Cognitive Disorders
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Cognitive Disorders

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Cognitive Disorders Cognitive Disorders Presentation Transcript

  • Cognitive Disorders 2.27.2007
  • Delirium
    • A. Disturbance of consciousness
    • B. Change in cognition
    • C. Disturbance develops over a short period of time (hours to days) and tends to fluctuate over the course of the day
    • D. Evidence that the disturbance is caused by the direct physiological consequences of a GMC, substance, or both
  • Facts about Delirium
    • Prevalence:
    • Gender: Males might be at higher risk
  • Facts about Delirium
    • Age of onset:
    • Course:
  • Causes of Delirium
    • Psychoactive substances of abuse
    • Medications other than above
    • Infection, especially in the brain
    • Toxins
    • Surgery
    • Head injury
    • Shock
  • Dementia
    • Development of multiple cognitive deficits manifested by both:
      • Memory impairment
        • (Retrograde or Anterograde)
      • One or more of the following cognitive disturbances:
        • (Aphasia, Apraxia, Agnosia, or Disturbance in executive functioning)
    • Cognitive deficits cause significant impairment in functioning and represent a significant decline from a previous level of functioning
  • Facts about Dementia
    • Prevalence:
    • Gender:
    • Age of onset:
    • Course:
  • Causes of Dementia
    • Alzheimer’s (Cause of 70% of dementias)
    • Vascular lesions in the brain (reduces blood flow to the brain)
    • HIV
    • Head trauma
    • Parkinson’s Disease
    • Huntington’s Disease
    • Pick’s Disease
    • Creutzfeldt-Jakob Disease
  • Alzheimer’s Disease: Forms
    • Early Onset – develops prior to age 60
    • Late Onset – develops at age 60 or later
    • Risk for developing Alzheimer’s increases with age
  • Alzheimer’s Disease: Pathology
    • Neuropathology
      • Plaques, neurofibrillary tangles of tau protein
      • Plaques of amyloid and protein
      • Research in mice also implicate excessive iron in the brain
      • Small holes in neural tissue (granulovacuoles)
      • Atrophy (“wasting away”) of the brain
      • Firm diagnosis is only possible after death, at autopsy
  • Alzheimer’s Disease: Genetics
    • All Down syndrome kids get Dementia of Alzheimer’s type
    • Down syndrome due to trisomy on Chromosome 21
    • Chromosome 21 is also linked to early onset form of Alzheimer’s Disease
    • Production of the amyloid protein is linked to Chromosome 21
    • However, we don’t know if the amyloid tangles are the cause of Alzheimer’s Disease or an additional symptom of the real cause…thus, we still don’t know if Chromosome 21 has a causal role in Alzheimer’s
  • Alzheimer’s Disease: Treatment
    • No effective treatment exists to restore lost functioning
    • Behavioral therapy works to control wandering, incontinence, inappropriate sexual behavior, and poor self-care behaviors
    • Drugs that enhance the availability of the neurotransmitter acetylcholine
    • Trying to pursue medications or vaccines that will clear away the tangles and plaques
  • Alzheimer’s Disease: Caregivers
    • Caregivers of Alzheimer’s patients must deal with the “social death” of the patient even before the actual physical death
    • Financial burden
    • Chronic stress
    • High risk for depression
  • Vascular Dementia
    • Second most common cause of dementia (19% of cases), more common in men
    • Damage caused to specific areas of the brain
    • Stroke – interruption of blood flow to the brain, results in lack of oxygen to parts of the brain, which may die
    • Aneurism – rupture of blood vessels in the brain, blood floods the brain, pushing blood against the skull, crushing cells and killing parts of the brain
    • Abrupt, sudden onset of symptoms with fast decline
    • May be normal functioning in parts of brain not affected
  • Dementia due to HIV
    • Researchers found that HIV could result in the destruction of brain cells
    • Causes generalized atrophy, edema (swelling), inflammation, and patches of demyelination
    • May lead to psychotic phenomena as well
    • 30-60% of untreated AIDS/HIV patients will develop dementia
    • Only 20% of AIDS/HIV patients who receive antiviral treatment develop dementia
  • Huntington’s Disease
    • Inherited disease caused by an autosomal dominant gene
    • 100% determined by your genes (i.e. if you have the genes for it, you will develop Huntington’s Disease)
    • Age of onset: approximately 35 – 45
    • Progressive deterioration of motor skills, personality, cognitive functions (dementia), and mood
    • Results in death within 10-20 years of developing symptoms
  • Parkinson’s Disease
    • Slowly progressive neurological disorder
    • More common in men
    • Age of onset is typically between ages 50-70, although Michael J. Fox developed symptoms at age 30
    • Causes rigidity, tremors, lack of balance, diminished small motor control, and difficulties communicating
    • Caused by both genetic and environmental factors
    • 20-60% of cases result in dementia