Lesson 1 - Cognitive Disorders


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Lesson 1 - Cognitive Disorders

  1. 1. Cognitive Disorders 7.10.2006
  2. 2. Delirium <ul><li>A. Disturbance of consciousness </li></ul><ul><ul><li>i.e. Reduced clarity of awareness of the environment </li></ul></ul><ul><ul><li>Reduced ability to focus, sustain, or shift attention </li></ul></ul><ul><li>B. Change in cognition </li></ul><ul><ul><li>E.g. Memory deficit, disorientation, language disturbance </li></ul></ul><ul><li>C. Disturbance develops over a short period of time (hours to days) and tends to fluctuate over the course of the day </li></ul><ul><li>D. Evidence that the disturbance is caused by the direct physiological consequences of a GMC, substance, or both </li></ul>
  3. 3. Facts about Delirium <ul><li>Prevalence: At any point in time… </li></ul><ul><li>0.4% of adults age 18 and older </li></ul><ul><li>1.1% of adults age 55 and older </li></ul><ul><li>Up to 60% of nursing home residents age 75 and older </li></ul><ul><li>Gender: Males might be at higher risk </li></ul><ul><li>Age of onset: Most common in the elderly and medically ill </li></ul><ul><li>Course: Develops over hours to days </li></ul><ul><li>Majority of cases resolve (could be hours, days, weeks, or months…) </li></ul><ul><li>Some cases progress to coma, stupor, or death </li></ul><ul><li>Increases risk of mortality for hospital patients </li></ul>
  4. 4. Causes of Delirium <ul><li>Psychoactive substances of abuse </li></ul><ul><li>Medications other than above (e.g. steroids) </li></ul><ul><li>Infection, especially in the brain (e.g. bacterial, viral, etc.) </li></ul><ul><li>Toxins (e.g. heavy metals like mercury) </li></ul><ul><li>Surgery </li></ul><ul><li>Head injury </li></ul><ul><li>Shock </li></ul>
  5. 5. Dementia <ul><li>Development of multiple cognitive deficits manifested by both: </li></ul><ul><ul><li>Memory impairment (either old or new information) </li></ul></ul><ul><ul><li>One or more of the following cognitive disturbances: </li></ul></ul><ul><ul><ul><li>Aphasia (impaired speech) </li></ul></ul></ul><ul><ul><ul><li>Apraxia (impaired ability to carry out motor activities) </li></ul></ul></ul><ul><ul><ul><li>Agnosia (failure to recognize/identify objects) </li></ul></ul></ul><ul><ul><ul><li>Disturbance in executive functioning (planning, organizing, sequencing complex activities) </li></ul></ul></ul><ul><li>Cognitive deficits cause significant impairment in functioning and represent a significant decline from a previous level of functioning </li></ul>
  6. 6. Facts about Dementia <ul><li>Prevalence: 0.5-1% adults age 65 and above </li></ul><ul><li>10-15% adults age 85 and above </li></ul><ul><li>20-25% adults 90 and above </li></ul><ul><li>35-40% adults 95 and above </li></ul><ul><li>Gender: Slightly more common in females </li></ul><ul><li>Age of onset: Typically in the elderly (depends on cause) </li></ul><ul><li>Course: Typically gradual onset, chronic, progressive (depends on cause) </li></ul>
  7. 7. Causes of Dementia <ul><li>Alzheimer’s (Cause of 70% of dementias) </li></ul><ul><li>Vascular lesions in the brain (reduces blood flow to the brain) </li></ul><ul><li>HIV </li></ul><ul><li>Head trauma </li></ul><ul><li>Parkinson’s Disease </li></ul><ul><li>Huntington’s Disease </li></ul><ul><li>Pick’s Disease </li></ul><ul><li>Creutzfeldt-Jakob Disease </li></ul>
  8. 8. Alzheimer’s Disease: Forms <ul><li>Early Onset – develops prior to age 60 </li></ul><ul><ul><li>Runs more strongly in families </li></ul></ul><ul><ul><li>Progresses more rapidly </li></ul></ul><ul><li>Late Onset – develops at age 60 or later </li></ul><ul><li>Risk for developing Alzheimer’s increases with age </li></ul>
  9. 9. Alzheimer’s Disease: Pathology <ul><li>Neuropathology </li></ul><ul><ul><li>Plaques, neurofibrillary tangles of tau protein </li></ul></ul><ul><ul><li>Plaques of amyloid and protein </li></ul></ul><ul><ul><ul><li>Protein that is present in all kinds of tissues </li></ul></ul></ul><ul><ul><ul><li>Responsible for “housekeeping” </li></ul></ul></ul><ul><ul><ul><li>Abnormal growth creates plaques </li></ul></ul></ul><ul><ul><ul><li>Plaque count positively correlated with cognitive decline </li></ul></ul></ul><ul><ul><li>Research in mice also implicate excessive iron in the brain </li></ul></ul><ul><ul><li>Small holes in neural tissue (granulovacuoles) </li></ul></ul><ul><ul><li>Atrophy (“wasting away”) of the brain </li></ul></ul><ul><ul><li>Firm diagnosis is only possible after death, at autopsy </li></ul></ul>
  10. 10. Alzheimer’s Disease: Pathology Brain of someone with Alzheimer’s Disease – plaques, tangles, and overall brain atrophy are present Brain of a healthy person
  11. 11. Alzheimer’s Disease: Genetics <ul><li>All Down syndrome kids get Dementia of Alzheimer’s type </li></ul><ul><li>Down syndrome due to trisomy on Chromosome 21 </li></ul><ul><li>Chromosome 21 is also linked to early onset form of Alzheimer’s Disease </li></ul><ul><li>Production of the amyloid protein is linked to Chromosome 21 </li></ul><ul><li>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 </li></ul>
  12. 12. Alzheimer’s Disease: Treatment <ul><li>No effective treatment exists to restore lost functioning </li></ul><ul><li>Behavioral therapy works to control wandering, incontinence, inappropriate sexual behavior, and poor self-care behaviors </li></ul><ul><li>Drugs that enhance the availability of the neurotransmitter acetylcholine (acetylcholine depletion has also been found in Alzheimer’s patients) </li></ul><ul><ul><li>Slows, but doesn’t stop decline </li></ul></ul><ul><li>Trying to pursue medications or vaccines that will clear away the tangles and plaques </li></ul>
  13. 13. Alzheimer’s Disease: Caregivers <ul><li>Caregivers of Alzheimer’s patients must deal with the “social death” of the patient even before the actual physical death </li></ul><ul><li>Financial burden </li></ul><ul><li>Chronic stress </li></ul><ul><li>High risk for depression </li></ul>
  14. 14. Vascular Dementia <ul><li>Second most common cause of dementia (19% of cases), more common in men </li></ul><ul><li>Damage caused to specific areas of the brain </li></ul><ul><li>Stroke – interruption of blood flow to the brain, results in lack of oxygen to parts of the brain, which may die </li></ul><ul><li>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 </li></ul><ul><li>Abrupt, sudden onset of symptoms with fast decline </li></ul><ul><li>May be normal functioning in parts of brain not affected </li></ul>
  15. 15. Dementia due to HIV <ul><li>Researchers found that HIV could result in the destruction of brain cells </li></ul><ul><li>Causes generalized atrophy, edema (swelling), inflammation, and patches of demyelination </li></ul><ul><li>May lead to psychotic phenomena as well </li></ul><ul><li>30-60% of untreated AIDS/HIV patients will develop dementia </li></ul><ul><li>Only 20% of AIDS/HIV patients who receive antiviral treatment develop dementia </li></ul>
  16. 16. Huntington’s Disease <ul><li>Inherited disease caused by an autosomal dominant gene </li></ul><ul><li>100% determined by your genes (i.e. if you have the genes for it, you will develop Huntington’s Disease) </li></ul><ul><li>Age of onset: approximately 35 – 45 </li></ul><ul><li>Progressive deterioration of motor skills, personality, cognitive functions (dementia), and mood </li></ul><ul><li>Results in death within 10-20 years of developing symptoms </li></ul>
  17. 17. Parkinson’s Disease <ul><li>Slowly progressive neurological disorder </li></ul><ul><li>More common in men </li></ul><ul><li>Age of onset is typically between ages 50-70, although Michael J. Fox developed symptoms at age 30 </li></ul><ul><li>Causes rigidity, tremors, lack of balance, diminished small motor control, and difficulties communicating </li></ul><ul><li>Caused by both genetic and environmental factors </li></ul><ul><li>20-60% of cases result in dementia </li></ul>