Brain Disorders and Cognitive Impairments

1
Brain Disorders and Cognitive Impairments

• Brain Impairment in Adults
• Diffuse Versus Focal Damage
• Delirium
• Dementia
• Alzheimeizers
• Dementia from HIV-1 Infection
• Vascular Dementia
• Amnestic Syndrome
• Head Injuries

2
Cognitive Impairments

• Prior to the DSM-IV
• Disorders involving some kind of identifiable
  pathology.
• Ex brain tumor, stroke, drug intoxication
• Were labeled organic mental disorders.
• Functional mental disorders were considered not
  to have an organic basis.

3
Brain Impairment in Adults

• Mini-Mental State Examination
• Orientation (Where are we now?)
• Registration (Repeat these three words.)
• Attention and concentration (Count backwards by
  seven.)
• Recall (Do you remember those three words?)
• Language (Name what Im pointing to.)
• Comprehension (Pick up the paper in front of
  you.)
• Construction ability (Copy this design.)

4
Diffuse Versus Focal Damage

• Diffuse Damage
• Damage that involves more than one area of the
  brain.
• Attention is often impaired.
• Damage from moderate oxygen deprivation.
• Ex. Concussion
• Focal Damage
• Damage to one area of the brain.
• Can cause different problems depending on what
  part of the brain is affected.
• Damage from an injury or stroke.

5
(No Transcript)
6
Diffuse Versus Focal Damage

• Some consequences of brain disorders that have
  mainly focal origins but commonly appear in the
  context of progressively diffuse damage are as
  follows
• Impairment of memory
• Impairment of orientation
• Impairment of learning,
• comprehension, and judgment
• Impairment of emotional control or
• modulation

7
Diffuse Versus Focal Damage

• Some consequences of brain disorders that have
  mainly focal origins but commonly appear in the
  context of progressively diffuse damage are as
  follows
• Apathy or emotional blunting
• Impairment in the initiation of behavior
• Impairment of controls over matters of propriety
  and ethical conduct
• Impairment of receptive and expressive
  communication
• Impaired visuospatial ability

8
Diffuse Versus Focal Damage

• There appears to be a close link between
  neuropsychological and psychopathological
  conditions.
• It is erroneous to assume that a psychological
  disorder is necessarily and completely explained
  by the patients brain damage.

9
Delirium

• Commonly occurring syndrome.
• Acute confusional state that lies between normal
  wakefulness and stupor or coma.
• Has a sudden onset and involves a fluctuating
  state of reduced awareness.
• Reflects a major change in the way the brain is
  working.
• Can occur in a person of any age, though the
  elderly are at particularly high risk.

10
Delirium

• May result from several conditions
• Head injury
• Infection
• Is most commonly caused by
• Drug intoxication
• Withdrawal
• Is a true medical emergency.
• Is often reversible.
• Is most often treated by
• Medications
• Environmental manipulations
• Family support

11
Dementia

• Is not a rapidly fluctuating condition.
• Is characterized by a decline from a previously
  attained level of functioning.
• Has a slow onset and a deteriorating course.
• Can be caused by over 50 different disorders.
• Is most commonly caused by Alzheimers disease.

12
Alzheimeizers Disease

• Alzheimers disease is associated with a
  characteristic dementia syndrome that has
• A very gradual and subtle onset.
• A usually slow but progressively deteriorating
  course terminating in delirium and death.

13
Alzheimeizers Disease

• Age is a major risk factor.
• Genes play a major role in susceptibility.
• Genetic mutations of genes
• APP
• Presenilin 1
• Presenilin 2
• Presentation of
• APOE-4 allele of the APOE gene

14
Alzheimeizers Disease

• The characteristic neuropathology
• Cell loss
• Plaques
• Which contain a sticky protein called beta
  amyloid.
• Neurofibrillary tangles
• Which contain an abnormal tau protein.

15
Alzheimeizers Disease

• Causes the destruction of cells that make
  aceytlcholine.
• Neurotransmitter important for memory.
• Drug treatments include
• Cholinesterase inhibitors
• Donepezil
• These drugs help stop ACh from being broken down.
• Making more of it available to the brain.

16
Alzheimeizers Disease

• Any comprehensive approach to therapeutic
  intervention must consider
• Situation of caregivers.

17
Dementia from HIV-1 Infection

• The HIV-1 virus (or a mutant form of it) can
  itself result in the destruction of brain cells.
• Neuropsychological features include
• Mild memory difficulties
• Psychomotor slowing
• Diminished attention and concentration
• Somewhere between 30 and 60 of untreated
  patients with HIV/AIDS will develop AIDS-related
  dementia.

18
Vascular Dementia

• Series of circumscribed cerebral infarcts
  cumulatively destroy neurons over expanding brain
  regions.
• Basically Blockages in the brains blood supply.

19
Amnestic Syndrome

• Characteristic feature
• Strikingly disturbed memory.
• Causes of amnestic syndrome include
• Chronic alcohol use
• Head trauma
• Stroke
• A wide range of techniques have been developed to
  assist the good-prognosis amnestic patient in
  remembering recent events.

20
Head Injuries

• Head injuries can cause
• Retrograde amnesia
• Anterograde amnesia
• Personality changes
• Prompt treatment of brain injury may prevent
  further damage.