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7/29/2019 Chapter 14 Cognitive Disorders
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Cognitive Disorders
Chapter 14
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Cognitive Disorders
Cognitive Disorders: Behavioral disturbances that
result from transient or permanent damage to the
brain.
Affect thinking processes, memory, perception,consciousness, etc. caused by brain dysfunction
DSM-IV-TR categories:
Dementia
Delirium
Amnestic Disorders
Cognitive Disorders Not Otherwise Specified
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Cognitive Disorders
Diagnosis is often a process of elimination
Possible causes: Aging, trauma, infection, loss ofblood supply, substance abuse, and biochemical
imbalance.Cognitive, emotional, and behavioral symptoms
Prevalence: ~1% for severe disorders, 6% for milddisorders
Severe impairment: At age 75, the rate is 22 timesthat of persons 18-34
Rate is higher for African Americans than for whiteor Hispanic Americans.
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Prevalence of Cognitive Impairment by
Demographic Characteristics
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Cognitive Disorders
The Assessment of Brain Damage
Psychological tests and inventories assess
behavioral responses and functions such as
memory and manual dexterity.
Neurological tests permit direct monitoring of
brain functioning and structure.
Electroencephalograph (EEG)
Computerized axial tomography (CAT) scan
Cerebral blood flow measurement
Positron emission tomography (PET) scan
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Cognitive Disorders
The Assessment of Brain Damage
Neurological tests:
Magnetic resonance imaging (MRI):
Produces snapshots of brain anatomyWith patient in magnetic field, radio waves
are used to produce pictures of the brain
without bone obstruction. fMRI produces dynamic pictures
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Cognitive Disorders
The Assessment of Brain Damage
Neurological tests:
Each technique has strengths and
weaknesses in costs, benefits, and possible
side effects.
CAT scan is less expensive and faster
than MRI
MRI does not use X-rays and is better at
detecting neoplasms, brain abnormalities
related to seizures, and certain lesions.
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Cognitive Disorders
The Assessment of Brain Damage
Initial screening/assessment:
Mental status examination
Specific interview questions about generalfunctioning, personality characteristics, and
coping skills, changes in behavior.
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Cognitive Disorders
Localization of Brain Damage
Overlap of functions complicates assessment.
There is no 1:1 correspondence for specific
physical areas related to specific psychological
functions from brain to brain.
Diaschisis: A lesion in a specific area of the
brain disrupts other intact areas, sometimes in
the other hemisphere.
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Cognitive Disorders
Localization of Brain Damage
Recovery of function:
Redundancy (unused portions of the brain
take up functions of damaged areas).
Plasticity: Undeveloped portions of the brain
substitute for damaged portions.
Plasticity and compensatory reorganizationmay improve functioning in one area at the
expense of another function.
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The Major Areas of the Brain
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Brain Areas and the Functions They Control
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Cognitive Disorders
The Dimensions of Brain Damage
Brain damage is evaluated on a continuum:
Mild to moderate to severe
Endogenous versus exogenous causes
Diffuse versus specific damage
Acute versus chronic conditions
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Cognitive Disorders
Diagnostic Problems
Overlap with symptoms of psychological disorders:
Depression: Neuropsychological tests show similar
characteristics.
Tests may not show clear distinction betweencognitive disorders and schizophrenia.
If a general medical condition and mood disorder
are related, diagnosis may be mood disorder due togeneral medical condition
Impairment may show up where none exists if there
is a monetary motive (e.g., lawsuit).
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Cognitive Disorders
Diagnostic Problems
Are symptoms due to CNS damage or some othercausal agent (e.g., a toxin)?
A person with brain damage may be diagnosed as
having a psychological disorder.Age-related misdiagnosis may be due to reduced
sensory acuity, performance anxiety, fatigue, failure tounderstand test instructions, or lack of agreement
between different measures of cognitive functioningElderly may score poorly on Halstead-Reitan
Neuropsychological Test Battery but well on WAISand daily functioning.
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Types of Cognitive Disorders
Dementia: Syndrome characterized by memoryimpairment and cognitive disturbances, suchas:
Aphasia: (Language disturbance)Apraxia: Inability to carry out motor activities
despite comprehension and motor function
Agnosia: Failure to recognize/identify objectsdespites intact sensory function
Thought disturbances: Planning andabstraction
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Types of Cognitive Disorders
Dementia:
Causes may include general medical conditions,
substance use, multiple etiologies, and other
causes not specified.Prevalence:
1.5 million Americans have severe dementia, 1-5
million have mild-moderate forms5-7% over age 65; greater than 20% over age 85
2-4% have Alzheimers
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Types of Cognitive Disorders
Dementia:
Associated disorders:
Alzheimers, vasculardisease, normal
pressure
hydrocephalus,
alcoholism,
intracranial masses,
and Huntingtons
disease
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Types of Cognitive Disorders
Delirium:
Disturbance of consciousness and changes incognition, (e.g., memory deficit, disorientation,
language and perceptual disturbances).Rapid development over hours or days
10% of persons over age 65 hospitalized forgeneral medical conditions exhibit delirium
At-risk groups: The elderly and patients recoveringfrom surgery, having preexisting brain dysfunction,in drug withdrawal, with AIDS, and high illnessburden.
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Types of Cognitive Disorders
Delirium Tremens: Occurs with alcohol
withdrawal.
Disorientation (self, place, time)
Vivid hallucinations, intense fear
Extreme suggestibility
Tremor in hands, tongue, lipsRapid HR, fever, foul breath
Death as high as 35%, but rare if treated with
drugs like chlordiazapoxide
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Types of Cognitive Disorders
Amnestic Disorders: Characterized by memory
impairment as manifested by inability to learn
new information and inability to recall previously
learned knowledge or past events.
Results from insult to central nervous
system:
Head trauma, stroke, Wernickes
encephalopathy (alcohol-induced organic
mental disorder involving thiamine
deficiency).
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Types of Cognitive Disorders
Cognitive Disorders Not-Otherwise-Specified:
Cognitive disorders that do not meet the criteria
for dementia, delirium, or amnestic disorder.
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Etiology of Cognitive Disorders
Brain Trauma: Physical wound or injury to the
brain.
Concussion: Mild brain injury, typically
caused by a blow to the head.
Contusion: The brain is forced to shift slightly
and press against the side of the skull.
Laceration: Brain tissue is torn, pierced, or
ruptured.
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Etiology of Cognitive Disorders
Thomas E. Witte/NewSport/CORBIS
ATLANTA
PRO WRESTLER CHRIS BENOITSUFFERED BRAIN DAMAGE FROM HIS YEARS IN
THE RING THAT COULD HELP EXPLAIN WHY HE
KILLED HIS WIFE, SON AND HIMSELF, A DOCTOR
WHO STUDIED BENOIT'S BRAIN SAID WEDNESDAY.
THE ANALYSIS BY DOCTORS AFFILIATED WITH THE
SPORTS LEGACY INSTITUTE SUGGESTS
REPEATED CONCUSSIONS COULD HAVECONTRIBUTED TO THE KILLINGS AT BENOIT'S
SUBURBAN ATLANTA HOME.
FoxNews.com 9-5-07
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Aging and Disorders Associated with Aging
Cerebrovascular Accident (stroke): Sudden
stoppage of blood flow to a portion of thebrain, leading to loss of brain function.
Causes: burst blood vessels (25%),
narrowing of blood vessels
(atherosclerosis), or blocked blood
vessels.
Cerebral Infarction: death of brain tissue
from decreased supply of blood to tissue. Vascular Dementia: Uneven deterioration of
intellectual abilities resulting from several
cerebral infarctions.
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Aging and Disorders Associated with Aging
Memory loss in older people:
Alzheimer's
Brain cell deterioration, which may be mitigated in
cognitively active persons
People that remain cognitively tend to remain
relatively free of dementia and Alzheimers
Vascular dementiaOccasional loss due to normal aging process (not
indicative of dementia)
Medications
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Aging and Disorders Associated with Aging
Fluid abilities decline with age (novel problems,
creativity); acquired knowledge remains stable
75% of elderly retain sharp mental functioning, 10-
15% have mild-moderate memory loss.
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Aging and Disorders Associated with Aging
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Aging and Disorders Associated with Aging
Cross-Sectionalmethod suggestsdecline
Longitudinal
method suggestsmore stability
Aging and Disorders Associated with Aging
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Aging and Disorders Associated with Aging
Alzheimers Disease
Alzheimers Disease: Dementia in which braintissue atrophies, leading to markeddeterioration of intellectual and emotional
functioning.Accounts for 80% of dementia in the elderly
Prevalence: 8-15% for people older than 65
Early symptoms: Memory dysfunction,irritability, cognitive impairment
Later symptoms: Social withdrawal,depression, apathy, delusions, impulsivebehaviors, neglect of personal hygiene
Aging and Disorders Associated with Aging
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Aging and Disorders Associated with Aging
Alzheimers Disease
Death usually occurs within 5 years of onset; 4th
leading cause of death in the U.S.
Atrophy of cortical tissue in the brain:
Neurofibrillary Tangles: Abnormal fibers that appearto be tangles of brain tissue filaments.
Senile Plaques: Patches of degenerated nerve
endings.
Aging and Disorders Associated with Aging
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Aging and Disorders Associated with Aging
Alzheimers Disease
Etiology: Unknown (hereditary or environmental
factors)
Explanations: Reduced ACTH, repeated head
injuries, infections and viruses, decreased cerebralblood flow, plaques and tangles (chromosome 21),
aluminum, genetic anomalies
Protective factors to delay onset: Genetic
endowment with ApoE-e2 allele, higher
education/occupation, NSAIDs, estrogen
replacement therapy, vitamin E
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Other Diseases and Conditions of the Brain
Parkinsons Disease: Progressively worseningdisorder with muscle tremors, stiff, shufflinggait, lack of facial expression, social withdrawal,
possibly dementia and depressionPrevalence: 0.1%, 1-2% over the age of 65
Causes: brain infection, cerebrovascular
disorders, brain trauma, carbon monoxidepoisoning, genetic predisposition, otherunknown causes
Associated with lesions in the motor area of
brainstem and lower dopamine levels
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Other Diseases and Conditions of the Brain
AIDS (Acquired Immunodeficiency Syndrome)
Dementia may be due to: AIDS virus
reaching the brain, compromised immune
functioning, effects of knowing one has AIDS,
medications
Neurosyphilis (general paresis): Spirochete
Treponema pallidum
Encephalitis (sleeping sickness): Brain
inflammation caused by viral infection.
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Other Diseases and Conditions of the Brain
Meningitis: Inflammation of meninges
(membrane surrounding the brain and spinal
cord)
Bacterial, viral, and fungal
Huntingtons Disease: Genetically transmitted
degenerative disease; involuntary twitching
movements and eventual dementia and death.
50% of offspring of affected person develop it
Prevalence: 5-7 per 100,000 population
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Other Diseases and Conditions of the Brain
Cerebral Tumors: Mass of abnormal tissue growing
within the brain causing disturbances of
consciousness, mild dementia, problems of thinking,
mood changes. Epilepsy: Intermittent/brief periods of altered
consciousness often accompanied by seizures or
excessive electrical discharge from brain cells.
1-2% of U.S. population has seizures at some point
in their lives
Use of psychoactive substances
Cognitive Disorders
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Cognitive Disorders
Treatment Considerations
Major interventions: Surgical, medical,
psychological, and environmental.
Comprehensive: Medication, rehabilitation,
therapy, and environmental modifications.
Surgical: Remove tumors, relieve pressure
caused by tumors, restore ruptured blood
vessels.
Psychotherapy: Help patients deal with
emotional aspects of the disorders.
Cognitive Disorders
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Cognitive Disorders
Treatment Considerations
Medication: Prevent, control, reduce symptoms; also
control accompanying emotional problems.
Side effects: Decrease in speed of motor
responding; tremors; weight gain; swollen gumsAlzheimers: Acetylcholinesterase inhibitors; anti-
inflammatory medications reduce risk.
Current treatment goals: Delay onset of symptoms,
slow progression, improve symptoms, reduce
morbidity, modify risk factors, prevent disease.
Cognitive Disorders
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Cognitive Disorders
Treatment Considerations
Environmental interventions:
Modify patients environment to preserve
sense of independence and control.
Continued social contacts
Diversions
Tasks to provide sense of contributing
Caregiver support:
Education about disease and proper care