Chapter 15 Cognitive Disorders

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Chapter 15Cognitive Disorders
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Nature of Cognitive Disorders An Overview
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• 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

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Delirium An Overview
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• 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

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Medical Conditions Related to Delirium
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• 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

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Treatment and Prevention of Delirium
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• 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

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Dementia An Overview
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• 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

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Dementia An Overview (cont.)
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• 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

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Dementia Facts and Statistics
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• 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 Alzheimers 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

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DSM-IV and DSM-IV-TR Classes of Dementia
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• Dementia of the Alzheimers type
• Vascular Dementia
• Dementia Due to Other General Medical Conditions
• Substance-Induced Persisting Dementia
• Dementia Due to Multiple Etiologies
• Dementia Not Otherwise Specified

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Dementia of the Alzheimers Type An Overview
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• 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

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Dementia of the Alzheimers Type An Overview
(cont.)
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• 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

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Alzheimers Disease Some Facts and Statistics
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• 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 Alzheimers 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)

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Vascular Dementia An Overview
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• Nature of Vascular Dementia
• Progressive brain disorder caused by blockage or
  damage to blood vessels
• Second leading cause of dementia next to
  Alzheimers
• 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 Alzheimers, obvious neurological signs of
  brain tissue damage occur
• Incidence is believed to be about 4.7 of men and
  3.8 of women

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Dementia Related to HumanImmunodeficiency
Virus-Type 1 (HIV-1)
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• 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

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Other Causes of DementiaHead Trauma and
Parkinsons Disease
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• Head Trauma
• Accidents are leading causes of such cognitive
  impairments
• Memory loss is the most common symptom
• Parkinsons 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

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Other Causes of DementiaHuntingtons and Picks
Disease
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• Huntingtons 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
• Picks Disease
• Rare neurological condition that produces a
  cortical dementia like Alzheimers
• Also occurs later in life (around 40s or 50s)
• Little is known about what causes this disease

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Other Dementias Creutzfeldt-Jakob Diseaseand
Substance-Induced Dementia
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• 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 Alzheimers
• Deficits may include aphasia, apraxia, agnosia,
  or disturbed executive functioning

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

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

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The Contributions of Psychosocial Factors in
Dementia
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• 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

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Medical and Psychosocial Treatment of Dementia
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• 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

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Prevention of Dementia
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• Reducing Risk of Dementia in Older Adults Via
• Estrogen-replacement therapy Reduces risk of
  Alzheimers 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

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Amnestic Disorder An Overview
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• 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

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Amnestic Disorder An Overview (cont.)
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• 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

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Summary of Cognitive Disorders
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• 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