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Chapter 15 Cognitive Disorders

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  1. 0 Chapter 15Cognitive Disorders

  2. 0 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. 0 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. 0 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. 0 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. 0 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. 0 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. 0 Dementia: Facts and Statistics • Onset and Prevalence • Can occur at any age, but most common in the elderly • Affects 1% of those between 65-74 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 75-79 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. 0 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. 0 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. 0 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. 0 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. 0 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. 0 Dementia Related to HumanImmunodeficiency 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. 0 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. 0 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. 0 Other Dementias: Creutzfeldt-Jakob Diseaseand 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. 0 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. 0 Causes of Dementia: The Example ofAlzheimer’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 onset Alzheimer’s

  20. 0 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. 0 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. 0 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. 0 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. 0 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. 0 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