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Chapter 15 Cognitive Disorders

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1 Chapter 15 Cognitive Disorders
Chapter 15 Cognitive Disorders

2 Nature of Cognitive Disorders: An Overview
Nature of Cognitive Disorders: An Overview Perspectives on Cognitive Disorders Affect cognitive processes such as learning, memory, and consciousness Most develop later in life Three Classes of Cognitive Disorders Delirium – Often temporary confusion and disorientation Dementia – Degenerative condition marked by broad cognitive deterioration Amnestic disorders – Memory dysfunctions caused by disease, drugs, or toxins Shifting DSM Perspectives From “organic” mental disorders to “cognitive” disorders Broad impairments in memory, attention, perception, and thinking Profound changes in behavior and personality

3 Delirium: An Overview Nature of Delirium
Delirium: An Overview Nature of Delirium Central features – Impaired consciousness and cognition Impairments develop rapidly over several hours or days Examples include confusion, disorientation, attention, memory, and language deficits Facts and Statistics Affects 10% to 30% of persons in acute care facilities Most prevalent in older adults, AIDS patients, and medical patients Full recovery often occurs within several weeks

4 Medical Conditions Related to Delirium
Medical Conditions Related to Delirium Medical Conditions Drug intoxication, poisons, withdrawal from drugs Infections, head injury, and several forms of brain trauma Sleep deprivation, immobility, and excessive stress DSM-IV and DSM-IV Subtypes of Delirium Delirium due to a general medical condition Substance-induced delirium Delirium due to multiple etiologies Delirium not otherwise specified

5 Treatment and Prevention of Delirium
Treatment and Prevention of Delirium Treatment Attention to precipitating medical problems Psychosocial interventions include reassurance, coping strategies Prevention Address proper medical care for illnesses Address proper use and adherence to therapeutic drugs

6 Dementia: An Overview Nature of Dementia
Dementia: An Overview Nature of Dementia Gradual deterioration of brain functioning Affects judgment, memory, language, and advanced cognitive processes Dementia has many causes and may be reversible or irreversible Progression of Dementia: Initial Stages Memory impairment, visuospatial skills deficits Agnosia – Inability to recognize and name objects (most common symptom) Facial agnosia – Inability to recognize familiar faces Other symptoms – Delusions, depression, agitation, aggression, and apathy

7 Dementia: An Overview (cont.)
Dementia: An Overview (cont.) Progression of Dementia: Later Stages Cognitive functioning continues to deteriorate Person requires almost total support to carry out day-to-day activities Death results from inactivity combined with onset of other illnesses

8 Dementia: Facts and Statistics
Dementia: Facts and Statistics Onset and Prevalence Can occur at any age, but most common in the elderly Affects 1% of those between years of age Affects over 10% of persons 85 years and older 47% of adults over the age of 85 have dementia of the Alzheimer’s type Incidence of Dementia Affects 2.3% of those years of age and 8.5% of persons 85 and older Rates of new cases appear to double with every 5 years of age Gender and Sociocultural Factors Dementia occurs equally in men and women Dementia occurs equally across educational level and social class

9 DSM-IV and DSM-IV-TR Classes of Dementia
DSM-IV and 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

10 Dementia of the Alzheimer’s Type: An Overview
Dementia of the Alzheimer’s Type: An Overview DSM-IV-TR Criteria and Clinical Features Multiple cognitive deficits that develop gradually and steadily Predominant impairment in memory, orientation, judgment, and reasoning Can include agitation, confusion, depression, anxiety, or combativeness Symptoms are usually more pronounced at the end of the day

11 Dementia of the Alzheimer’s Type: An Overview (cont.)
Dementia of the Alzheimer’s Type: An Overview (cont.) Range of Cognitive Deficits Aphasia – Difficulty with language Apraxia – Impaired motor functioning Agnosia – Failure to recognize objects Difficulties with planning, organizing, sequencing, or abstracting information Impairments have a marked negative impact on social and occupational functioning An Autopsy Is Required for a Definitive Diagnosis

12 Alzheimer’s Disease: Some Facts and Statistics
Alzheimer’s Disease: Some Facts and Statistics Nature and Progression of the Disease Deterioration is slow during the early and later stages, but rapid during middle stages Average survival time is about 8 years Onset usually occurs in the 60s or 70s, but may occur earlier Prevalence of Alzheimer’s Disease Affects about 4 million Americans and many more worldwide Prevalence is greater in poorly educated persons and women Prevalence rates are low in some ethnic groups (e.g., Japanese, Nigerian, Amish)

13 Vascular Dementia: An Overview
Vascular Dementia: An Overview Nature of Vascular Dementia Progressive brain disorder 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, and most require formal care in later stages DSM-IV and DSM-IV Criteria and Incidence Cognitive disturbances that are identical to dementia Unlike Alzheimer’s, obvious neurological signs of brain tissue damage occur Incidence is believed to be about 4.7% of men and 3.8% of women

14 Dementia Related to Human Immunodeficiency Virus-Type 1 (HIV-1)
Dementia Related to Human Immunodeficiency Virus-Type 1 (HIV-1) Overview and Clinical Features HIV causes neurological impairments and dementia Cognitive slowness, impaired attention, and forgetfulness, clumsiness Repetitive movements (e.g., tremors/leg weakness), apathy, and social withdrawal Progression of HIV-Related Cognitive Impairments Tend to occur during the later stages of HIV infection Impairments are observed in 29% to 87% of people with AIDS Sub-cortical dementia – Refers to deficits that affect inner brain regions Aphasia is uncommon in sub-cortical dementia, but anxiety and depression occur

15 Other Causes of Dementia: Head Trauma and Parkinson’s Disease
Other Causes of Dementia: Head Trauma and Parkinson’s Disease Head Trauma Accidents are leading causes of such cognitive impairments Memory loss is the most common symptom Parkinson’s Disease Degenerative brain disorder Affects about 1 out of 1,000 people worldwide Motor problems are characteristic of this disorder Damage to dopamine pathways is believed to cause motor problems Pattern of impairments are similar to sub-cortical dementia

16 Other Causes of Dementia: Huntington’s and Pick’s Disease
Other Causes of Dementia: Huntington’s and Pick’s Disease Huntington’s Disease Genetic autosomal dominant disorder (i.e., chromosome 4) Manifests initially as chorea, usually later in life (around 40s or 50s) About 20% to 80% of persons go on to display dementia of the sub-cortical pattern Pick’s Disease Rare neurological condition that produces a cortical dementia like Alzheimer’s Also occurs later in life (around 40s or 50s) Little is known about what causes this disease

17 Other Dementias: Creutzfeldt-Jakob Disease and Substance-Induced Dementia Creutzfeldt-Jakob Disease Affects 1 out of 1,000,000 persons Linked to mad cow disease Substance-Induced Persisting Dementia Results from drug use in combination with poor diet Examples include alcohol, inhalants, sedative, hypnotic, and anxiolytic drugs Resulting brain damage may be permanent Dementia is similar to that of Alzheimer’s Deficits may include aphasia, apraxia, agnosia, or disturbed executive functioning

18 Causes of Dementia: The Example of Alzheimer’s Disease
Causes of Dementia: The Example of Alzheimer’s Disease Early and Largely Unsupported Views Implicated aluminum and smoking Current Neurobiological Findings Neurofibrillary tangles – Occur in all brains of Alzheimer’s patients Amyloid plaques – Accumulate excessively in brains of Alzheimer’s patients The role of amyloid proteins (apoE-2, apoE-3, and apoE-4) Brains of Alzheimer’s patients tend to atrophy

19 Causes of Dementia: The Example of Alzheimer’s Disease (cont.)
Causes of Dementia: The Example of Alzheimer’s Disease (cont.) Current Neurobiological Findings Multiple genes are involved in Alzheimer’s disease (chromosomes 21, 19, 14, 12, 1) Chromosome 14 – Associated with early onset Alzheimer’s Chromosome 19 – Associated with a late

20 The Contributions of Psychosocial Factors in Dementia
The Contributions of Psychosocial Factors in Dementia Psychosocial Factors Do not cause dementia directly, but may influence onset and course Lifestyle factors – Drug use, diet, exercise, stress Cultural factors – Risk for certain diseases and accidents vary by ethnicity and class Psychosocial factors – Educational attainment, coping skills, social support

21 Medical and Psychosocial Treatment of Dementia
Medical and Psychosocial Treatment of Dementia Medical Treatment: Best if Enacted Early Few medical treatments exist for most types of dementia Most medical treatments attempt to slow progression of deterioration Examples include glial cell-derived neurotrophic factor, Cognex, vitamin E, aspirin Medical treatments do not stop progression of dementia Psychosocial Treatments Focus on enhancing the lives of dementia patients and their families/caregivers Teach adaptive skills Use memory enhancement prosthetic devices (e.g., memory wallet) Main emphasis of psychosocial interventions appears to be on the caregivers

22 Prevention of Dementia
Prevention of Dementia Reducing Risk of Dementia in Older Adults Via Estrogen-replacement therapy – Reduces risk of Alzheimer’s dementia in women Proper treatment of cardiovascular diseases Use of anti-inflammatory medications Other Targets of Prevention Efforts Increasing safety behaviors to reduce head trauma Reducing exposure to neurotoxins and use of drugs

23 Amnestic Disorder: An Overview
Amnestic Disorder: An Overview Nature of Amnestic Disorder Circumscribed loss of memory Inability to transfer information into long-term memory Often results from medical conditions, head trauma, or long-term drug use DSM-IV and DSM-IV-TR Criteria for Amnestic Disorder Cover the inability to learn new information Inability to recall previously learned information Memory disturbance causes significant impairment in functioning

24 Amnestic Disorder: An Overview (cont.)
Amnestic Disorder: An Overview (cont.) The Example of Wernicke-Korsakoff Syndrome Caused by thalamic damage resulting from stroke or chronic heavy alcohol use Attempt to restore thiamine deficiency in the case of chronic alcohol abuse Research on Amnestic Disorders Is Scant

25 Summary of Cognitive Disorders
Summary of Cognitive Disorders Cognitive Disorders Span a Range of Deficits Attention, memory, language, and motor behavior Causes include medical conditions, drug use, or environmental factors Most Cognitive Disorders Result in Progressive Deterioration of Functioning Few Treatments Exist to Reverse Pattern of Damage and Resulting Deficits


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