Chapter 14: Neurocognitive Disorders

Question 1

T or F: changes in cognitive functioning are the most obvious signs of a damaged brain.

Answer 1

True.

Question 2

Why are neurocognitive disorders discussed in an abnormal psychology text?

Answer 2

1. These disorders are regarded as psychopathological conditions.
2. Some brain disorders cause symptoms that look remarkably like other abnormal psychology disorders
3. Brain damage can cause changes in behaviour, mood, and personality.
4. Many people who suffer from brain disorders (e.g., people who are diagnosed as having Alzheimer’s disease) react to the news of their diagnosis with depression or anxiety.
5. Neurocognitive disorders take a heavy toll on family members, who, for many patients, must shoulder the bur-den of care. Again, depression and anxiety in relatives of the patients themselves are not uncommon.

Question 3

What types of disorders fall into neurocognitive disorders?

Answer 3

Disorders in this category are those that involve a loss of previously attained cognitive ability and where the presumed cause is brain damage or disease.

Question 4

What are the subsections of neurocognitive disorders in the DSM-5?

Answer 4

Subsections of this diagnostic category include delirium, major neurocognitive disorder (which includes the former diagnosis of dementia), and a new category of mild neurocognitive disorder.

Question 5

What are focal brain lesions?

Answer 5

Involve circumscribed areas of abnormal change in brain structure. This is the kind of damage that might occur with a sharply defined traumatic injury or an interruption of blood supply (a stroke) to a specific part of the brain.

Question 6

What is delirium?

Answer 6

Delirium is a state of acute brain failure that lies between

normal wakefulness and stupor or coma

Question 7

What is delirium characterized by?

Answer 7

confusion, disturbed concentration, and cognitive dysfunction; it can quickly fluctuate in severity; involves impairments of memory and attention as well as disorganized thinking; hallucinations and delusions are quite common; abnormal psychomotor activity such as wild thrashing about and disturbance of the sleep cycle

Question 8

Age group most at risk for experiencing delirium?

Answer 8

Elderly are at particularly high risk (patients over age 80 being particularly at risk); children are also at high risk of delirium (perhaps because their brains are not yet fully developed).

Question 9

Delirium may result from several conditions including head injury and infection, but what is the cause of delirium?

Answer 9

Drug intoxication or withdrawal; toxicity from medications also causes many cases of delirium.

Question 10

T or F: Most cases of delirium are reversible

Answer 10

True, except when the delirium is caused by a terminal illness or by severe brain trauma.

Question 11

What does the treatment of delirium involve?

Answer 11

Treatment involves medication (neuroleptics; benzodiazepines for delirium caused by alcohol or drug withdrawal), environmental manipulations, and family support.

Question 12

What subsection does dementia now fall under in the DSM-5?

Answer 12

Major neurocognitive disorder

Question 13

Major neurocognitive disorders are characterized by?

Answer 13

Deficits in attention, executive ability, learning and memory, language, perception, and social cognition
(skills required for understanding, interpreting, and responding to the behaviour of others).

Question 14

Name some of the causes of cognitive deficits that are now included in the category of major neurocognitive disorders

Answer 14

Parkinson’s disease and Huntington’s disease; strokes; certain infectious diseases such as syphilis, meningitis, and AIDS; intracranial tumours and abscesses; certain dietary deficiencies (especially of the
B vitamins); severe or repeated head injury; anoxia (oxygen deprivation); and the ingestion or inhalation of toxic sub-stances such as lead or mercury.

Question 15

T or F: The most common cause of major neurocognitive disorder is degenerative brain disease, particularly Alzheimer’s disease.

Answer 15

True.

Question 16

What is Parkinson’s disease?

Answer 16

Characterized by motor symptoms such as resting tremors or rigid movements. The underlying cause of this is loss of dopamine neurons in an area of the brain called the substantia nigra; can involve psychological symptoms such as depression, anxiety, apathy, cognitive problems, and even hallucinations and delusions

Question 17

What is Huntington’s disease?

Answer 17

rare degenerative disorder of the central nervous system; characterized by a chronic, progressive chorea (involuntary and irregular movements that flow randomly from one area of the body to another). However, subtle cognitive problems often predate the onset of motor symptoms by many years. Patients eventually develop dementia, and death usually occurs within 10 to 20 years of first developing the illness.

Question 18

Does Parkinson’s or Huntington’s impact more men in contrast to women?

Answer 18

Parkinson’s impacts more men than women. Huntington’s impacts both genders equally.

Question 19

What is Alzheimer’s disease?

Answer 19

a progressive and fatal neurode-generative disorder.

Question 20

What is the significance regarding the temporal lobes of the brain being the first regions to be damaged in the person with Alzheimer’s disease?

Answer 20

Because the hippocampus is located here, memory impairment is an early symptom of the disease. Loss of brain tissue in the temporal lobes may also explain why delusions are found in some patients

Question 21

T or F: women seem to have a higher risk of developing Alzheimer’s disease than men

Answer 21

True.

Question 22

Why is loneliness a relevant factor when considering the gender differences in alzheimer’s?

Answer 22

• those who reported that they felt lonely had twice the risk of developing Alzheimer’s disease
• reasonable to suggest that women are more likely to experience loneliness because they live longer and so outlive their husbands.

Question 23

What is a causal factor for early-onset Alzheimer’s disease?

Answer 23

Rare genetic mutations, which involve the APP (amyloid precursor protein) gene (chromosome 21), mutations of a gene on chromosome 14 called presenilin 1 (PS1), and with a mutation of the presenilin 2 (PS2) gene on chromosome 1.

*probably account, together, for no more than about 5 percent of cases of Alzheimer’s disease.

Question 24

What is a gene that plays into late-onset Alzheimer’s disease?

Answer 24

APOE (apolipoprotein) gene on chromosome 19.

Question 25

T or F: One prospective study has found that traumatic brain injury is associated, for up to 5 years after the injury, with a fourfold increase in the risk of developing Alzheimer’s disease

Answer 25

True.

Question 26

Regarding neuropathology, what are characteristics of Alzheimers?

Answer 26

(1) amyloid plaques, (2) neurofibrillary tangles, and (3) atrophy (shrinkage) of the brain. Although plaques and tangles are also found in normal brains, they are present in much greater numbers in patients with Alzheimer’s disease, particularly in the temporal lobes.

Question 27

What are amyloid plaques (Alzheimers)?

Answer 27

Neurons in the brain secrete a sticky protein substance called beta amyloid much faster than it can be broken down and cleared away. This beta amyloid (toxic, causes cell death) then accumulates into amyloid plaques. These are thought to interfere with synaptic functioning and to set off a cascade of events that leads to the death of brain cells.

Question 28

What are neurofibrillary tangles (Alzheimers)?

Answer 28

Webs of abnormal filaments within a nerve cell. These filaments are made up of another protein called tau. In a normal, healthy brain, tau acts like scaffolding, supporting a tube inside neurons and allowing them to conduct nerve impulses. In Alzheimer’s disease the tau is misshaped and tangled. This causes the neuron tube to collapse.

*there is reason to believe that buildup of tau
protein is accelerated by an increasing burden of amyloid in the brain

Question 29

What does the neurotransmitter, acetylcholine, do? What does this neurotransmitter do for those with Alzheimers?

Answer 29

This neurotransmitter is known to be important in the mediation of memory.

*The reduction in brain ACh activity in patients with Alzheimer’s disease is correlated with the extent of neuronal damage (i.e., plaques, tangles) that they have sustained. The loss of cells that produce ACh makes a bad situa-tion much worse. Because ACh is so important in memory, its depletion contributes greatly to the cognitive and behavioral deficits that are characteristic of Alzheimer’s disease.

Question 30

T or F: Carriers of the APOE-E4 allele may have to work harder to prevent the development of Alzheimers.

Answer 30

True. Because their brain tissue is still healthy (unlike in people with Alzheimer’s disease or Minor Cognitive Impairment - MCI), we see an increase in brain activation in response to a cognitive challenge rather than the decrease in activation that is more typical of patients with Alzheimer’s disease or those with MCI.

Question 31

Why is providing caregivers with counseling and supportive therapy is very beneficial?

Answer 31

To prevent them from isolating themselves, developing depression, and increasing their own risk for Alzheimers.

Question 32

How is the HIV virus is capable of inducing neurological disease that can result in neurocognitive problems?

Answer 32

1. First, because the immune system is weakened, people with HIV are more susceptible to rare infections caused by parasites and fungi.
2. HIV-associated neurocognitive impairment involves various changes in the brain, among them generalized atrophy, edema (swelling), inflammation, and patches of demyelination

Question 33

What is vascular dementia?

Answer 33

In this disorder, a series of circumscribed cerebral infarcts—interruptions of the blood supply to minute areas of the brain because of arterial disease, commonly known as “small strokes”—cumulatively destroy neurons over expanding brain regions.

*the progressive loss of cells leads to brain atrophy and behavioural impairments that ultimately mimic those of Alzheimer’s dis-ease

Question 34

T or F: Accompanying mood disorders are also more common in vascular dementia than in Alzheimer’s disease

Answer 34

True, perhaps because subcortical areas of the brain are more affected

Question 35

What does amnestic disorder (term replaced with major neurocognitive disorder in DSM-5) involve?

Answer 35

Short-term memory is typically so impaired that the person is unable to recall events that took place only a few minutes previously.

*cognitive functioning in a patient with amnestic disorder is often quite good.

Question 36

T or F: Brain damage is the root cause of amnestic disorder.

Answer 36

True, damage might be caused by strokes, injury, tumours, or infections

Question 37

What is Korsakoff’s syndrome?

Answer 37

An amnestic disorder that is caused by a vitamin B1 (thiamine) deficiency. The memory problems associated with Korsakoff’s syndrome can sometimes be reversed if the syndrome is detected very early and vita-min B1 is given. Korsakoff’s syndrome is often found in people with chronic alcoholism or in those who do not eat a healthy diet.

Question 38

The most common causes of Traumatic brain injury (TBI) are?

Answer 38

Falls (followed by motor vehicle accidents).

Question 39

What is retrograde amnesia?

Answer 39

inability to recall events immediately preceding the injury

Question 40

What is anterograde amnesia?

Answer 40

inability to store effectively in memory events that happen during variable periods of time after the trauma

*regarded by many as a negative prognostic sign.

Question 41

What is a factor that may increase a person’s susceptibility to having problems after a brain injury?

Answer 41

One important risk factor appears to be the presence of the APOE-E4 allele. *Found to be associated with more chronic neurological deficits