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 Dementia H H A Agnosia - A disturbance of sensory perception, 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 dementias - 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 Delirium 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 alcoholism 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 amnesia - 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 Anterograde amnesia - 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 anxiety disorder (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.