Cognitive Disorders

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Cognitive Disorders

• 2.27.2007

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Delirium

• A. Disturbance of consciousness
• B. Change in cognition
• C. Disturbance develops over a short period of
  time (hours to days) and tends to fluctuate over
  the course of the day
• D. Evidence that the disturbance is caused by the
  direct physiological consequences of a GMC,
  substance, or both

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Facts about Delirium

• Prevalence
• Gender Males might be at higher risk

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Facts about Delirium

• Age of onset
• Course

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Causes of Delirium

• Psychoactive substances of abuse
• Medications other than above
• Infection, especially in the brain
• Toxins
• Surgery
• Head injury
• Shock

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Dementia

• Development of multiple cognitive deficits
  manifested by both
• Memory impairment
• (Retrograde or Anterograde)
• One or more of the following cognitive
  disturbances
• (Aphasia, Apraxia, Agnosia, or Disturbance in
  executive functioning)
• Cognitive deficits cause significant impairment
  in functioning and represent a significant
  decline from a previous level of functioning

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Facts about Dementia

• Prevalence
• Gender
• Age of onset
• Course

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Causes of Dementia

• Alzheimers (Cause of 70 of dementias)
• Vascular lesions in the brain (reduces blood flow
  to the brain)
• HIV
• Head trauma
• Parkinsons Disease
• Huntingtons Disease
• Picks Disease
• Creutzfeldt-Jakob Disease

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Alzheimers Disease Forms

• Early Onset develops prior to age 60
• Late Onset develops at age 60 or later
• Risk for developing Alzheimers increases with
  age

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Alzheimers Disease Pathology

• Neuropathology
• Plaques, neurofibrillary tangles of tau protein
• Plaques of amyloid and protein
• Research in mice also implicate excessive iron in
  the brain
• Small holes in neural tissue (granulovacuoles)
• Atrophy (wasting away) of the brain
• Firm diagnosis is only possible after death, at
  autopsy

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Alzheimers Disease Genetics

• All Down syndrome kids get Dementia of
  Alzheimers type
• Down syndrome due to trisomy on Chromosome 21
• Chromosome 21 is also linked to early onset form
  of Alzheimers Disease
• Production of the amyloid protein is linked to
  Chromosome 21
• However, we dont know if the amyloid tangles are
  the cause of Alzheimers Disease or an additional
  symptom of the real causethus, we still dont
  know if Chromosome 21 has a causal role in
  Alzheimers

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Alzheimers Disease Treatment

• No effective treatment exists to restore lost
  functioning
• Behavioral therapy works to control wandering,
  incontinence, inappropriate sexual behavior, and
  poor self-care behaviors
• Drugs that enhance the availability of the
  neurotransmitter acetylcholine
• Trying to pursue medications or vaccines that
  will clear away the tangles and plaques

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Alzheimers Disease Caregivers

• Caregivers of Alzheimers patients must deal with
  the social death of the patient even before the
  actual physical death
• Financial burden
• Chronic stress
• High risk for depression

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Vascular Dementia

• Second most common cause of dementia (19 of
  cases), more common in men
• Damage caused to specific areas of the brain
• Stroke interruption of blood flow to the brain,
  results in lack of oxygen to parts of the brain,
  which may die
• Aneurism rupture of blood vessels in the brain,
  blood floods the brain, pushing blood against the
  skull, crushing cells and killing parts of the
  brain
• Abrupt, sudden onset of symptoms with fast
  decline
• May be normal functioning in parts of brain not
  affected

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Dementia due to HIV

• Researchers found that HIV could result in the
  destruction of brain cells
• Causes generalized atrophy, edema (swelling),
  inflammation, and patches of demyelination
• May lead to psychotic phenomena as well
• 30-60 of untreated AIDS/HIV patients will
  develop dementia
• Only 20 of AIDS/HIV patients who receive
  antiviral treatment develop dementia

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Huntingtons Disease

• Inherited disease caused by an autosomal dominant
  gene
• 100 determined by your genes (i.e. if you have
  the genes for it, you will develop Huntingtons
  Disease)
• Age of onset approximately 35 45
• Progressive deterioration of motor skills,
  personality, cognitive functions (dementia), and
  mood
• Results in death within 10-20 years of developing
  symptoms

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Parkinsons Disease

• Slowly progressive neurological disorder
• More common in men
• Age of onset is typically between ages 50-70,
  although Michael J. Fox developed symptoms at age
  30
• Causes rigidity, tremors, lack of balance,
  diminished small motor control, and difficulties
  communicating
• Caused by both genetic and environmental factors
• 20-60 of cases result in dementia