Chapter 15 - Cognitive Disorders

I. Delirium

• Acute, temporary impairment

in perception & cognition

• Fluctuating course

Symptoms

1.Disturbance in consciousness

- perseveration

- emotional changes

- hallucinations & paranoid delusions

Capgras syndrome

2. Change in cognition

- ST memory

3. Lasts short period of time

4. Caused by a general medical condition

OR substance intoxication/withdrawal

OR multiple etiologies

To diagnose

- Mental Status Exam

Treatment

- antipsychotics

- treat general medical condition

- time

- reassurance

II.Dementia- gradual deterioration in perception & cognition

Description - multiple cognitive deficits1. Memory impairment

- trouble learning new information(Anterograde amnesia)

- trouble recalling known information(Retrograde amnesia)

2. At least one of:

aphasia (impaired language)

apraxia (impaired movement)

agnosia (can’t name/recognize objects)

disturbance in executive functioning

3. Social/occupational impairment

4. Decline from previous functioning

Types of dementias

Alzheimer’s

• Brain atrophy

• Tangles & plaques

• Only diagnosed by autopsy

• Many mimicking conditions

• Slightly more in women

Vascular dementia• Brain damage (blocked/damaged blood vessels)• Dx: neurological exam, CT/MRI• Many strokes• Onset typically abrupt• Stepwise but fluctuating course• Rapid change in fx• Individual variability• Men

Parkinson’s disease

• Slow, progressive deterioration

• Psychomotor: tremors, rigidity, instability

• Dementia present in 20-60%

• Decreased DA

Huntington’s disease• Progressive impairment in cognition, emotion,

movement• Single dominant gene• Dx usually in 40s• Onset: insidious personality change• Movement: fidgeting (“chorea”)• Cognitive: memory, executive fx, judgment• Sometimes disorganized speech & psychosis• Men & women

Pick’s disease

• Degeneration primarily in frontal & temporal lobes

• Memory impairment later

• Primitive reflexes

• With progression, either apathy or agitation

• Onset usually in 50s or 60s

Other

• Head trauma (e.g., pugilistic)

• HIV

• General medical conditions

• Substances

Possible causes(mostly re Alzheimer’s)

Genes• Concordance in first-degree relatives• Dominant trait• 3+ chromosomes (21, 14, 19)• Some genes are deterministic• Some increase susceptibility• Genes cause buildup of amyloid protein into

plaques & plaques cause cell death

Environmental exacerbations• Cigarette smoking• Alcohol• Repeated head trauma• Diabetes• Strokes• Aluminum?• Viruses (Creutzfeldt-Jakob disease)

• Buckner (2005) – brain’s default state

(when daydreaming, etc.)

• Same area active in Alzheimers

• Young adults can shift to concentration mode

• If Alzheimer’s, instead of shifting areas, default areas become more active

• Same posterior & cortical

regions show plaques in

Alzheimer’s

Treatments

• Cannot yet regenerate brain cells

• Compensation by other brain areas

Thus treatment =

1.Prevent exacerbating conditions

2.Stop brain damage from progressing

- GDNF to restore neurons

- implant fetal brain tissue

- prevent strokes (e.g., aspirin, no smoking)

- enhance cognitive abilities

3.Help person & caregiver cope

- treat depression in both

- memory aids

- well lit environment

- loose, easy clothing

- labels on clothes

- familiar schedules

III. Amnestic Disorder

Description

• Anterograde amnesia

• Retrograde amnesia

• No other serious cognitive impairment

• Impairment in function

• Decline from previous function

• Confabulation

- making up information to fill gaps

• Can be transient (< 1 month)

• Or chronic (> 1 month)

Etiology

• head trauma, drugs

Treatment

• Memory aids

• Treat other conditions