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0. Chapter 15 Cognitive Disorders. 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

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nature of cognitive disorders an overview

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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
delirium an overview

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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
medical conditions related to delirium

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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
treatment and prevention of delirium

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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
dementia an overview

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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
dementia an overview cont

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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
dementia facts and statistics

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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
dsm iv and dsm iv tr classes of dementia

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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
dementia of the alzheimer s type an overview

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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
dementia of the alzheimer s type an overview cont

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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
alzheimer s disease some facts and statistics

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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, 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)
vascular dementia an overview

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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
dementia related to human immunodeficiency virus type 1 hiv 1

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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
other causes of dementia head trauma and parkinson s disease

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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
other causes of dementia huntington s and pick s disease

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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
other dementias creutzfeldt jakob disease and substance induced dementia

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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
causes of dementia the example of alzheimer s disease

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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
causes of dementia the example of alzheimer s disease cont

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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

the contributions of psychosocial factors in dementia

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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
medical and psychosocial treatment of dementia

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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
prevention of dementia

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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
amnestic disorder an overview

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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
amnestic disorder an overview cont

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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
summary of cognitive disorders

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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