1. Aging-Related and Cognitive Disorders
Chapter 12
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2. NATURE OF COGNITIVE DISORDERS
Injuries to the brain including brain trauma, disease, or exposure to toxic substances including drugs
DSM-IV diagnoses include:
Delirium
Dementia
Amnesia
Brain’s functioning affects our abilities to think, remember, and pay attention.
In DSM-IV-TR, this set of disorders is titled delirium, dementia, amnestic, and other cognitive disorders.
Symptoms:
Mood disorders
Personality disorders
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3. Delirium
A temporary state in which individuals experience a clouding of consciousness
Unaware of what is happening around them
Unable to focus or pay attention
Core of the disorder involves an acute state of confusion, impairment in cognitive processing that affects memory, orientation, executive functioning, ability to use language, visual perception, and learning.
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4. Delirium Develops for a variety of reasons Substance intoxication
Substance withdrawal
Head injury
High fever
Vitamin deficiency
People of any age can experience delirium, common among medically or psychiatrically hospitalized older adult patients.
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5. Delirium Causes Tests and treatment Infection
Central nervous system disorder
Metabolic disorders
Tests and treatment
Delirium Rating Scale-Revised
Pharmacological approach
Haloperidol and respiridone
Apart from the cognitive symptoms of inattention and memory loss, individuals experiencing delirium have hallucinations, delusions, abnormalities in sleep-wake cycles, changes in mood, and movement abnormalities.
The advantage of using Delirium Rating Scale-Revised is that although designed for psychiatrists, other professionals and researchers can also use it.
Pharmacological approach administers antipsychotics.
Standard approach uses haloperidol, but clinicians may use “off-label” antipsychotics such as respiridone.
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6. Amnestic Disorder Cognitive disorders involve inability to:
Recall previously learned information
Register new memories
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7. Categories of Amnestic Disorder
Amnestic disorders due to medical conditions
Chronic
Transient
Substance-induced persisting amnestic disorders
Those due to medical conditions can be chronic (lasting a month or more) or transient (temporary).
Such medical conditions include head trauma, loss of oxygen, herpes simplex.
Substance-induced – Memory impairment
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8. Substances That Induce Amnestic Disorder
Medications
Illicit drugs
Lead
Mercury
Insecticides
Industrial solvents
The most common cause:
Chronic alcohol use
Memory loss must persist over time for the clinician to assign the diagnosis of amnestic disorder.
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9. Traumatic Brain Injury (TBI)
Damage to the brain caused by exposure to trauma
Post-concussion syndrome: Constellation of physical, emotional, and cognitive symptoms persists from weeks to years
In older adults, falls are the most common cause of TBIs.
People undergoing mild TBI may experience a related condition known as post-concussion syndrome (PCS).
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10. Dementia
Involves generalized progressive deficits in a person’s memory
Learning of new information
Ability to communicate
Judgment
Motor coordination
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11. Table 12.2 - Symptoms of Dementia
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12. Alzheimer’s Disease
Progressive and gradual cognitive deficits due to severe cerebral atrophy
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13. Stages of Alzheimer’s Disease
Not Alzheimer
Early-stage
Middle-stage
Late-stage
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14. Figure 12.3 - Charting the Course of Healthy Aging, MCI, and AD
Mild cognitive impairment (MCI): A condition in which an individual suffers some memory problems but does not show symptoms of dementia.
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15. Dementia Caused by Conditions Other than Alzheimer’s Disease
Physical conditions and toxins
Infectious diseases can cause the changes that occur with dementia
Infectious diseases
Neurosyphilis
Encephalitis
Tuberculosis
Meningitis
Localized infections in the brain
Anoxia
Exposure to certain drugs and environmental toxins
Nutritional deficiencies
Anoxia can have severe effects on many brain functions, because neurons quickly die if they are deprived of oxygen.
Exposure to certain drugs and environmental toxins can cause brain damage and result in a condition called substance-induced persisting dementia.
People who are severely undernourished are prone to develop a deficiency of folate, a critical nutrient, which can lead to progressive cerebral atrophy.
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16. Figure 12.4 – Other Diseases that can Cause Dementia
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17. VARIOUS DEMENTIAS Pick’s disease Parkinson's disease
Pick's disease: Affects the frontal and temporal lobes of the cerebral cortex and can cause dementia.
Parkinson's disease: Degeneration of neurons in subcortical structures that control motor movements.
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18. Parkinson’s Disease Symptoms
Hands, ankles, or head may shake involuntarily
Akinesia: Muscular rigidity, difficulty initiating movement
Bradykinesia: General slowing of motor activity
Loss of fine motor coordination
Slowed, shuffling gait
Difficulty starting or stopping movement like walking
Signs of cognitive deterioration
Expressionless and speech becomes stilted
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19. VARIOUS DEMENTIAS Lewy body dementia Frontotemporal dementias
Huntington’s disease
Creutzfeldt-Jakob disease
Vascular dementia
Lewy body dementia: Similar to Alzheimer's disease with progressive loss of memory, language, calculation, and reasoning, as well as other higher mental functions.
Diagnosed when Lewy bodies are found more diffusely throughout the brain.
Frontotemporal dementias: Involve the frontotemporal area of the brain.
Reflected in personality changes such as apathy, lack of inhibition, obsessiveness, or loss of judgment.
Motivation and communication are lost.
Huntington's disease: Hereditary condition causing dementia that involves a widespread deterioration of the subcortical brain structures and parts of the frontal cortex that control motor movements.
Creutzfeldt-Jakob disease: A neurological disease transmitted from animals to humans that leads to dementia and death resulting from abnormal protein accumulations in the brain.
Vascular dementia: Resulting from a vascular disease that causes deprivation of the blood supply to the brain.
Multi-infarct dementia: Caused by transient attacks in which blood flow to the brain is interrupted by a clogged or burst artery.
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20. Pseudodementia
False dementia, symptoms caused by depression that mimic those apparent in early stages of Alzheimer's
People with depression are anxious, have difficulty sleeping, show disturbed appetite patterns, and experience suicidal thoughts, low self-esteem, guilt, and lack of motivation.
People with pseudodementia are likely to have a history of prior depressive episodes that may have been undiagnosed.
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21. Diagnosis of Alzheimer’s Disease
Brain imaging techniques
Neuropsychological testing
NINCDS/ADRDA guidelines
Mini-Mental State Examination
The diagnosis of Alzheimer’s disease based on the NINCDS/ADRDA criteria involves thorough medical and neuropsychological screenings.
Continued improvement of MRI has resulted in a virtual explosion of studies on the diagnosis of Alzheimer’s disease through brain imaging.
Clinicians convened to revise the 1984 NINCDS/ADRDA Guidelines.
Goal was to develop diagnostic criteria not dependent on the expensive and potentially invasive brain scans used in research.
The clinical tool that clinicians most commonly use for diagnosing Alzheimer’s disease is a specialized form of the mental status examination, which we call the Mini-Mental State Examination.
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22. ALZHEIMER’S DEMENTIA Biological features
Neurofibrillary tangles
Amyloid plaques
Risk factors for Alzheimer's disease:
Cigarette smoking
Obesity
Lack of physical exercise
Neurofibrillary tangles: Material within the cell bodies of neurons becomes filled with densely packed, twisted protein microfibrils, or tiny strands.
Tau: A protein that normally helps maintain the internal support structure of the axons.
Amyloid plaques: Clusters of dead or dying neurons become mixed together with fragments of protein molecules.
Two main implications of research documenting the behavioral risk factors for Alzheimer’s disease:
People can reduce their risk of Alzheimer’s disease by taking advantage of behaviors that contribute to its development.
Risk factors increase the likelihood of an individual developing cerebrovascular disease, depression, and other causes of dementia.
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23. Figure 12.5 - Neurofibrillary Tangle
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24. Figure 12.6 - Development of Amyloid Plaques
Secretases: Enzymes that trim part of the APP remaining outside the neuron so that it is flush with the neuron’s outer membrane.
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25. Table 12.5 - Mechanism of Action and Side Effects of Alzheimer’s Medications
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26. ALZHEIMER’S TREATMENT
Behavioral strategies
Target both patient and caregiver to:
Increase patient independence
Eliminate wandering and aggression
Provide social support for caregivers
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27. Biopsychosocial Perspective
No viable treatment for Alzheimer’s disease
Computer networks - Innovative, high-technology methods for reducing the stress placed on caregivers
Traditional approach – Emotional support
Cognitive-behavioral
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