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0. Chapter 15 Cognitive Disorders. 0. 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 - PowerPoint PPT Presentation
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Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark DurandChapter 15: Cognitive Disorders
Chapter 15
Cognitive Disorders
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark DurandChapter 15: Cognitive Disorders
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark DurandChapter 15: Cognitive Disorders
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark DurandChapter 15: Cognitive Disorders
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark DurandChapter 15: Cognitive Disorders
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark DurandChapter 15: Cognitive Disorders
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark DurandChapter 15: Cognitive Disorders
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark DurandChapter 15: Cognitive Disorders
Dementia: Facts and Statistics
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
Alzheimer’s 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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark DurandChapter 15: Cognitive Disorders
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark DurandChapter 15: Cognitive Disorders
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark DurandChapter 15: Cognitive Disorders
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark DurandChapter 15: Cognitive Disorders
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)
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark DurandChapter 15: Cognitive Disorders
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark DurandChapter 15: Cognitive Disorders
Dementia Related to HumanImmunodeficiency 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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark DurandChapter 15: Cognitive Disorders
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark DurandChapter 15: Cognitive Disorders
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark DurandChapter 15: Cognitive Disorders
Other Dementias: Creutzfeldt-Jakob Diseaseand 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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark DurandChapter 15: Cognitive Disorders
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark DurandChapter 15: Cognitive Disorders
Causes of Dementia: The Example ofAlzheimer’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
onset Alzheimer’s
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark DurandChapter 15: Cognitive Disorders
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark DurandChapter 15: Cognitive Disorders
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark DurandChapter 15: Cognitive Disorders
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark DurandChapter 15: Cognitive Disorders
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark DurandChapter 15: Cognitive Disorders
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark DurandChapter 15: 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