Chapter 15 Cognitive Disorders

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark DurandChapter 15: Cognitive Disorders

Chapter 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


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


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


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


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


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


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


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


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


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


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)


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


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


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


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


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


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


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


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


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


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


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


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


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

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Chapter 15 Cognitive Disorders