Lecture 11


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Lecture 11

  1. 1. Developmental and Cognitive Disorders Chapter 13
  2. 2. Perspectives on Developmental Disorders <ul><li>Normal vs. Abnormal Development </li></ul><ul><ul><li>Childhood is associated with significant developmental changes </li></ul></ul><ul><ul><li>Disruption of early skills will likely disrupt development of later skills </li></ul></ul><ul><li>Developmental Disorders </li></ul><ul><ul><li>Diagnosed first in infancy, childhood, or adolescence </li></ul></ul><ul><ul><li>Attention deficit hyperactivity disorder (ADHD) </li></ul></ul><ul><ul><li>Learning disorders </li></ul></ul><ul><ul><li>Autism </li></ul></ul><ul><ul><li>Mental retardation </li></ul></ul>
  3. 3. Attention Deficit Hyperactivity Disorder (ADHD): An Overview <ul><li>Nature of ADHD </li></ul><ul><ul><li>Central features – Inattention, overactivity, and impulsivity </li></ul></ul><ul><ul><li>Associated with behavioral, cognitive, social, and academic problems </li></ul></ul><ul><li>DSM-IV and DSM-IV-TR Symptom Clusters </li></ul><ul><ul><li>Cluster 1 – Symptoms of inattention </li></ul></ul><ul><ul><li>Cluster 2 – Symptoms of hyperactivity and impulsivity cluster </li></ul></ul><ul><ul><li>Either cluster 1 or 2 must be present for a diagnosis </li></ul></ul>
  4. 4. ADHD: Facts and Statistics <ul><li>Prevalence </li></ul><ul><ul><li>Occurs in 4%-12% of children who are 6 to 12 years of age </li></ul></ul><ul><ul><li>Symptoms are usually present around age 3 or 4 </li></ul></ul><ul><ul><li>68% of children with ADHD have problems as adults </li></ul></ul><ul><li>Gender Differences </li></ul><ul><ul><li>Boys outnumber girls 4 to 1 </li></ul></ul><ul><li>Cultural Factors </li></ul><ul><ul><li>Probability of ADHD diagnosis is greatest in the United States </li></ul></ul>
  5. 5. ADHD: Biological Contributions <ul><li>Genetic Contributions </li></ul><ul><ul><li>ADHD runs in families </li></ul></ul><ul><ul><li>Familial ADHD may involve deficits on chromosome 20 </li></ul></ul><ul><li>Neurobiological Contributions: Brain Dysfunction and Damage </li></ul><ul><ul><li>Inactivity of the frontal cortex and basal ganglia </li></ul></ul><ul><ul><li>Right hemisphere malfunction </li></ul></ul><ul><ul><li>Abnormal frontal lobe development and functioning </li></ul></ul><ul><ul><li>Yet to identify a precise neurobiological mechanism for ADHD </li></ul></ul><ul><li>The Role of Toxins </li></ul><ul><ul><li>Allergens and food additives do not appear to cause ADHD </li></ul></ul><ul><ul><li>Maternal smoking increases risk of having a child with ADHD </li></ul></ul>
  6. 6. ADHD: Psychosocial Contributions <ul><li>Psychosocial Factors Can Influence the Disorder Itself </li></ul><ul><ul><li>Constant negative feedback from teachers, parents, and peers </li></ul></ul><ul><ul><li>Peer rejection and resulting social isolation </li></ul></ul><ul><ul><li>Such factors foster low self-image </li></ul></ul>
  7. 7. Biological Treatment of ADHD <ul><li>Goal of Biological Treatments </li></ul><ul><ul><li>To reduce impulsivity/hyperactivity and to improve attention </li></ul></ul><ul><li>Stimulant Medications </li></ul><ul><ul><li>Reduce the core symptoms of ADHD in 70% of cases </li></ul></ul><ul><ul><li>Examples include Ritalin, Dexedrine </li></ul></ul><ul><li>Effects of Medications </li></ul><ul><ul><li>Improve compliance and decrease negative behaviors in many children </li></ul></ul><ul><ul><li>Beneficial effects are not lasting following drug discontinuation </li></ul></ul><ul><ul><li>Negative side effects include insomnia, drowsiness, and irritability </li></ul></ul>
  8. 8. Behavioral and Combined Treatment of ADHD <ul><li>Behavioral Treatment </li></ul><ul><ul><li>Involve reinforcement programs </li></ul></ul><ul><ul><li>Aim to increase appropriate behaviors and decrease inappropriate behaviors </li></ul></ul><ul><ul><li>May also involve parent training </li></ul></ul><ul><li>Combined Bio-Psycho-Social Treatments </li></ul><ul><ul><li>Are highly recommended </li></ul></ul>
  9. 9. Learning Disorders <ul><li>Scope of Learning Disorders </li></ul><ul><ul><li>Problems related to academic performance in reading, mathematics, and writing </li></ul></ul><ul><ul><li>Performance is substantially below what would be expected </li></ul></ul><ul><li>DSM-IV and DSM-IV-TR Reading Disorder </li></ul><ul><ul><li>Discrepancy between actual and expected reading achievement </li></ul></ul><ul><ul><li>Reading is at a level significantly below that of a typical person of the same age </li></ul></ul><ul><ul><li>Problem cannot be caused by sensory deficits (e.g., poor vision) </li></ul></ul><ul><li>DSM-IV and DSM-IV-TR Mathematics Disorder </li></ul><ul><ul><li>Achievement below expected performance in mathematics </li></ul></ul><ul><li>DSM-IV and DSM-IV-TR Disorder of Written Expression </li></ul><ul><ul><li>Achievement below expected performance in writing </li></ul></ul>
  10. 10. Learning Disorders: Some Facts and Statistics <ul><li>Incidence and Prevalence of Learning Disorders </li></ul><ul><ul><li>1% to 3% incidence of learning disorders in the United States </li></ul></ul><ul><ul><li>Prevalence is highest in wealthier regions of the United States </li></ul></ul><ul><ul><li>Prevalence rate is 10% to 15% among school age children </li></ul></ul><ul><ul><li>Reading difficulties are the most common of the learning disorders </li></ul></ul><ul><ul><li>About 32% of students with learning disabilities drop out of school </li></ul></ul><ul><ul><li>School experience for such persons tends to be quite negative </li></ul></ul>
  11. 11. Biological and Psychosocial Causes of Learning Disorders <ul><li>Genetic and Neurobiological Contributions </li></ul><ul><ul><li>Reading disorder runs in families, with 100% concordance rate for identical twins </li></ul></ul><ul><ul><li>Evidence for subtle forms of brain damage is inconclusive </li></ul></ul><ul><ul><li>Overall, genetic and neurobiological contributions are unclear </li></ul></ul><ul><li>Psychological and motivational factors seem to affect eventual outcome </li></ul>
  12. 12. Treatment of Learning Disorders <ul><li>Requires Intense Educational Interventions </li></ul><ul><ul><li>Remediation of basic processing problems (e.g., teaching visual skills) </li></ul></ul><ul><ul><li>Efforts to improve of cognitive skills (e.g., instruction in listening) </li></ul></ul><ul><ul><li>Targeting behavioral skills to compensate for problem areas </li></ul></ul><ul><li>Data Support Behavioral Educational Interventions for Learning Disorders </li></ul>
  13. 13. Pervasive Developmental Disorders: An Overview <ul><li>Nature of Pervasive Developmental Disorders </li></ul><ul><ul><li>Problems occur in language, socialization, and cognition </li></ul></ul><ul><ul><li>Pervasive – Means the problems span the person’s entire life </li></ul></ul><ul><li>Examples of Pervasive Developmental Disorders </li></ul><ul><ul><li>Autistic disorder </li></ul></ul><ul><ul><li>Asperger’s syndrome </li></ul></ul>
  14. 14. Autistic Disorder <ul><li>Autism </li></ul><ul><ul><li>Significant impairment in social interactions and communication </li></ul></ul><ul><ul><li>Restricted patterns of behavior, interest, and activities </li></ul></ul><ul><li>Three Central DSM-IV and DSM-IV-TR Features of Autism </li></ul><ul><ul><li>Problems in socialization and social function </li></ul></ul><ul><ul><li>Problems in communication – 50% never acquire useful speech </li></ul></ul><ul><ul><li>Restricted patterns of behavior, interests, and activities </li></ul></ul>
  15. 15. Autistic Disorder: Facts and Statistics <ul><li>Prevalence and Features of Autism </li></ul><ul><ul><li>Affects 2 to 20 persons for every 10,000 people </li></ul></ul><ul><ul><li>More prevalent in females with IQs below 35, and in males with higher IQs </li></ul></ul><ul><ul><li>Autism occurs worldwide </li></ul></ul><ul><ul><li>Symptoms usually develop before 36 months of age </li></ul></ul><ul><li>Autism and Intellectual Functioning </li></ul><ul><ul><li>50% have IQs in the severe-to-profound range of mental retardation </li></ul></ul><ul><ul><li>25% test in the mild-to-moderate IQ range (i.e., IQ of 50 to 70) </li></ul></ul><ul><ul><li>Remaining people display abilities in the borderline-to-average IQ range </li></ul></ul><ul><ul><li>Better language skills and IQ test performance predicts better lifetime prognosis </li></ul></ul>
  16. 16. Causes of Autism: Early and More Recent Contributions <ul><li>Historical Views </li></ul><ul><ul><li>Bad parenting </li></ul></ul><ul><ul><li>Unusual speech patterns </li></ul></ul><ul><ul><li>Lack of self-awareness </li></ul></ul><ul><ul><li>Echolalia </li></ul></ul><ul><li>Current Understanding of Autism </li></ul><ul><ul><li>Medical conditions – Not always associated with autism </li></ul></ul><ul><ul><li>Autism has a genetic component that is largely unclear </li></ul></ul><ul><ul><li>Neurobiological evidence for brain damage – Link with mental retardation </li></ul></ul><ul><ul><li>Cerebellum size – Substantially reduced in persons with autism </li></ul></ul>
  17. 17. Treatment of Pervasive Developmental Disorders <ul><li>Psychosocial “Behavioral” Treatments </li></ul><ul><ul><li>Skill building and treatment of problem behaviors </li></ul></ul><ul><ul><li>Communication and language problems </li></ul></ul><ul><ul><li>Address socialization deficits </li></ul></ul><ul><ul><li>Early intervention is critical </li></ul></ul><ul><li>Biological and Medical Treatments Are Unavailable </li></ul><ul><li>Integrated Treatments: The Preferred Model </li></ul><ul><ul><li>Focus on children, their families, parents, schools, and the home </li></ul></ul><ul><ul><li>Build in appropriate community and social support </li></ul></ul>
  18. 18. Mental Retardation (MR) <ul><li>Nature of Mental Retardation </li></ul><ul><ul><li>Disorder of childhood </li></ul></ul><ul><ul><li>Below-average intellectual and adaptive functioning </li></ul></ul><ul><ul><li>Range of impairment varies greatly across persons </li></ul></ul><ul><li>Mental Retardation and the DSM-IV and DSM-IV-TR </li></ul><ul><ul><li>Significantly subaverage intellectual functioning ( IQ below 70 ) </li></ul></ul><ul><ul><li>Concurrent deficits or impairments two or more areas of adaptive functioning </li></ul></ul><ul><ul><li>MR must be evident before the person is 18 years of age </li></ul></ul>
  19. 19. DSM-IV and DSM-IV-TR Levels of Mental Retardation (MR) <ul><li>Mild MR </li></ul><ul><ul><li>Includes persons with an IQ score between 50 or 55 and 70 </li></ul></ul><ul><li>Moderate MR </li></ul><ul><ul><li>Includes persons in the IQ range of 35-40 to 50-55 </li></ul></ul><ul><li>Severe MR </li></ul><ul><ul><li>Includes people with IQs ranging from 20-25 up to 35-40 </li></ul></ul><ul><li>Profound MR </li></ul><ul><ul><li>Includes people with IQ scores below 20-25 </li></ul></ul>
  20. 20. Other Classification Systems for Mental Retardation (MR) <ul><li>American Association of Mental Retardation (AAMR) </li></ul><ul><ul><li>Defines MR based on levels of assistance required </li></ul></ul><ul><ul><li>Examples of levels include intermittent, limited, extensive, or pervasive assistance </li></ul></ul><ul><li>Classification of MR in Educational Systems </li></ul><ul><ul><li>Educable mental retardation (i.e., IQ of 50 to approximately 70-75) </li></ul></ul><ul><ul><li>Trainable mental retardation (i.e., IQ of 30 to 50) </li></ul></ul><ul><ul><li>Severe mental retardation (i.e., IQ below 30) </li></ul></ul>
  21. 21. Mental Retardation (MR): Some Facts and Statistics <ul><li>Prevalence </li></ul><ul><ul><li>About 1% to 3% of the general population </li></ul></ul><ul><ul><li>90% of MR persons are labeled with mild mental retardation </li></ul></ul><ul><li>Gender Differences </li></ul><ul><ul><li>MR occurs more often in males, male-to-female ratio of about 1.6:1 </li></ul></ul><ul><li>Course of MR </li></ul><ul><ul><li>Tends to be chronic, but prognosis varies greatly from person to person </li></ul></ul>
  22. 22. Mental Retardation (MR): Biological Contributions <ul><li>Genetic Research </li></ul><ul><ul><li>MR involves multiple genes, and at times single genes </li></ul></ul><ul><li>Chromosomal Abnormalities and Other Forms of MR </li></ul><ul><ul><li>Down syndrome – Trisomy 21 </li></ul></ul><ul><ul><li>Fragile X syndrome – Abnormality on X chromosome </li></ul></ul><ul><li>Maternal Age and Risk of Having a Down’s Baby </li></ul><ul><li>Nearly 75% of cases cannot be attributed to any known biological cause </li></ul>
  23. 23. Mental Retardation (MR): Psychosocial Contributions <ul><li>Cultural-Familial Retardation </li></ul><ul><ul><li>Believed to cause about 75% of MR cases and is the least understood </li></ul></ul><ul><ul><li>Associated with mild levels of retardation on IQ tests and good adaptive skills </li></ul></ul><ul><li>Cultural-Familial Retardation: Difference vs. Developmental Views </li></ul><ul><ul><li>Difference view – Mild MR is a matter of degree and kind </li></ul></ul><ul><ul><li>Developmental view – Mild MR reflects a slowing or delay of normal development </li></ul></ul>
  24. 24. Treatment of Mental Retardation (MR) <ul><li>Parallels Treatment of Pervasive Developmental Disorders </li></ul><ul><ul><li>Teach needed skills to foster productivity and independence </li></ul></ul><ul><ul><li>Educational and behavioral management </li></ul></ul><ul><ul><li>Living and self-care skills via task analysis </li></ul></ul><ul><ul><li>Communication training – Often most challenging treatment target! </li></ul></ul><ul><ul><li>Community and supportive interventions </li></ul></ul><ul><li>Persons with MR Can Benefit from Such Interventions </li></ul>
  25. 25. Summary of Developmental Disorders <ul><li>Developmental Psychopathology and Normal and Abnormal Development </li></ul><ul><li>Attention Deficit Hyperactivity Disorder </li></ul><ul><ul><li>Deficits in inattention, hyperactivity, or impulsivity </li></ul></ul><ul><ul><li>Disrupt academic and social functioning </li></ul></ul><ul><li>Learning Disorders </li></ul><ul><ul><li>All share deficits in performance below expectations for IQ and school preparation </li></ul></ul><ul><li>Pervasive Developmental Disorder </li></ul><ul><ul><li>All share deficits in language, socialization, and cognition </li></ul></ul><ul><li>Mental Retardation </li></ul><ul><ul><li>Subaverage IQ, deficits in adaptive functioning, onset before age 18 </li></ul></ul><ul><ul><li>Prevention and Early Intervention Are Critical for Developmental Disorders </li></ul></ul>
  26. 26. Cognitive Disorders: An Overview <ul><li>Perspectives on Cognitive Disorders </li></ul><ul><ul><li>Affect cognitive processes such as learning, memory, and consciousness </li></ul></ul><ul><ul><li>Most develop later in life </li></ul></ul><ul><li>Three Classes of Cognitive Disorders </li></ul><ul><ul><li>Delirium – Often temporary confusion and disorientation </li></ul></ul><ul><ul><li>Dementia – Degenerative condition marked by broad cognitive deterioration </li></ul></ul><ul><ul><li>Amnestic disorders – Memory dysfunctions caused by disease, drugs, or toxins </li></ul></ul><ul><li>Shifting DSM Perspectives </li></ul><ul><ul><li>From “organic” mental disorders to “cognitive” disorders </li></ul></ul><ul><ul><li>Broad impairments in memory, attention, perception, and thinking </li></ul></ul><ul><ul><li>Profound changes in behavior and personality </li></ul></ul>
  27. 27. Delirium <ul><li>Nature of Delirium </li></ul><ul><ul><li>Central features – Impaired consciousness and cognition </li></ul></ul><ul><ul><li>Impairments develop rapidly over several hours or days </li></ul></ul><ul><ul><li>Examples include confusion, disorientation, attention, memory, and language deficits </li></ul></ul><ul><li>Facts and Statistics </li></ul><ul><ul><li>Affects 10% to 30% of persons in acute care facilities </li></ul></ul><ul><ul><li>Most prevalent in older adults, AIDS patients, and medical patients </li></ul></ul><ul><ul><li>Full recovery often occurs within several weeks </li></ul></ul>
  28. 28. Medical Conditions Related to Delirium <ul><li>Medical Conditions </li></ul><ul><ul><li>Drug intoxication, poisons, withdrawal from drugs </li></ul></ul><ul><ul><li>Infections, head injury, and several forms of brain trauma </li></ul></ul><ul><ul><li>Sleep deprivation, immobility, and excessive stress </li></ul></ul><ul><li>DSM-IV and DSM-IV Subtypes of Delirium </li></ul><ul><ul><li>Delirium due to a general medical condition </li></ul></ul><ul><ul><li>Substance-induced delirium </li></ul></ul><ul><ul><li>Delirium due to multiple etiologies </li></ul></ul><ul><ul><li>Delirium not otherwise specified </li></ul></ul>
  29. 29. Treatment and Prevention of Delirium <ul><li>Treatment </li></ul><ul><ul><li>Attention to precipitating medical problems </li></ul></ul><ul><ul><li>Psychosocial interventions include reassurance, coping strategies </li></ul></ul><ul><li>Prevention </li></ul><ul><ul><li>Address proper medical care for illnesses </li></ul></ul><ul><ul><li>Address proper use and adherence to therapeutic drugs </li></ul></ul>
  30. 30. Dementia <ul><li>Nature of Dementia </li></ul><ul><ul><li>Gradual deterioration of brain functioning </li></ul></ul><ul><ul><li>Affects judgment, memory, language, and advanced cognitive processes </li></ul></ul><ul><ul><li>Dementia has many causes and may be reversible or irreversible </li></ul></ul><ul><li>Progression of Dementia: Initial Stages </li></ul><ul><ul><li>Memory impairment, visuospatial skills deficits </li></ul></ul><ul><ul><li>Agnosia – Inability to recognize and name objects (most common symptom) </li></ul></ul><ul><ul><li>Facial agnosia – Inability to recognize familiar faces </li></ul></ul><ul><ul><li>Other symptoms – Delusions, depression, agitation, aggression, and apathy </li></ul></ul><ul><li>Progression of Dementia: Later Stages </li></ul><ul><ul><li>Cognitive functioning continues to deteriorate </li></ul></ul><ul><ul><li>Person requires almost total support to carry out day-to-day activities </li></ul></ul><ul><ul><li>Death results from inactivity combined with onset of other illnesses </li></ul></ul>
  31. 31. Dementia: Facts and Statistics <ul><li>Onset and Prevalence </li></ul><ul><ul><li>Can occur at any age, but most common in the elderly </li></ul></ul><ul><ul><li>Affects 1% of those between 65-74 years of age </li></ul></ul><ul><ul><li>Affects over 10% of persons 85 years and older </li></ul></ul><ul><ul><li>47% of adults over the age of 85 have dementia of the Alzheimer’s type </li></ul></ul><ul><li>Incidence of Dementia </li></ul><ul><ul><li>Affects 2.3% of those 75-79 years of age and 8.5% of persons 85 and older </li></ul></ul><ul><ul><li>Rates of new cases appear to double with every 5 years of age </li></ul></ul><ul><li>Gender and Sociocultural Factors </li></ul><ul><ul><li>Dementia occurs equally in men and women </li></ul></ul><ul><ul><li>Dementia occurs equally across educational level and social class </li></ul></ul>
  32. 32. DSM-IV and DSM-IV-TR Classes of Dementia <ul><li>Dementia of the Alzheimer’s type </li></ul><ul><li>Vascular Dementia </li></ul><ul><li>Dementia Due to Other General Medical Conditions </li></ul><ul><li>Substance-Induced Persisting Dementia </li></ul><ul><li>Dementia Due to Multiple Etiologies </li></ul><ul><li>Dementia Not Otherwise Specified </li></ul>
  33. 33. Dementia of the Alzheimer’s Type <ul><li>DSM-IV-TR Criteria and Clinical Features </li></ul><ul><ul><li>Multiple cognitive deficits that develop gradually and steadily </li></ul></ul><ul><ul><li>Predominant impairment in memory, orientation, judgment, and reasoning </li></ul></ul><ul><ul><li>Can include agitation, confusion, depression, anxiety, or combativeness </li></ul></ul><ul><ul><li>Symptoms are usually more pronounced at the end of the day </li></ul></ul><ul><li>Range of Cognitive Deficits </li></ul><ul><ul><li>Aphasia – Difficulty with language </li></ul></ul><ul><ul><li>Apraxia – Impaired motor functioning </li></ul></ul><ul><ul><li>Agnosia – Failure to recognize objects </li></ul></ul><ul><ul><li>Difficulties with planning, organizing, sequencing, or abstracting information </li></ul></ul><ul><ul><li>Impairments have a marked negative impact on social and occupational functioning </li></ul></ul><ul><li>An Autopsy Is Required for a Definitive Diagnosis </li></ul>
  34. 34. Alzheimer’s Disease: Some Facts and Statistics <ul><li>Nature and Progression of the Disease </li></ul><ul><ul><li>Deterioration is slow during the early and later stages, but rapid during middle stages </li></ul></ul><ul><ul><li>Average survival time is about 8 years </li></ul></ul><ul><ul><li>Onset usually occurs in the 60s or 70s, but may occur earlier </li></ul></ul><ul><li>Prevalence of Alzheimer’s Disease </li></ul><ul><ul><li>Affects about 4 million Americans and many more worldwide </li></ul></ul><ul><ul><li>Prevalence is greater in poorly educated persons and women </li></ul></ul><ul><ul><li>Prevalence rates are low in some ethnic groups (e.g., Japanese, Nigerian, Amish) </li></ul></ul>
  35. 35. Vascular Dementia <ul><li>Nature of Vascular Dementia </li></ul><ul><ul><li>Progressive brain disorder caused by blockage or damage to blood vessels </li></ul></ul><ul><ul><li>Second leading cause of dementia next to Alzheimer’s </li></ul></ul><ul><ul><li>Onset is often sudden (e.g., stroke) </li></ul></ul><ul><ul><li>Patterns of impairment are variable, and most require formal care in later stages </li></ul></ul><ul><li>DSM-IV and DSM-IV Criteria and Incidence </li></ul><ul><ul><li>Cognitive disturbances are identical to dementia </li></ul></ul><ul><ul><li>Unlike Alzheimer’s, obvious neurological signs of brain tissue damage occur </li></ul></ul><ul><ul><li>Incidence is believed to be about 4.7% or men and 3.8% of women </li></ul></ul>
  36. 36. Dementia Due to HIV Disease <ul><li>Overview and Clinical Features </li></ul><ul><ul><li>HIV causes neurological impairments and dementia </li></ul></ul><ul><ul><li>Cognitive slowness, impaired attention, forgetfulness, and clumsiness </li></ul></ul><ul><ul><li>Repetitive movements (e.g., tremors/leg weakness), apathy, and social withdrawal </li></ul></ul><ul><li>Progression of HIV-Related Cognitive Impairments </li></ul><ul><ul><li>Tend to occur during the later stages of HIV infection </li></ul></ul><ul><ul><li>Impairments are observed in 29% to 87% of people with AIDS </li></ul></ul><ul><ul><li>Subcortical dementia – Refers to deficits that affect inner brain regions </li></ul></ul><ul><ul><li>Aphasia is uncommon in subcortical dementia, but anxiety and depression occur </li></ul></ul>
  37. 37. Other Causes of Dementia: Head Trauma and Parkinson’s Disease <ul><li>Head Trauma </li></ul><ul><ul><li>Accidents are leading causes of such cognitive impairments </li></ul></ul><ul><ul><li>Memory loss is the most common symptom </li></ul></ul><ul><li>Parkinson’s Disease </li></ul><ul><ul><li>Degenerative brain disorder </li></ul></ul><ul><ul><li>Affects about 1 out of 1,000 people worldwide </li></ul></ul><ul><ul><li>Motor problems are characteristic of this disorder </li></ul></ul><ul><ul><li>Damage to dopamine pathways is believed to cause motor problems </li></ul></ul><ul><ul><li>Pattern of impairments are similar to subcortical dementia </li></ul></ul>
  38. 38. Other Causes of Dementia: Huntington’s and Pick’s Disease <ul><li>Huntington’s Disease </li></ul><ul><ul><li>Genetic autosomal dominant disorder (i.e., chromosome 4) </li></ul></ul><ul><ul><li>Manifests initially as chorea, usually later in life (around 40s or 50s) </li></ul></ul><ul><ul><li>About 20% to 80% of persons go on to display dementia of the subcortical pattern </li></ul></ul><ul><li>Pick’s Disease </li></ul><ul><ul><li>Rare neurological condition that produces a cortical dementia like Alzheimer’s </li></ul></ul><ul><ul><li>Also occurs later in life (around 40s or 50s) </li></ul></ul><ul><ul><li>Little is known about what causes this disease </li></ul></ul>
  39. 39. Other Dementias: Creutzfeldt-Jakob Disease and Substance-Induced Dementia <ul><li>Creutzfeldt-Jakob Disease </li></ul><ul><ul><li>Affects 1 out of 1,000,000 persons </li></ul></ul><ul><ul><li>Linked to mad cow disease </li></ul></ul><ul><li>Substance-Induced Persisting Dementia </li></ul><ul><ul><li>Results from drug use in combination with poor diet </li></ul></ul><ul><ul><li>Examples include alcohol, inhalants, and sedative, hypnotic, and anxiolytic drugs </li></ul></ul><ul><ul><li>Resulting brain damage may be permanent </li></ul></ul><ul><ul><li>Dementia is similar to that of Alzheimer’s </li></ul></ul><ul><ul><li>Deficits may include aphasia, apraxia, agnosia, or disturbed executive functioning </li></ul></ul>
  40. 40. Causes of Dementia: The Example of Alzheimer’s Disease <ul><li>Early and Largely Unsupported Views: The Example of Smoking </li></ul><ul><li>Current Neurobiological Findings </li></ul><ul><ul><li>Neurofibrillary tangles – Occur in all brains of Alzheimer’s patients </li></ul></ul><ul><ul><li>Amyloid plaques – Accumulate excessively in brains of Alzheimer’s patients </li></ul></ul><ul><ul><li>Brains of Alzheimer’s patients tend to atrophy </li></ul></ul><ul><li>Current Neurobiological Findings </li></ul><ul><ul><li>Multiple genes are involved in Alzheimer’s disease (chromosomes 21, 19, 14, 12, 1) </li></ul></ul><ul><ul><li>Chromosome 14 – Associated with early onset Alzheimer’s </li></ul></ul><ul><ul><li>Chromosome 19 – Associated with a late onset Alzheimer’s </li></ul></ul>
  41. 41. The Contributions of Psychosocial Factors in Dementia <ul><li>Do not cause dementia directly, but may influence onset and course </li></ul><ul><li>Lifestyle factors – Drug use, diet, exercise, stress </li></ul><ul><li>Cultural factors – Risk for certain diseases and accidents vary by ethnicity and class </li></ul><ul><li>Psychosocial factors – Educational attainment, coping skills, social support </li></ul>
  42. 42. Medical and Psychosocial Treatment of Dementia <ul><li>Medical Treatment: Best if Enacted Early </li></ul><ul><ul><li>Few medical treatments exist for most types of dementia </li></ul></ul><ul><ul><li>Most medical treatments attempt to slow progression of deterioration </li></ul></ul><ul><ul><li>Examples include glial cell-derived neurotrophic factor, Cognex, vitamin E, aspirin </li></ul></ul><ul><ul><li>Medical treatments do not stop progression of dementia </li></ul></ul><ul><li>Psychosocial Treatments </li></ul><ul><ul><li>Focus on enhancing the lives of dementia patients and their families/caregivers </li></ul></ul><ul><ul><li>Teach adaptive skills </li></ul></ul><ul><ul><li>Use memory enhancement prosthetic devices (e.g., memory wallet) </li></ul></ul><ul><ul><li>Main emphasis of psychosocial interventions appears to be on the caregivers </li></ul></ul>
  43. 43. Prevention of Dementia <ul><li>Reducing Risk of Dementia in Older Adults Via </li></ul><ul><ul><li>Estrogen-replacement therapy – Reduces risk of Alzheimer’s dementia in women </li></ul></ul><ul><ul><li>Proper treatment of cardiovascular diseases </li></ul></ul><ul><ul><li>Use of anti-inflammatory medications </li></ul></ul><ul><li>Other Targets of Prevention Efforts </li></ul><ul><ul><li>Increasing safety behaviors to reduce head trauma </li></ul></ul><ul><ul><li>Reducing exposure to neurotoxins and use of drugs </li></ul></ul>
  44. 44. Amnestic Disorder <ul><li>Nature of Amnestic Disorder </li></ul><ul><ul><li>Inability to transfer information from short-term memory into long-term memory </li></ul></ul><ul><ul><li>Often results from medical conditions, head trauma, or long-term drug use </li></ul></ul><ul><li>DSM-IV and DSM-IV-TR Criteria for Amnestic Disorder </li></ul><ul><ul><li>Cover the inability to learn new information </li></ul></ul><ul><ul><li>Inability to recall previously learned information </li></ul></ul><ul><ul><li>Memory disturbance causes significant impairment in functioning </li></ul></ul><ul><li>The Example of Wernicke-Korsakoff Syndrome </li></ul><ul><ul><li>Caused by thalamic damage resulting from stroke or chronic heavy alcohol use </li></ul></ul><ul><ul><li>Attempt to restore thiamine deficiency in the case of chronic alcohol abuse </li></ul></ul><ul><li>Research on Amnestic Disorders Is Scant </li></ul>