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Cognitive Disorders

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