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CHAPTER 12. COGNITIVE IMPAIRMENT DISORDERS. 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
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CHAPTER 12 COGNITIVE IMPAIRMENT DISORDERS
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.
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.
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
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)
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.”
CONDITIONS MAKRED BY COGNITIVE IMPAIRMENT • Delirium • Delirium tremens • Dementia • Alzheimer’s disease • Pick’s disease • Huntington’s disease • Parkinson’s disease
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.
BRAINS OF PEOPLE AT RISK FOR ALZHEIMER’S DISEASE COMPARED WITH NORMAL BRAINS
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
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
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
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
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.
TREATMENT OF EPILEPSY • Medical • Antiepileptic medications • Surgery as a last resort • Antidepressant medication • Psychological • Operant conditioning • Desensitization and relaxation training • Biofeedback