CHAPTER 12

1. CHAPTER 12 COGNITIVE IMPAIRMENT DISORDERS

2. THE BRAIN: AN INTERACTIONAL PERSPECTIVE • Brain research helps us understand normal and abnormal behavior by • Specifying how the brain grows and maintains itself. • Identifying the mechanisms by which the brain acquires, stores, and used information • at the cellular and molecular levels, and • at the level of behavior and social interaction. • Explaining how the brain monitors and regulates internal bodily processes.

3. FACTORS THAT INFLUENCE VULNERABILITY TO BRAIN DISORDERS • Age – Infant brain more susceptible to pathological conditions • Social support – Presence of caring people eases adjustment to brain conditions • Stress – The greater the stress, the greater the cognitive and behavioral deficits will be • Personality factors – Some react with intense anxiety, paranoia, defensiveness to brain conditions • Physical condition – Site of disorder, rate of onset, duration of disorder, and general health influence the clinical picture.

4. PERSONALITY AND COGNITIVE CHANGES ASSOCIATED WITH FRONTAL LOBE MALFUNCTION • Apathy and loss of interest in social interaction • Inattention to personal appearance • Boisterousness; profanity; loud speech • Irritability and violence • Increased risk-taking • Overeating and overdrinking • Reduced capacity to use language, symbols and logic • Diminished ability to concentrate • Loss of orientation to time or place

5. ASSESSING BRAIN DAMAGE • Mental status examination • Information about current behavior and thought including orientation to reality, memory, and ability to follow instructions • Neuropsychological testing • Assess impairment in awareness of and responsiveness to sensory stimulation, ability to understand verbal communication, and ability in verbal and emotional expression • Brain imaging • Computerized tomography (CT scan) • Positron emission tomography (PT scan) • Magnetic resonance imaging (MRI)

6. THREE MAJOR BRAIN SCANNING TECHNIQUES

7. MENTAL STATUS EXAMINATION • Time – “What year is this? What day?” • Place – “What city and state are we in?” • Immediate memory – “Repeat these words….” • Attention – “Subtract 7 from 100 and continue to do so.” • Recall – “Repeat the words I mentioned earlier.” • Naming – “What is this?” (Show object) • Repetition – “Repeat: East, west, home’s best.” • Following command – “Put this watch on the table.” • Visual construction – “Copy this figure.”

8. CONDITIONS MAKRED BY COGNITIVE IMPAIRMENT • Delirium • Delirium tremens • Dementia • Alzheimer’s disease • Pick’s disease • Huntington’s disease • Parkinson’s disease

9. AUTOSOMAL DOMINANT DISORDERS (SUCH AS HUNTINGTON’S DISEASE)

10. PHASES OF COGNITIVE DECLINE IN ALZHEIMER’S DISEASE • Complaints of memory deficit • Forgets names • Increased cognitive decline and signs of confusion • Lose, misplace valuable objects. • Moderately severe cognitive decline and intensified confusion (early dementia) • Can’t recall names of family members or life events. • Severe cognitive decline and confusion (middle dementia) • Unaware of recent events and experiences. • Very severe cognitive decline and confusion (late dementia) • Loss of verbal ability; need assistance in tasks of daily living.

11. BRAIN OF ALZHEIMER’S PATIENT

12. BRAINS OF PEOPLE AT RISK FOR ALZHEIMER’S DISEASE COMPARED WITH NORMAL BRAINS

13. CORE CRITERIA FOR DEMENTIA • Memory impairment • Inability to learn new information and to recall previously learned information • One or more cognitive disturbances • Deterioration of language function • Impaired ability to execute motor activities despite intact motor function • Failure to recognize or identify objects despite intact sensory function • Disturbance in executive functions such as planning, organizing, sequencing, and abstracting

14. BRAIN TRAUMA AND INFECTIONS • Injuries • Concussions – transient problems • Contusions – diffuse damage • Lacerations – major tears or ruptures • Tumors • Symptoms depend on the site of the tumor • Sudden onset or slow-growing • HIV-associated cognitive impairment • Cortical atrophy caused by AIDS • General Paresis • Acute onset or slow-acting viral infections like syphilitic infections

15. AMNESTIC DISORDERS • Disturbances of memory • Impairs ability to learn information or recall previously learned information • Impairment evident in social and occupational functioning • Impairment apparent in verbal and visual tasks requiring spontaneous recall

16. OTHER COGNITIVE IMPAIRMENT DISORDERS • Cerebrovascular disorders • Cerebrovascular accidents (CVAs) or strokes interrupt blood flow to the brain • Symptoms include some paralysis and aphasia (total or partial loss of speech) • Vascular dementia – series of minor strokes that occur at different times • Korsakoff’s syndrome • Vitamin B1 and thiamine deficiencies that occur in some chronic alcoholics • Recent and past memories are lost, along with inability to form new memories • Epilepsy • Transient change of consciousness resulting from electrical instability

17. EPILEPTIC DISORDERS • Types • Grand mal seizure • Two to five minutes; patient cries, falls to floor unconsciousness, extreme spasms. • Petit mal seizure • Common in children; no convulsion, but lapse of consciousness characterized by blank staring or lack of responsiveness. • Psychomotor epilepsy • Semiautomatic motor responses that show clouding of consciousness, confused state; often accompanied by hallucinations.

18. TREATMENT OF EPILEPSY • Medical • Antiepileptic medications • Surgery as a last resort • Antidepressant medication • Psychological • Operant conditioning • Desensitization and relaxation training • Biofeedback