tip: CH.A.D.D. (Children and Adults with Attention Deficit Disorders). CH.A.D.D. is a non-profit organization devoted to educating the public about attention deficit and hyperactivity disorders. This site includes information on the symptoms of ADDHD, treatments, and as well as CH.A.D.D. chapters throughout the country.
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Learning Disorders: An Overview
Scope of learning disorders Academic problems in reading, mathematics, and writing Performance substantially below expected levels Technology Tip: Learning Disabilities Association of America. This web site provides information and news updates on learning disabilities. This site is aimed at parents, teachers, and other professionals.
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Learning Disorders: An Overview
DSM-IV-TR reading disorder Discrepancy between actual and expected achievement Performance significantly below age or grade level Cannot be caused by sensory deficits DSM-IV-TR mathematics disorder Achievement below expected performance DSM-IV-TR disorder of written expression Achievement below expected performance in writing Technology Tip: NLDline This is a non-verbal learning disabilities website with a huge array of information about learning disabilities common in people with pervasive developmental disorders.
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Learning Disorders: Statistics
Prevalence of learning disorders 5-10% prevalence in the United States Highest in wealthier regions of the United States Six million children have been diagnosed 4-10% prevalence for reading difficulties School experience tends to be generally negative Technology Tip: Dyslexia Online. A website maintained by Dr. Harold Levinson devoted to "resolving the traditional misconceptions of dyslexia and related attention deficit and anxiety disorders."
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FIGURE 13. 1 Uneven distribution
FIGURE 13.1 Uneven distribution. The highest percentages of schoolchildren diagnosed with learning disabilities are in the wealthiest states.
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Biological and Psychosocial Causes of Learning Disorders
Genetic and neurobiological contributions Reading disorder runs in families Evidence for subtle forms of brain damage is mounting Overall, contributions are unclear Psychosocial contributions are largely unknown
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Treatment of Learning Disorders
Requires intense educational interventions Remediation of basic processing problems Improvement of cognitive skills Targeting skills to compensate for problem areas Data support behavioral educational interventions
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Pervasive Developmental Disorders: An Overview
Nature of pervasive developmental disorders Problems occur in language, socialization, and cognition Pervasive – problems span many life areas Examples of pervasive developmental disorders Autistic disorder Asperger’s syndrome
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The Nature of Autistic Disorder: An Overview
Autism – significant impairments Social interactions and communication Restricted patterns of behavior, interest, and activities Technology Tip: Autistic Disorder. This site contains a wealth of scholarly information and links related to autistic disorder.
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The Nature of Autistic Disorder: An Overview
Three central DSM-IV-TR features of autism Qualitative impairment of social interaction Problems in communication 50% never acquire useful speech Restricted patterns of behavior, interests, and activities
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Autistic Disorder: Statistics
Prevalence and features of autism – One in every 500 births More prevalent in females with IQs below 35 More prevalent in males with higher IQs Occurs worldwide Symptoms usually develop before 36 months of age
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Autistic Disorder: Statistics
Autism and intellectual functioning 45%- 60% with autism have average or above average IQs Reliable indicators of good prognosis Language ability and IQ
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Causes of Autism: Early and More Recent Contributions (continued)
Current understanding of autism Medical conditions – not always related to autism Genetic component is largely unclear Neurobiological evidence of brain damage Substantially reduced cerebellum size Psychosocial contributions are unclear Technology Tip: Ask NOAH about Autism. This is an excellent mega site on information related to child developmental disorders and includes many useful links to teaching and scholarly resources.
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“Autism Diagnosis in Children” 04:12
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Asperger’s Disorder: Part of the Autistic Spectrum
The nature of Asperger’s disorder Show significant social impairments Restricted and repetitive stereotyped behaviors May be clumsy Often quite verbal No severe language and/or cognitive delays Technology Tip: Asperger's Disorder. This site contains a wealth of scholarly information and links related to Asperger’s disorder.
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Asperger’s Disorder: Part of the Autistic Spectrum
Prevalence of Asperger’s disorder Often under diagnosed Affects about one - two persons per 10,000 people More often in boys that girls Causes of Asperger’s disorder are somewhat unclear
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Treatment of Pervasive Developmental Disorders: Example of Autism
Psychosocial “behavioral” treatments Skill building Reduction of problem behaviors Target communication and language problems Address socialization deficits Early intervention is critical Technology Tip: Autism Center. This web page, in addition to providing links to other related sources on the web, gives information on the symptoms of autism, guidelines for families and caregivers, and relevant books and resources.
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Treatment of Pervasive Developmental Disorders: Example of Autism
Biological and medical treatments are unavailable Integrated treatments: The preferred model Focus on children, their families, schools, and home Build in appropriate community and social support
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Intellectual disability (ID): An Overview
Nature of mental retardation Disorder of childhood Below-average intellectual and adaptive functioning Range of impairment varies greatly across persons Technology Tip: An excellent resource of historical information related to intelligence testing:
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Intellectual disability (ID): An Overview
DSM-IV-TR criteria Significantly sub-average intellectual functioning Deficits or impairments in present adaptive functioning Must be evident before the person is 18 years of age Technology Tip: Information on intellectual disability. Provided by the US Centers for Disease Control & Prevention :
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DSM-IV-TR Levels of Intellectual disability (ID)
Mild ID IQ score between 50 or 55 and 70 Moderate ID IQ range of to 50-55 Severe ID IQs ranging from up to 35-40 Profound ID IQ scores below 20-25
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Other Classification Systems for Intellectual disability (ID)
American Association of Mental Retardation (AAID) Defines ID based on levels of assistance required Levels of assistance Intermittent, limited, extensive, pervasive
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Other Classification Systems for Intellectual disability (ID)
Classification of ID in educational systems Educable (IQ of 50 to 70-75) Trainable (IQ of 30 to 50) Severe (IQ below 30) Implications of different ID classification systems
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Intellectual disability (ID): Some Facts and Statistics
Prevalence About 1-3% of the general population 90% are labeled with mild intellectual disability Course of ID Tends to be chronic Prognosis varies greatly from person to person Technology Tip: Visit the American Association of Mental Retardation website for more information:
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Causes of Intellectual disability (ID): Biological Contributions
Hundreds of known causes Environmental – deprivation, abuse Prenatal – exposure to disease or a drug/toxin Perinatal – difficulties during labor Postnatal – head injury
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Causes of Intellectual disability (ID): Biological Contributions
Genetic research Multiple genes, and at times single genes Chromosomal abnormalities Down syndrome and fragile X syndrome PKU Lesch-Nyhan syndrome
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Causes of Intellectual disability (ID): Biological Contributions
Down syndrome Maternal age and risk of having a Down’s baby Amniocentesis Chorionic villus sampling (CVS)
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FIGURE 13.2 The increasing likelihood of Down syndrome with maternal age. (Based on data from Hook, E. B., Epidemiology of Down syndrome. In S. M. Pueschel & J. E. Rynders, Eds., Down syndrome: Advances in biomedicine and the behavioral sciences (pp. 11–88). Cambridge, MA: Ware Press, © 1982 Ware University Press.)
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Cultural-familial intellectual disability
Believed to cause about 75% of ID cases Is the least understood Associated with Mild levels of retardation on IQ tests Good adaptive skills Technology Tip: Down Syndrome Page. This page was established in 1995 and provides information on healthcare guidelines for patients, education resources, events & conferences, and Down Syndrome organizations worldwide.
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FIGURE 13.3 The actual distribution of IQ scores for individuals with cultural–familial retardation and organic retardation. Note that the cultural–familial group represents the normal expected lower end of the continuum but the organic group is a separate and overlapping group. (Adapted, with permission, from Zigler, E., & Hodapp, R. M., Understanding mental retardation. Cambridge: Cambridge University Press, © 1986 Cambridge University Press.)
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Treatment of Intellectual disability (ID)
Parallels treatment of pervasive developmental disorders Teach needed skills To foster productivity To foster independence Educational and behavioral management Living and self-care skills via task analysis Communication training – often most challenging
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Treatment of Intellectual disability (ID)
Community and supportive interventions Persons with ID can benefit from such interventions
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Summary of Developmental Disorders
Developmental psychopathology Attention deficit hyperactivity disorder Deficits in attention, hyperactivity, or impulsivity Learning disorders Deficits in performance below expectations
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Summary of Developmental Disorders
Pervasive developmental disorder All share deficits in language, socialization, and cognition Intellectual disability Sub-average IQ, deficits in adaptive functioning Onset before age 18 Prevention and early intervention are critical Technology Tip: Information provided by the US Centers for Disease Control & Prevention :
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Nature of Cognitive Disorders: An Overview
Perspectives on cognitive disorders Affect learning, memory, and consciousness Most develop later in life Three classes of cognitive disorders Delirium – temporary confusion and disorientation Dementia – marked by broad cognitive deterioration Amnestic disorders – memory dysfunctions
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Nature of Cognitive Disorders: An Overview
Shifting DSM perspectives From “organic” mental disorders to “cognitive” disorders Broad impairments in cognitive functioning Profound changes in behavior and personality
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Delirium: An Overview Nature of delirium
Central features – impaired consciousness and cognition Develops rapidly over several hours or days Appear confused, disoriented, and inattentive Marked memory and language deficits Technology Tip: Delirium. This web page provides diagnostic and clinically-relevant research information and links about delirium.
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Delirium: An Overview (continued)
Facts and statistics Affects up 30% of persons in acute care facilities Most prevalent in older adults Those undergoing medical procedures AIDS patients and cancer patients Full recovery often occurs within several weeks
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Medical Conditions Related to Delirium
Drug intoxication, poisons, withdrawal from drugs Infections Head injury and several forms of brain trauma Sleep deprivation, immobility, and excessive stress
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Medical Conditions Related to Delirium
DSM-IV-TR subtypes of delirium Delirium due to a general medical condition Substance-induced delirium Delirium due to multiple etiologies Delirium not otherwise specified
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Treatment and Prevention of Delirium
Attention to precipitating medical problems Psychosocial interventions include reassurance Focus on coping strategies Inclusion of patients in treatment decisions Prevention Address proper medical care for illnesses Address proper use and adherence to therapeutic drugs
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Dementia: An Overview Nature of dementia
Gradual deterioration of brain functioning Deterioration in judgment and memory Deterioration in language / advanced cognitive processes Has many causes and may be irreversible Technology Tip: Dementia. Web Good site with a lot of information/links on a wide variety of topics/research. Includes a support database.
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Dementia: Initial and Later Stages
Initial stages Memory and visuospatial skills impairments Agnosia – inability to recognize and name objects Facial agnosia – inability to recognize familiar faces Other symptoms Delusions, apathy, depression, agitation, aggression
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Dementia: Initial and Later Stages
Cognitive functioning continues to deteriorate Total support is needed to carry out day-to-day activities Death due to inactivity and onset of other illnesses
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DSM-IV-TR Classes of Dementia
Dementia of the Alzheimer’s type Vascular dementia Dementia due to other general medical conditions Substance-induced persisting dementia Dementia due to multiple etiologies Dementia not otherwise specified
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Dementia of the Alzheimer’s Type: An Overview
DSM-IV-TR criteria and clinical features Multiple cognitive deficits Develop gradually and steadily Memory, orientation, judgment, and reasoning deficits Additional symptoms may include Agitation, confusion, or combativeness Depression and/or anxiety “Sundowner syndrome” Technology Tip: Alzheimer's Association. The Alzheimer's Association web site contains information on local chapters, coping strategies for caregivers, and scientific progress towards effective treatment and understanding of this disorder.
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Dementia of the Alzheimer’s Type: Extent of Deficits
Range of cognitive deficits Aphasia – difficulty with language Apraxia – impaired motor functioning Agnosia – failure to recognize objects Difficulties with Planning Organizing Sequencing Abstracting information Negative impact on social and occupational functioning
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Dementia of the Alzheimer’s Type: Extent of Deficits
Until recently an autopsy is required for a definitive diagnosis
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Alzheimer’s Disease: Some Facts and Statistics
Nature and progression of the disease Deterioration is slow during the early and later stages Deterioration is rapid during middle stages Average survival time is about eight years Onset usually occurs in the 60s or 70s
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Alzheimer’s Disease: Some Facts and Statistics
Prevalence of Alzheimer’s disease Prevalence greater in Poorly educated persons Prevalence rates are low in some ethnic groups
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Vascular Dementia: An Overview
Nature of vascular dementia Caused by blockage or damage to blood vessels Second leading cause of dementia next to Alzheimer’s Onset is often sudden (e.g., stroke) Patterns of impairment are variable Most require formal care in later stages Technology Tip: For more information, visit the UCSF site on vascular dementia:
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Vascular Dementia: An Overview
DSM-IV-TR criteria and incidence Cognitive disturbances – identical to dementia Obvious neurological signs of brain tissue damage Prevalence 1.5% in people 70 and 15% for people over 80 Risk slightly higher in men
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Other Causes of Dementia: Head Trauma
Head trauma – accidents are leading cause Memory loss is the most common symptom Technology Tip: Dementia. This web page provides diagnostic and clinically-relevant research information and links about dementia. Technology Tip: For more information on traumatic brain injury, visit the following sites:
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Other Causes of Dementia: HIV-1
Causes neurological impairments and dementia Cognitive slowness, impaired attention, and forgetfulness Apathy and social withdrawal Technology Tip: For more information on AIDS dementia, visit the following sites:
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Other Causes of Dementia: Parkinson’s Disease
Parkinson’s disease – degenerative brain disorder Affects about one out of 1,000 people worldwide Motor problems – central feature of this disorder Caused by damage to dopamine pathways 75% survival rate for 10 years Technology Tip: For more information on Parkinson’s disease visit the following site:
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Other Causes of Dementia: Huntington’s
Huntington’s disease Genetic autosomal dominant disorder Manifests initially as chorea, usually later in life About 20-80% display dementia Dementia follows a subcortical pattern Technology Tip: For more information on Huntington’s Disease, visit the following sites:
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Other Causes of Dementia: Pick’s Disease
Rare neurological condition Produces a cortical dementia like Alzheimer’s Also occurs later in life (around 40s or 50s) Little is known about what causes this disease Technology Tip: For more information on Pick’s disease and frontotemporal dementia, visit the following sites:
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Other Dementias: Creutzfeldt-Jakob Disease
Affects one out of 1,000,000 persons Linked to mad cow disease Technology Tip: For more information on Creutzfeldt-Jakob Disease, visit the following sites:
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Other Dementias: Substance-Induced Dementia
Substance-induced persisting dementia Results from drug use in combination with poor diet Several drugs can lead to symptoms of dementia Resulting brain damage may be permanent Dementia is similar to that of Alzheimer’s Deficits may include Aphasia, apraxia, agnosia Disturbed executive functioning Technology Tip: For more information on Substance-Induced Persisting Dementia, visit the following sites: neurology.health-cares.net/alcohol-related-dementia.php
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Causes of Dementia: The Example of Alzheimer’s Disease
Early and largely unsupported views Implicated smoking, negative correlation
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Causes of Dementia: The Example of Alzheimer’s Disease
Current neurobiological findings Neurofibrillary tangles Amyloid plaques The role of deterministic genes Beta-amyloid precursor gene Presenilin-1 and Presenilin-2 genes The role of susceptibility genes - ApoE4 gene Brains of Alzheimer’s patients tend to atrophy Technology Tip: For more information on the genetics of Alzheimer’s disease, visit the following sites: ghr.nlm.nih.gov/condition=alzheimerdisease
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Causes of Dementia: The Example of Alzheimer’s Disease
Current neurobiological findings Multiple genes are involved in Alzheimer’s disease Chromosomes 21, 19, 14, 12, Chromosome 14 Associated with early onset Alzheimer’s Chromosome 19 Associated with late onset Alzheimer’s
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The Contributions of Psychosocial Factors in Dementia
Do not cause dementia directly May influence onset and course Lifestyle factors – drug use, diet, exercise, stress Cultural factors Risk for certain conditions vary by ethnicity and class Educational attainment, coping skills, social support
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Medical and Psychosocial Treatment of Dementia
Medical treatment: Best if enacted early Few exist for most types of dementias Most attempt to slow progression of deterioration Do not stop progression of dementia Caregiver can be negatively impacted
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Medical and Psychosocial Treatment of Dementia
Psychosocial treatments – aims To enhance lives of patients and their families To teach compensatory skills To use memory enhancement devices, if needed Psychosocial interventions appear to focus on caregivers Technology Tip: For more information on behavioral treatments of AD, visit the following site:
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Prevention of Dementia
Reducing risk of dementia in older adults Estrogen-replacement therapy Proper treatment of cardiovascular diseases Use of anti-inflammatory medications Control blood pressure and lead an active social life Other targets of prevention efforts Increasing safety behaviors to reduce head trauma Reducing exposure to neurotoxins and use of drugs
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Amnestic Disorder: An Overview
Nature of amnestic disorder Circumscribed loss of memory Inability to transfer information into long-term memory No loss of other high-level cognitive functions
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Amnestic Disorder: An Overview
Causes may include Medical conditions, head trauma, or long-term drug use DSM-IV-TR criteria Inability to Learn new information or recall learned information Significant impairment in functioning
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Amnestic Disorder: An Overview
The example of Wernicke-Korsakoff syndrome Damage to the thalamus Thiamine (vitamin B-1) deficiency Resulting from stroke or chronic heavy alcohol use Prevention Use of thiamine supplements with heavy drinkers Research on amnestic disorders is scant Technology Tip: For more information on Wernicke-Korsakoff Syndrome, visit the following sites: ww.ninds.nih.gov/disorders/wernicke_korsakoff/wernicke-korsakoff.htm
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Summary of Cognitive Disorders
Cognitive disorders span a range of deficits Affect attention, memory, language, and motor behavior Causes include Medical conditions Drug use Environmental factors
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Summary of Cognitive Disorders
Most result in progressive deterioration of functioning Few treatments exist to reverse damage and deficits
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Dementia: Statistics Onset and prevalence Incidence of dementia
Can occur at any age, but most common in the elderly Affects over 10% of persons 85 years and older Incidence of dementia Affects 8.5% of those 85 and older Rates seem to double with every five years of age
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Dementia: Facts and Statistics
Gender and sociocultural factors Occurs equally in men and women Occurs equally across educational level and social class
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