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What are cognitive disorders?
Clinically significant deficits in cognition that represent a significant change from a previous level of functioning.
May affect: sensation/perception, motor skills, attention, memory, thinking, language, emotion, comportment.
What are the common causes of cognitive disorders?
- Traumatic brain injuries
- Vascular disorders
- Amnestic disorders
What are the causes of brain damage?
- Degenerative disease, e.g. Huntingtons, Parkinsons, Alzheimers, dementia
- Nutritional deficiencies, e.g. Korsakoff's
- Toxic disorders, i.e. exposure to certain metals, gases, toxins, and plants.
What are the types of brain damage?
- ~ Focal: localised damage, small or well differentiated area
- ~ Diffuse axonal: axon and cell damage across a wide range of areas with mild pathology
- ~ Lateralised: effects confined to one hemisphere
- ~ Generalised: widespread damage with multiple symptoms.
- Traumatic brain injury:
- ~ Open head injury: primarily focal damage at site of injury, some diffuse damage leading to problems with attention and speed of information processing
- ~ Close head injury: mainly diffuse damage with common emphasis on frontal and temporal lobes. Personality changes, deregulation of behaviour, memory problems.
Often impairments of executive function after TBI.
TBI leads to poor recognition of emotional expressions, reduce empathy and reduce facial mimicry to negative expressions.
What is dementia?
Progressive condition marked by a gradual deterioration of a range of cognitive abilities.
- DSM criteria:
- ~ Impairment in memory
- ~ At least one other cognitive dysfunction to a degree that there is significant impairment in social or occupational functioning.
What are the 5 main classes of dementia?
- Vascular dementia
- Dementia due to other medical conditions
- Substance induced
- Multiple etiologies
What are some factors influencing dementia?
- Psychosocial factors influence the course of dementia, e.g. education as a buffer, coping skills, cultural acceptance.
- Survival rates alter the outcomes - makes prevalence rates hard to determine (because women live longer they are more likely to experience dementia)
- HIV can cause dementia. Affects mainly inner areas of the brain - mood changes and motor impairments.
- Parkinsons and Huntingtons are both associated with dementia.
- Education levels predicts a delay in the presentation of symptoms - the more synapses a person develops the more neuronal death must occur before dementia is obvious.
What is Alzheimers?
- The most common form of dementia.
- Cortical degeneration.
- Typically diagnosed on death (need autopsy to identify plaques and tangles), but new imaging techniques means it can be diagnosed earlier.
- There is a lot of brain loss involved. Relying on tiny patches of the cortex.
- Effects include: poor recent memory, deficits in judgement and reasoning, poor planning, naming difficulties, personality changes.
What is Korsakoff's dementia?
- Alcohol abuse leads to damage to the thalamus.
- Severe loss of retention - memory span disappears.
What is frontotemporal dementia?
- Chiefly affects the frontal and temporal lobes.
- Poor organisation, ineffective learning, susceptible to interference.
- No evidence of rapid forgetting,
- Often a very quick course and younger onset.
- Connection to motor-neurone disease.
- Behavioural variant FTD: mainly affects the frontal lobe. Lack of insight, disinhibition/impulsivity, apathy, inertia, personal neglect, stereotypic behaviour, changes in eating habits.
- Semantic dementia: mainly affects anterior temporal lobe. Loss of memory for words, word comprehension difficulties, impaired recognition of objects/faces.
What is vascular dementia?
- Blocked/damaged blood vessels in the brain.
- Profile varies from person to person depending on where the blockage is.
- More common in men (high incidence of cardiovascular disease)
- More sudden onset.
What are the treatments for dementia?
- Prevent conditions that might trigger onset, e.g. substance abuse.
- Delaying onset of symptoms to provide better quality of life: biological treatments to stop cerebral deterioration, stem cells (?), drugs to enhance cognitive abilities of Alzheimers (increasing the neurotransmitter acetycholine or targeting plaques)
- Helping individuals and caregivers with advancing deterioration (taught skills to compensate)
What are amnestic disorders?
Inability to learn new information or to recall previously learned information.
Most people who complain of memory problems don't have an organic impairment.
- Retrograde amnesia: loss of memory for events prior to trauma
- Anterograde amnesia: loss of memory for events after trauma.
- Amnesia vs ....:
- ~ Dementia: memory impairment accompanied by other cognitive impairments in dementia
- ~ Delirium: memory impairment occurs within attention/concentration impairments in delirium
- ~ Normal ageing: significant impairments to social and occupation functioning required for diagnosis
- ~ Dissociative disorders: patients with dissociative disorders are more likely to have lost their orientation to self.
- ~ Factitious disorder: inconsistent results on memory tests. No evidence of identifiable cause.
What is delirium?
An often temporary condition displayed as confusion and disorientation.
May be caused by a medical condition, substance use, or withdrawal.
Acute onset. Typically resolves with medical attention.
- Delirium vs. ...... :
- ~ Psychosis: patients with psychotic disorders may have periods of extremely disorganised behaviour difficult to distinguish from delirium.
- ~ Schizophrenia: hallucinations and delusions of patients with schizophrenia are more constant and better organised.
- ~ Depression: hypoactive delirium may appear similar to depression. EEG differentiates.
Preventative efforts may be successful in assisting people, e.g. proper medical care for illnesses and therapeutic drug monitoring.
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