Chapter 11

1. Chapter 11 Cognitive Disorders and Life-Span Issues

2. Symptoms of Dementia • Memory impairment • Aphasia (language disturbance) • Aprixia (inability to carry out motor activities despite intact motor function) • Agnosia (failure to recognize or identify objects despite intact sensory functioning) • Disturbance in executive functioning • Changes in emotional and personality functioning

3. DSM-IV-TR Diagnostic Criteria for Dementia

4. DSM-5 Considerations of Dementia • Various forms of dementia are likely to be subsumed under one overarching category of major neurocognitive disorder. • This disorder would be characterized by evidence of significant cognitive decline from a previous level of performance that is sufficient to interfere with independence. • A diagnosis of minor neurocognitive disorder would apply to individuals with less severe cognitive decline, who might be in the early stages of what will eventually develop into a major neurocognitive disorder.

5. Types of Dementia • Alzheimer’s disease • Vascular disease (blockage of blood to the brain, commonly referred to as a stroke) • Head injury • Progressive diseases (e.g., Parkinson’s disease and HIV disease) • Chronic drug abuse

6. Dementia of the Alzheimer’s Type • Usually begins after the age of 65, but there is an early-onset type of Alzheimer’s disease • Typically begins with mild memory loss • As the disease progresses, the memory loss and disorientation become profound • About two-thirds show psychiatric symptoms, including agitation, irritability, apathy, and dysphoria • As the disease worsens, people may become violent and experience hallucinations and delusions • On average, people die within 8 to 10 years

7. BRAIN ABNORMALITIES IN ALZHEIMER’S DISEASE

8. Brain Map

11. Vascular Dementia

12. Dementia Associated with Other Medical Conditions

13. Treatments for Dementia • Medications • Cholinesterase inhibitors (e.g., Aricept), which help prevent the breakdown of the neurotransmitter acetylcholine • Other drugs regulate the activity of glutamate (e.g., Namenda) • In some cases, drugs do not work for all patients and have only temporary effects • Behavior therapies

14. Prevention of Dementia • Aerobic exercise and mental activity may have some protective value • Reducing the risk factors for stroke, for example, avoiding smoking, obesity, and hypertension, may reduce the risk for vascular dementia • Nun study: Demonstrated a link between intellectual activity beginning early in life and reduced risk of Alzheimer’s disease

15. Delirium

16. Causes of Delirum • Dementia • Many medical disorders, including stroke, congestive heart failure, an infectious disease, a high fever, or HIV infection • Intoxication with illicit drugs and withdrawal from these drugs or prescription medications • Fluid and electrolyte imbalances • Toxic substances

17. Amnesia • Unlike dementia and delirium, in amnesic disorders only memory is affected • Anterograde amnesia—impaired in the ability to learn new information • Retrograde amnesia—impaired in the ability to recall previously learned information

18. Mental Disorders in Later Life • Anxiety Disorders • Depression • Substance Use Disorders

19. Integrated Biopsychosocial Model