chapter 13 neurocognitive disorders copyright © 2014 mcgraw-hill education. all rights reserved. no...
TRANSCRIPT
CHAPTER 13
NEUROCOGNITIVE DISORDERS
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CHARACTERISTICS OFNEUROCOGNITIVE DISORDERS
• These disorders involve cognitive decline acquired in life in one or more domains of cognition.• Based upon concerns of the client or someone who knows the client
well, and performance on objective assessment measures.
• The DSM-5 provides descriptions to help clinicians provide a diagnosis that indicates both the fact that the individual has a neurocognitive disorder and, where known, the possible cause.
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NEUROCOGNITIVE DISORDERS
• In DSM-5, the term neurocognitive disorder replaces dementia
• Refers to a form of cognitive impairment in which individuals undergo progressive loss of cognitive functions severe enough to interfere with their normal daily activities and social relationships.
• Clinicians still use the term “dementia,” and the DSM-5 work group considered dementia to be useful in settings where medical personnel are familiar with the term.
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DELIRIUM
• A neurocognitive disorder that is temporary in nature involving disturbances in attention or awareness.
• A temporary state in which individuals experience a clouding of consciousness• Unaware of what is happening around them • Unable to focus or pay attention
• The symptoms tend to appear abruptly and fluctuate over the course of the time that they have the disorder
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DELIRIUM
• Develops for a variety of reasons• Substance intoxication• Substance withdrawal• Head injury• High fever• Vitamin deficiency
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DELIRIUM
• Causes• Infection• Central nervous system disorder• Metabolic disorders
• Tests and treatment• Delirium Rating Scale-Revised• Pharmacological approach• Haloperidol and respiridone
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NEUROCOGNITIVE DISORDER DUE TOALZHEIMER’S DISEASE
• This is a neurocognitive disorder associated with progressive, gradual declines in memory, learning, and at least one other cognitive domain.
• Progressive and gradual cognitive deficits due to severe cerebral atrophy
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DIAGNOSTIC CRITERIA FOR NEUROCOGNITIVE DISORDER DUE
TO ALZHEIMER’S DISEASE
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FIGURE 13.1 - CHANGES INTHE BRAIN ASSOCIATED WITH
ALZHEIMER’S DISEASE
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STAGES OF ALZHEIMER’S DISEASE
• Not Alzheimer• Early-stage• Middle-stage• Late-stage
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STAGES OF ALZHEIMER’S DISEASE
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DIAGNOSIS OF ALZHEIMER’S DISEASE
• Brain imaging techniques• Neuropsychological testing• NINCDS/ADRDA guidelines• Mini-Mental State Examination
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PSEUDODEMENTIA
• False dementia, symptoms caused by depression that mimic those apparent in early stages of Alzheimer's
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THEORIES AND TREATMENT OF ALZHEIMER’S DISEASE
• All theories regarding the cause of Alzheimer’s disease focus on biological abnormalities involving the nervous system.
• Neurofibrillary tangles• Tau• Amyloid plaques• Secretases
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FIGURE 13.3 - NEUROFIBRILLARYTANGLE
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FIGURE 13.4 - DEVELOPMENT OF AMYLOID PLAQUES
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RISK FACTORS FOR ALZHEIMER'S DISEASE
• Cigarette smoking• Obesity• Lack of physical exercise
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MECHANISM OF ACTION AND SIDE EFFECTS OF ALZHEIMER’S
MEDICATIONS
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BEHAVIORAL STRATEGIES
• Behavioral psychologists are developing strategies to maximize the daily functioning of people with Alzheimer’s disease.
• Target both patient and caregiver to:• Increase patient independence• Eliminate wandering and aggression• Provide social support for caregivers
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NEUROCOGNITIVE DISORDERS DUE TONEUROLOGICAL DISORDERS OTHER THAN
ALZHEIMER’S DISEASECAUSES THAT INCLUDE DEGENERATIVE
NEUROLOGICAL CONDITIONS OTHER THAN ALZHEIMER’S DISEASE
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NEUROCOGNITIVE DISORDERS DUE TONEUROLOGICAL DISORDERS OTHER THAN
ALZHEIMER’S DISEASE
• Fronto-temporal neurocognitive disorder- Neurocognitive disorder that involves the fronto-temporal area of the brain.
• Symptoms are reflected in personality changes:• Apathy, lack of inhibition, obsessiveness, and loss of
judgment.
• Neglect of personal habits and loss of the ability to communicate eventually occurs.
• The onset of the disorder is slow and insidious.Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the
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NEUROCOGNITIVE DISORDER WITH LEWY BODIES
• A form of neurocognitive disorder with progressive loss of:• Memory• Language• Calculation• Reasoning and higher mental functions
• Results from the accumulation of abnormalities called Lewy bodies throughout the brain.
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• Vascular neurocognitive disorder A form of neurocognitive disorder resulting from a vascular disease that causes deprivation of the blood supply to the brain.
• multi-infarct dementia (MID), caused by transient attacks in which blood flow to the brain is interrupted by a clogged or burst artery.
• Although each infarct is too small to be noticed at first, over time the progressive damage caused by the infarcts leads the individual to lose cognitive abilities
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PICK’S DISEASE
• A relatively rare progressive degenerative disease that affects the cerebral cortex’s frontal and temporal lobes.
• It is caused by the accumulation in neurons of unusual protein deposits
• In addition to memory problems, people with this disorder become socially disinhibited, acting either inappropriately and impulsively or appearing apathetic and unmotivated.
• Unlike Alzheimer’s Disease, personality alterations occur before memory problems.
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NEUROCOGNITIVE DISORDER DUE TO PARKINSON’S DISEASE
• A neurocognitive disorder that involves degeneration of neurons in the subcortical structures that control motor movements.
• At rest, hands, ankles, or head may shake involuntarily
• Akinesia: Muscular rigidity, difficulty initiating movement
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PARKINSON’S DISEASE SYMPTOMS
• Bradykinesia: General slowing of motor activity• Loss of fine motor coordination• Slowed, shuffling gait• Difficulty starting or stopping movement like walking• Signs of cognitive deterioration• Expressionless and speech becomes stilted
• Many cognitive functions, such as attention, concentration, and immediate memory, remain intact.
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ADDITIONAL NEUROCOGNITIVE DISORDERS
• Huntington’s disease• Creutzfeldt-Jakob disease
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FIGURE 13.6 - OTHER DISEASES THAT CAN CAUSE DETERIORATION IN COGNITIVE
FUNCTION
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NEUROCOGNITIVE DISORDERDUE TO TRAUMATIC BRAIN INJURY
• Traumatic Brain Injury (TBI)- Damage to the brain caused by exposure to trauma.
• Post-concussion syndrome: Constellation of physical, emotional, and cognitive symptoms persists from weeks to years
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NEUROCOGNITIVE DISORDERS DUE TOANOTHER GENERAL MEDICAL CONDITION
• Previously referred to as amnesia
• Amnesia is the inability to recall information that was previously learned or to register new memories.
• Can result from a wide variety of medical problems, including:• Head trauma• Loss of oxygen• herpes simplex
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SUBSTANCE-INDUCED NEUROCOGNITIVE DISORDER
• Medications• Illicit drugs• Lead• Mercury• Insecticides • Industrial solvents
• The most common cause:• Chronic alcohol use
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BIOPSYCHOSOCIAL PERSPECTIVE
• No viable treatment for Alzheimer’s disease
• Computer networks - Innovative, high-technology methods for reducing the stress placed on caregivers
• Traditional approach – Emotional support
• Cognitive-behavioral
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