B B E E Cognitive Disorders H Chapter 15 H A A Cognitive disorders - A class of psychological V V disorders characterized by impairment in cognitive I Cognitive Disorders and I abilities and daily functioning in which biological causation is either known or presumed. O Disorders Related to Aging O R R Cognitive disorders are not psychologically based; they

D D are caused by physical or medical conditions, including drug use or withdrawals, which affect the functioning of I Sheila K. Grant, Ph.D. I S S the brain. Professor O O R R In some cases the specific cause of the cognitive D D disorder can be pinpointed; in others, it cannot. E E R R S S

B B Does this man’s singing help him E Cognitive Disorders E H H coordinate his actions? A In The Man Who Mistook His Wife for a Hat, the A V neurologist Oliver Sacks (1985) recounts how Dr. P. V I failed to recognize the faces of his students at the music I O school. O R R When a student spoke, however, Dr. P. immediately

D recognized his or her voice. D I I S Not only did the professor fail to discriminate faces S O visually, but sometimes he perceived faces where none O R existed. R D D E E R R S S

B B E Cognitive Disorders E H H A Agnosia - A disturbance of sensory , A Dementia - Profound deterioration of mental V usually affecting visual perception. V functioning, characterized by impaired memory, I I thinking, judgment, and language use. O People who suffer from cognitive disorders may O R become completely dependent on others to meet basic R There are many causes of dementia, including brain needs in feeding, toileting, and grooming. diseases, such as Alzheimer’s disease (AD) and Pick’s

D D disease, and infections or disorders that affect the I In other cases, although some assistance in meeting I functioning of the brain, such as meningitis, HIV S the demands of daily living may be required, people are S infection, and encephalitis. O able to function at a level that permits them to live O R semi- independently. R In some cases, the dementia can be halted or reversed, D D especially when it is caused by certain types of tumors, E E seizures, metabolic disturbances, and treatable R R infections, or when it results from depression or S S substance abuse.

1 B B E E Dementia H H A A Senile - Forms of dementia that begin V V after age 65. I I O O Presenile dementias - Forms of dementia that begin R R at or before age 65.

D D Although the risk of dementia is greater in later life, I I dementia is not a consequence of normal aging. S S O O It is a sign of a degenerative brain disease, such as R R Alzheimer’s disease. D D E E R R S S

B B E E H H Delirium - A state of mental confusion, disorientation, A A and inability to focus attention. V V I I The word delirium derives from the Latin roots de-, O O meaning “from,” and lira, meaning “line” or “furrow.” R R

It means straying from the line, or the norm, in D D I perception, cognition, and behavior. I S S O O R R D D E E R R S S

B B E E Delirium H H People with chronic who abruptly stop A A drinking may experience a form of delirium called V V delirium tremens or DTs. I I O O During an acute episode of the DTs, the person may be R R terrorized by wild and frightening hallucinations, such as “bugs crawling down walls” or on the skin. D D I I The DTs can last for a week or more and are best S S treated in a hospital, where the patient can be carefully O O monitored and the symptoms treated with mild R R tranquilizers and environmental support. D D E E R R S S

2 B B E Amnestic Disorders E Amnestic Disorders H H A Amnestic disorders - Disturbances of memory A V associated with inability to learn new material or recall V I past events or personal information. I O O R Amnestic disorders frequently follow a traumatic R event, such as a blow to the head, an electric shock, or

D an operation. D I I S A head injury may prevent people from remembering S O events that occurred shortly before the accident. O R R D D E E R R S S

B B E Amnestic Disorders E Korsakoff’s Syndrome H H A Retrograde - Loss or impairment of ability A Korsakoff’s syndrome - A syndrome associated V to recall past events. V with chronic alcoholism that is characterized by I I memory loss and disorientation (also called alcohol- O - Loss or impairment of ability O induced persisting amnestic disorder). R to form or store new memories. R People with Korsakoff ’s syndrome have major gaps in

D Hypoxia - Decreased supply of oxygen to the brain or D their memory of past experiences. I other organs. I S S Their memory deficits are believed to result from the O Infarction - The development of an infarct, or area of O loss of brain tissue due to bleeding in the brain. R dead or dying tissue, resulting from the blocking of R D blood vessels normally supplying the tissue. D E E R R S S

B B Psychological Disorders E Korsakoff’s Syndrome E H H Related To Aging A Wernicke’s disease - A brain disorder, associated A V with chronic alcoholism, characterized by confusion, V Dementia, or senility, is not the result of normal aging. I disorientation, and difficulty maintaining balance I while walking. O O It is a sign of degenerative brain disease. R R Ataxia - Loss of muscle coordination. Screening and testing on neurological and D D neuropsychological tests can help distinguish dementias I If, however, Wernicke’s disease is treated promptly I from normal aging processes. S with major doses of vitamin B1, Korsakoff ’s syndrome S O may not develop. O Generally speaking, the decline in intellectual R R functioning in dementia is more rapid and severe. D D E E R R S S

3 B B E Anxiety Disorders and Aging E Anxiety Disorders and Aging H H Although anxiety disorders may develop at any point in Older women are more likely to be affected than older A A life, they tend to be less prevalent among older adults men, by a ratio of about two to one. V V than their younger counterparts. I I The most frequently occurring anxiety disorders among O O Still, anxiety disorders are the most commonly older adults are generalized (GAD) and R R occurring psychological disorder among older adults, phobic disorders. even more common than depression. D D Panic disorder is rare. I I Approximately 1 in 10 adults over the age of 55 suffers S S from a diagnosable anxiety disorder Most cases of agoraphobia affecting older adults tend to O O be of recent origin and may involve the loss of social R R support systems due to the death of a spouse or close D D friends. E E R R S S

B B E Depression and Aging E Sleep Problems and Aging H H Insomnia in late adulthood is actually more prevalent A Although risks of major depression decline with age, A than depression. V many older adults encounter significant periods of V I depression. I Sleep problems reflect age related changes in sleep O O physiology, such as sleep apnea and tendencies to wake R For some older adults, recurring depression is a R continuation of a lifelong pattern; in others, it first up earlier in the morning.

D arises in later life. D However, sleep problems may be a feature of other I I psychological disorders, such as depression, dementia, S Between 8% and 20% of older adults experience some S and anxiety disorders, as well as medical illness. O symptoms of depression with perhaps about 3% of O R them suffering from major R Psychosocial factors, such as loneliness and the related D D difficulty of sleeping alone after the loss of a spouse, E E may also be involved. R R S S

B B E Dementia of the E Alzheimer’s Disease H Alzheimer’s Type H A A V V I Alzheimer’s disease (AD) - A progressive brain I O disease characterized by gradual loss of memory and O R intellectual functioning, personality changes, and R eventual loss of ability to care for oneself. D D I The risks of AD increase dramatically with advancing I S age. S O O R An estimated 10% of Americans over the age of 65, and R D about half of those in the 75- to 84-year age range, are D E believed to suffer from AD. E R R S S

4 B Prevalence of Alzheimer’s B PET scans of brains from a healthy E E aged adult (left) and a patient with H disease among older adults. H A A Alzheimer’s disease (right). V V I I O O R R

D D I I S S O O R R D D E E R R S S

B B E Diagnosis E Symptoms of H H There is no definitive diagnostic test for AD. Alzheimer’s Disease A A V V The diagnosis is generally based on a clinical The early stages of the disease are marked by limited I I evaluation and given only when other possible causes memory problems and subtle personality changes. O O of dementia are eliminated. R R In moderately severe AD, people require assistance in Other medical and psychological conditions may managing everyday tasks. D D mimic AD, such as severe depression resulting in I I memory loss and impaired cognitive functioning. At this stage, the Alzheimer’s patient may be unable to S S select appropriate clothes or recall their addresses or O O names of family members R R D D E E R R S S

B B E Do you know my name? E Causal Factors H H Plaques, steel-wool-like clumps, form in the brains of A A people with Alzheimer’s disease, are composed of a V V material called beta amyloid, which consists of fibrous I I protein fragments. O O R R Whether or not the accumulation of plaque plays a role in explaining memory loss and other symptoms of AD D D remains unclear. I I S S Laboratory experiments on other animals suggest that O O memory deficits may actually precede the formation of R R significant deposits of plaque. D D E E R R S S

5 B B E Plaques linked to E Treatment and Prevention H Alzheimer’s disease. H Presently available drugs for AD offer at best modest A A benefits in slowing cognitive decline and boosting V V cognitive unctioning. None is a cure. I I O O One widely used drug, (brand name Aricept), R R increases levels of the neurotransmitter acetylcholine (ACh). D D Hopes for the future lie in the development of an I I effective vaccine that might prevent this devastating S S disease. O O In the meantime, investigators report that lifestyle R R changes, such as engaging in intellectually challenging D D E E tasks and following a regular exercise program, may R R delay or even prevent the development of dementia in S S later life.

B B E E Features of H H Cerebrovascular accident (CVA) - A stroke, or Vascular Dementia A A brain damage resulting from a rupture or blockage of a V V The symptoms of vascular dementia are similar to blood vessel supplying oxygen to the brain. I I those of dementia of the Alzheimer’s type, including O O impaired memory and language ability, agitation and Vascular dementia - Dementia resulting from a R R emotional instability, and loss of ability to care for number of strokes in the brain. one’s own basic needs.

D D - Impaired ability to understand or express I I However, AD is characterized by an insidious onset speech. S S and a gradual decline of mental functioning, whereas O O vascular dementia typically occurs abruptly and follows R R a stepwise course of deterioration involving rapid D D declines in cognitive functioning that are believed to E E reflect the effects of additional strokes R R S S

B Dementia Due to B Dementia Due to E E Parkinson’s Disease H Pick’s Disease H Parkinson’s disease - A progressive disease of the A A Pick’s disease - A form of dementia, similar to basal ganglia characterized by muscle tremor and V V Alzheimer’s disease, but distinguished by specific shakiness, rigidity, difficulty walking, poor control of I I abnormalities (Pick’s bodies) in nerve cells and absence fine motor movements, lack of facial muscle tone, and O O of neurofibrillary tangles and plaques. in some cases, cognitive impairment. R R Parkinson’s disease affects between half a million and Symptoms include memory loss and social D D one million people in the United States, including the inappropriateness, such as a loss of modesty or the I I former heavyweight champion Muhammad Ali and the display of flagrant sexual behavior. S S actor Michael J. Fox. O O Diagnosis is confirmed only upon autopsy by the The disease affects men and women about equally and R R absence of the neurofibrillary tangles and plaques that most often strikes between the ages of 50 and 69. D D are found in AD and by the presence of other abnormal E E Dementia occurs in perhaps 20% to as many as 75% or structures—Pick’s bodies—in nerve cells. R R more of Parkinson’s patients over the course of the S S illness

6 B B E Dementia Due to E Dementia Due to H Parkinson’s Disease H Huntington’s Disease A A Parkinson’s disease is characterized by destruction or V V impairment of dopamine producing nerve cells in the Huntington’s disease - An inherited degenerative I I zubstantia nigra (“black substance”), an area of the disease that is characterized by jerking and twisting O O brain that helps regulate body movement. movements, paranoia, and mental deterioration. R R

Whatever the underlying cause, the symptoms of the The most prominent physical symptoms of the disease D D disease—the uncontrollable tremors, shaking, rigid are involuntary, jerky movements of the face I I muscles, and difficulty walking—are tied to deficiencies (grimaces), neck, limbs, and trunk—in contrast to the S S in the amount of dopamine in the brain. poverty of movement that typifies Parkinson’s disease. O O R R The drug L-dopa, which increases dopamine levels, These twitches are termed choreiform, which derives D D brought hope to Parkinson’s patients when it was from the Greek choreia, meaning “dance.” E E introduced in the 1970s. L-dopa is converted in the R R brain into dopamine. S S

B B E Dementia Due to HIV Disease E Dementia Due to H H The human immunodeficiency virus (HIV), which A A Creutzfeldt-Jakob Disease causes AIDS, can invade the central nervous system and V V cause a cognitive disorder—dementia due to HIV I I Creutzfeldt-Jakob disease is a rare and fatal brain disease. O O disease. R R The most typical signs of dementia due to HIV disease It is characterized by the formation of small cavities in include forgetfulness and impaired concentration and D D the brain that resemble the holes in a sponge. problem-solving ability. I I S S Dementia is a common feature of the disease. Dementia is rare in persons with HIV who have not yet O O developed full-blown AIDS. R R The disease typically affects people in the 40- to 60- D D year-old age range, although it may develop in adults E E at any age R R S S

B B E Dementia Due to E Neurosyphilis H Head Trauma H A A General paresis - A form of dementia resulting from V Progressive dementia due to head trauma is more V neurosyphilis. I likely to result from multiple head traumas (as in the I O case of boxers who receive multiple blows to the head O General paresis is of historical significance to abnormal R during their careers) than from a single blow or head R . trauma.

D D The 19th-century discovery of the connection between I Yet even a single head trauma can have psychological I this form of dementia and a concrete physical illness, S effects, and if severe enough, can lead to physical S syphilis, strengthened the medical model and held out O disability or death. O the promise that organic causes would eventually be R R found for other abnormal behavior patterns. D Specific changes in personality following traumatic D E injury to the brain vary with the site and extent of the E Syphilis is a sexually transmitted disease caused by the R injury, among other factors. R bacterium Treponema pallidum. S S

7 B E H A V I O R QUESTIONS?

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