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Cognitive Disorders
Cognitive Disorders: Behavioral disturbances that result from transient or permanent damage to the brain. Affect thinking processes, memory, perception, consciousness, etc. caused by brain dysfunction DSM-IV-TR categories: Dementia Delirium Amnestic Disorders Cognitive Disorders Not Otherwise Specified
Cognitive Disorders
Diagnosis is often a process of elimination Possible causes: Aging, trauma, infection, loss of blood supply, substance abuse, and biochemical imbalance. Cognitive, emotional, and behavioral symptoms Prevalence: ~1% for severe disorders, 6% for mild disorders Severe impairment: At age 75, the rate is 22 times that of persons 18-34 Rate is higher for African Americans than for white or Hispanic Americans.
Cognitive Disorders The Assessment of Brain Damage Psychological tests and inventories assess behavioral responses and functions such as memory and manual dexterity. Neurological tests permit direct monitoring of brain functioning and structure. Electroencephalograph (EEG) Computerized axial tomography (CAT) scan Cerebral blood flow measurement Positron emission tomography (PET) scan
Cognitive Disorders The Assessment of Brain Damage Neurological tests: Magnetic resonance imaging (MRI): Produces snapshots of brain anatomy With patient in magnetic field, radio waves are used to produce pictures of the brain without bone obstruction. fMRI produces dynamic pictures
Cognitive Disorders The Assessment of Brain Damage Neurological tests: Each technique has strengths and weaknesses in costs, benefits, and possible side effects. CAT scan is less expensive and faster than MRI MRI does not use X-rays and is better at detecting neoplasms, brain abnormalities related to seizures, and certain lesions.
Cognitive Disorders The Assessment of Brain Damage Initial screening/assessment: Mental status examination Specific interview questions about general functioning, personality characteristics, and coping skills, changes in behavior.
Cognitive Disorders Localization of Brain Damage Overlap of functions complicates assessment. There is no 1:1 correspondence for specific physical areas related to specific psychological functions from brain to brain. Diaschisis: A lesion in a specific area of the brain disrupts other intact areas, sometimes in the other hemisphere.
Cognitive Disorders Localization of Brain Damage Recovery of function: Redundancy (unused portions of the brain take up functions of damaged areas). Plasticity: Undeveloped portions of the brain substitute for damaged portions. Plasticity and compensatory reorganization may improve functioning in one area at the expense of another function.
Cognitive Disorders The Dimensions of Brain Damage Brain damage is evaluated on a continuum: Mild to moderate to severe Endogenous versus exogenous causes Diffuse versus specific damage Acute versus chronic conditions
Dementia: Associated disorders: Alzheimers, vascular disease, normal pressure hydrocephalus, alcoholism, intracranial masses, and Huntingtons disease
FoxNews.com 9-5-07
Thomas E. Witte/NewSport/CORBIS
Vascular dementia Occasional loss due to normal aging process (not indicative of dementia) Medications
Aging and Disorders Associated with Aging Alzheimers Disease Alzheimers Disease: Dementia in which brain tissue atrophies, leading to marked deterioration of intellectual and emotional functioning. Accounts for 80% of dementia in the elderly Prevalence: 8-15% for people older than 65 Early symptoms: Memory dysfunction, irritability, cognitive impairment Later symptoms: Social withdrawal, depression, apathy, delusions, impulsive behaviors, neglect of personal hygiene
Cognitive Disorders Treatment Considerations Major interventions: Surgical, medical, psychological, and environmental. Comprehensive: Medication, rehabilitation, therapy, and environmental modifications. Surgical: Remove tumors, relieve pressure caused by tumors, restore ruptured blood vessels. Psychotherapy: Help patients deal with emotional aspects of the disorders.
Cognitive Disorders Treatment Considerations Environmental interventions: Modify patients environment to preserve sense of independence and control. Continued social contacts Diversions Tasks to provide sense of contributing Caregiver support: Education about disease and proper care Social support