Cognitive Disorders

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Cognitive Disorders

• I. Nature of Cognitive Disorders

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Definition

• Cognitive disorders disorders in which the
  central feature is the impairment of memory,
  attention, perception, and thinking.

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A. DSM History

• Used to be called organic disorders
• Denoted dysfunction of the brain
• Not very descriptive
• DSM-IV uses cognitive
• Better reflects nature of problems

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B. Assessment

• Mental Status Exam brief interview used to
  assess cognitive disorders
• 5 major components
• Appearance and behavior
• Mood and affect
• Thought
• Perception
• Sensorium and Intellect
• Sensorium consciousness and awareness of
  surroundings

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Cognitive Disorders

• II. Types of Cognitive Disorders

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A. Delirium

• Features
• Key feature is disturbed consciousness
• Associated features include
• Clouded sensorium no clear awareness of
  surroundings
• Problems with attention
• Disturbance in memory
• Incoherent speech
• Perceptual disturbances (e.g., hallucinations)

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A. Delirium (cont.)

• Statistics and course
• Acute onset (within hours or days) and transient
  course (days to a few weeks)
• No life-long delirium
• Can be superimposed on another disorder (e.g.,
  dementia)

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2. Statistics and course (cont.)

• Tends to occur more in certain people
• Elderly
• Medically ill (e.g., cancer AIDS)
• Dementia

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A. Delirium (cont.)

• Causes
• Drugs intoxication, withdrawal, poison
• Delirium tremens tremors and vivid
  hallucinations of vermin associated with alcohol
  withdrawal
• Medications
• Infection
• Head injury
• Various kinds of brain trauma (e.g., stroke)

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A. Delirium (cont.)

• Treatment
• Attending to precipitating problem
• Treating medical condition counteracting effects
  of substance withdrawal using antipsychotic meds
• Prevention is most successful
• Recognizing people at risk and paying special
  attention to those cases to avoid delirium

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B. Dementia

• Features
• Key feature is gradual impairment of multiple
  cognitive abilities including memory, language,
  and judgment
• With impaired social/occupational functioning
• Often see global cognitive impairment ability
  to solve novel problems goes first, then
  overlearned abilities (e.g., vocabulary)
• First signs personality change and memory loss

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B. Dementia (cont.)

• Statistics and course
• Incidence is highest in older adults, but can
  onset at almost any age
• Not accurate to give one prevalence rate, because
  it differs by age group
• 65-74 1.29
• 75-84 3.83
• 85 10.14

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2. Statistics and course (cont.)

• Incidence is the same for males and females
• Onset varies by type of dementia
• e.g., Alzheimers vs. vascular dementia
• People over age 75 at increased risk for dementia

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B. Dementia (cont.)

• Example Alzheimers Disease
• DSM-IV Criteria (p. 526)
• Development of multiple cognitive deficits
  manifested by both
• Memory impairment
• One (or more) of the following
• Aphasia
• Apraxia
• Agnosia
• Disturbance in executive functioning

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DSM-IV criteria (cont.)

• B. Significant impairment and decline
• C. Gradual onset and continuing decline
• - Rule out other dementias and mental disorders
  (e.g., Sz)

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3. Alzheimers (cont.)

• Onset usually in 60s or 70s
• Early signs in 40s and 50s (presenile dementia)
• Definitive diagnosis can only be made on autopsy
  where histopathology confirmed
• Gross atrophy of the brain
• Neurofibrillary tangles
• Senile plaques

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B. Dementia (cont.)

• Causes of dementia
• Direct cause linked to type of dementia
• Plaques and tangles ? Alzheimers
• Blocked artery ? vascular dementia
• Genetic factors linked to some dementias
• Multiple genes ? Alzheimers risk
• Single dominant gene ? Huntingtons disease
• Head trauma is a risk factor (e.g., boxers
  dementia)

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4. Causes (cont.)

• Vascular dementia can be influenced by diet as
  well as genetic factors (link to heart disease)
• Psychosocial factors
• Higher education level is associated with lower
  dementia risk
• Social resources and family support can improve
  life for patients with dementia

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B. Dementia (cont.)

• Treatment of dementia
• Limited some drugs can improve cognitive
  functioning, but only temporary
• Psychological treatments
• Memory wallet
• Memory skills training
• Teach to use navigational cues to avoid getting
  lost

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Summary

• Cognitive disorders involve an impairment of
  memory, attention, perception, and thinking that
  represents a change from previous functioning
• Delirium short-lived treat precipitating
  factor (e.g., substance withdrawal) or prevent
• Dementia gradual, continual decline (e.g.,
  Alzheimers)
• Dementia treatments are limited help with memory
  skills