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Psych 235 Chapter 15.docx

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PSYC 235
Christopher Bowie

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Psych 235 Chapter 15: Cognitive disorders Cognitive functions associated with memory  Sensation  Perception  Attention  Memory (working, episodic, semantic) Memory Systems: Working memory: short-term storage, manipulation Episodic memory: (encoding, retrieval, transfer) -> memory for events, places, and emotions Semantic memory -> memory for the meaning of items Procedural Memory -> Implicit memory; memory for actions & skills Perspectives:  Affects cognitive processes such as learning, memory and consciousness  Develop later in life a) Delirium: temporary condition displayed as confusion & disorientation b) Dementia: degenerative condition marked by broad cognitive deterioration c) Amnestic disorder: memory dysfunctions caused by diseases, drugs or toxins Shifting DSM perspectives  From “organic” mental disorders to “cognitive” disorders  Broad impairments in memory, attention, perception, and thinking  Profound changes in behaviour and personality Delirium : impaired consciousness & cognition during several hours/days EX: confusion, disorientation, attention, memory & language deficits  10-13% of people in care facilities  Prevalent in older adults, AIDS & medical patients (65 years old -> 10%)  Full recovery often within several weeks  44% of people with dementia have atleast 1 episode of delirium Medical conditions  Drug intoxication, poisons, withdrawal from drugs  Infections, head injury and forms of brain trauma  Sleep deprivation, immobility & excessive stress  Small amount of individuals continue to have problems on and off some even lapse into a coma and die (common last symptom of terminally ill patients) DSM-IV subtypes  General medical condition  Substance-induced  Multiple etiologies  Not otherwise specified -Delirium can be brought on by improper use of medication. EX anticholinergic effects are associated with severe delirium in the elderly Cholinergic deficit may contribute to delirium -May be experienced by children who have high fevers or who are taking certain medications and is often mistaken for noncompliance -Environmental factors are risks for elderly people -> # of room changes, absence of a clock, watch or reading glass Treatment: rapid treatment is important with better long-term outcomes  Attention to precipitating medical problems  Psychosocial interventions include reassurance & coping strategies -Goal: reassure the person to deal with agitation, anxiety and hallucinations and to retain a sense of control -> Acute delirium ad delirium brought on by alcohol/drugs is usually treated with haloperidol to help calm the individual. Prevention : proper medical care for illnesses and therapeutic drug monitoring Dementia: Gradual deterioration of brain functioning  Affects judgment, memory, language and other advanced cognitive processes  Causes that may be reversible or irreversible (Alzheimer’s) -> insults to the brain (stroke which destroys blood vessels), syphilis, HIV, severe head injury, introduction of certain toxic/poisonous substances etc. a) Initial Stage  Memory impairment, visuo-spatial skills deficits  Agnosia- inability to recognize and name objects (most common)  Facial Agnosia- inability to recognize familiar faces  Others: delusions, depression, agitation, aggression & apathy b) Later Stage  Cognitive functioning continues to deteriorate  Person requires almost total support to carry out day-to-day activities  Death results from inactivity combined with onset of other illnesses Onset & Prevalence  Affects 2% of those between 65-74 years of age  33% of persons 85 years and older  Nearly 90% over 100 Incidence of Dementia: rates of new cases double with every 5 years of age Gender & Sociocultural Factors  Rate for dementia was comparable for men & women and was equivalent across social class and educational level -lifestyle variables associated with timing & progressions  Some studies find greater increase in women but might be due to the tendency that women live longer a) Dementia of the Alzheimer’s type : multiple cognitive deficits that develop gradually and steadily  Predominant impairment in memory, orientation, judgment & reasoning -> Inability to integrate new information results in failure to learn new associations -> Forget important events and lose objects  Include agitation, confusion, depression, anxiety or combativeness -> lose interest in others and become socially isolated -> disturbance in brain’s biological clock  Symptoms are usually more pronounced at the end of the day Range of Cognitive Deficits  Aphasia: difficulty with language -> “anomia” problems with naming objects  Apraxia: impaired motor functioning  Agnosia: failure to recognize objects  Difficulty with activities such as planning, organizing, sequencing or abstracting information.  Impairments have negative impact on social and occupational functioning An autopsy is required for a definitive diagnosis (accurate 70-90%) Mental status exam: Mini Mental state Examination is used to asses language and memory problems  Supplementary test clock-drawing subtest: asked to put the numbers on the clock and to place hands in the position of 11:10 (scored by #s and types of errors)  Patients with Alzheimer’s make more errors of omission and misplacements of numbers “Super Nuns”: David Snowdown’s study of lifestyle effects on cognitive aging -Collected several decades worth of writings a group of nuns wrote which appeared to indicate early in life which women were most likely to develop Alzheimer’s later -Observed writing samples over the years differed in number of ideas contained which they referred to as “idea density” (complex/elaborate or simple statements about their day)  Autopsy finding on 14 nuns were correlated with idea density -> very simple writing (low idea density) occurred among all 5 nuns with Alzheimer’s -Those with more detailed journals had less evidence of pathology  Exercise, cognitive stimulation might have neuroprotective effects Course of Alzheimers Dementia -“Mild Cognitive Impairment”: refers to early declines in memory  Cognitive deterioration is slow during the early and later stages but more rapid during the middle stages -Illness usually runs 8-10 year course  Median survival after onset of Alzheimers is 3 years  Disease can occur relatively early during 40’s and 50’s but usually around 60/70s -Occur most often in people who are poorly educated  Greater impairment among uneducated people might indicate much earlier onset which suggest that AD causes intellectual dysfunction that in turn hampers education 
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