1. Chapter 15 Cognitive Disorders
Chapter 15 Cognitive Disorders

2. Nature of Cognitive Disorders: An Overview
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. Delirium: An Overview Nature of Delirium
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. Medical Conditions Related to Delirium
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. Treatment and Prevention of Delirium
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. Dementia: An Overview Nature of Dementia
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. Dementia: An Overview (cont.)
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. Dementia: Facts and Statistics
Dementia: Facts and Statistics
Onset and Prevalence
Can occur at any age, but most common in the elderly
Affects 1% of those between 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 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. DSM-IV and DSM-IV-TR Classes of Dementia
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. Dementia of the Alzheimer’s Type: An Overview
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. Dementia of the Alzheimer’s Type: An Overview (cont.)
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. Alzheimer’s Disease: Some Facts and Statistics
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. Vascular Dementia: An Overview
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. Dementia Related to Human Immunodeficiency Virus-Type 1 (HIV-1)
Dementia Related to Human Immunodeficiency 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. Other Causes of Dementia: Head Trauma and Parkinson’s Disease
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. Other Causes of Dementia: Huntington’s and Pick’s Disease
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. Other Dementias: Creutzfeldt-Jakob Disease and 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. Causes of Dementia: The Example of Alzheimer’s Disease
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. Causes of Dementia: The Example of Alzheimer’s Disease (cont.)
Causes of Dementia: The Example of Alzheimer’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

20. The Contributions of Psychosocial Factors in Dementia
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. Medical and Psychosocial Treatment of Dementia
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. Prevention of Dementia
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. Amnestic Disorder: An Overview
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. Amnestic Disorder: An Overview (cont.)
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. Summary of Cognitive Disorders
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