Chapter 15 - Cognitive Disorders

1. Chapter 15 - Cognitive Disorders I. Delirium • Acute, temporary impairment in perception & cognition • Fluctuating course

2. Symptoms 1. Disturbance in consciousness - perseveration - emotional changes - hallucinations & paranoid delusions Capgras syndrome

3. 2. Change in cognition - ST memory 3. Lasts short period of time • Caused by a general medical condition OR substance intoxication/withdrawal OR multiple etiologies

4. To diagnose - Mental Status Exam Treatment - antipsychotics - treat general medical condition - time - reassurance

5. II. Dementia - gradual deterioration in perception & cognition Description - multiple cognitive deficits 1. Memory impairment - trouble learning new information (Anterograde amnesia) - trouble recalling known information (Retrograde amnesia)

6. 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

7. Types of dementias Alzheimer’s • Brain atrophy • Tangles & plaques

8. Only diagnosed by autopsy • Many mimicking conditions • Slightly more in women

9. 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

10. Parkinson’s disease • Slow, progressive deterioration • Psychomotor: tremors, rigidity, instability • Dementia present in 20-60% • Decreased DA

11. 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

12. 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

13. Other • Head trauma (e.g., pugilistic) • HIV • General medical conditions • Substances

14. 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

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

16. 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

17. Same posterior & cortical regions show plaques in Alzheimer’s

18. Treatments • Cannot yet regenerate brain cells • Compensation by other brain areas

19. 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

20. 3. Help person & caregiver cope - treat depression in both - memory aids - well lit environment - loose, easy clothing - labels on clothes - familiar schedules

21. III. Amnestic Disorder Description • Anterograde amnesia • Retrograde amnesia • No other serious cognitive impairment • Impairment in function • Decline from previous function

22. Confabulation - making up information to fill gaps • Can be transient (< 1 month) • Or chronic (> 1 month)

23. Etiology • head trauma, drugs Treatment • Memory aids • Treat other conditions