Cognitive Disorders

2. Cognitive Disorders Chapter 13

3. Nature of Cognitive Disorders: An Overview • Perspectives on Cognitive Disorders • Cognitive processes such as learning, memory, and consciousness are impaired • 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

5. 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

6. 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, isolation, 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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)

14. 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

15. Causes of Dementia: The Example of Alzheimer’s Disease • 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 • Multiple genetic abnormalities implicated in Alzheimer’s

16. 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 • Depression common • Family support may be crucial