Part 3: Cognitive Disorders

Question 1

Current category in the DSM is Neurocognitive Disorders.

Answer 1

• Delirium
• Minor Cognitive Disorder (Minor=1 symptom)—used to be called “minimal brain damage”
• Major Cognitive Disorder (Major= 2+)

Question 2

Indices of Organicity

Answer 2

“indicators of brain involvement”
Memory Loss– Most common, frequent evidence of brain involvement. Patients who exhibit memory loss engage in three behaviors:
1. Irritability: they are upset because they know that they should know the answer, but they don’t
2. Distraction: they try to distract you so they don’t have to answer questions they don’t know the answer to
3. Confabulation: they make things up to fill in the gaps of things they don’t know so they don’t feel stupid
Severe Symptoms—if you think something is extremely strange or out of the ordinary, this is a red flag for a medical exam
All others are ruled out—before you diagnose someone as “NOS,” consider the possibility of a neurocognitive disorder.
Movement Disorders—indicators of brain dysfunction.
Anorexia—there are brain syndromes that present as anorexia
Psychosis after 50—schizophrenia doesn’t start at 50 (if an individual doesn’t have a history of psychotic behavior…it is unlikely it is a mental illness)

Question 3

Brain Damage

Answer 3

Diffuse: meaning widespread, involving large portions; usually caused by disease, oxygen deprivation, and toxic substances
-Dementia
-Delirium
Focal: meaning more localized, concentration; usually caused by trauma
-Open
-Closed (does more extensive damage because of swelling, bleeds, rotation, Coup Contra Coup[if the skull doesn’t give, your brain absorbs the impact in multiple places])

Question 4

Dementia

Answer 4

Etiology (Study of Causes)
-Disease
-Drugs/Toxic substances
-Brain Trauma (accumulation of injuries (concussions, falls) over time)
-Age (debatable)
Terms (need to know them…see text book)
	-Aphasia: 
	-Apraxia:
	-Agnosia:
	-Ataxia:

Question 5

Delirium

Answer 5

Diagnosis
	-Disturbed consciousness
	-Disturbed cognition
Etiology
	-Drugs
	-Poisons
	-Metabolic
	-Infections
	-Brain trauma
*Blood is poison to the brain—this is why our bodies have a blood-brain barrier

Question 6

Alzheimer’s

Answer 6

A type of dementia
Sundowning (not specific to Alzheimer’s, but can be present in all dementias): symptoms get worse at night. Why? Patients get tired, low on energy—just like we do
Mortality—Alzheimer’s doesn’t kill you, its just a contributor
Diagnosis—due to treatment options, early diagnosis is most desirable; best early diagnosis is the neuropsychology assessment tests (accuracy rate is in the high 90’s)
-Suspected (until autopsy)
-Amyloid Plaques
-Neurofibrillary Tangles
-Misdiagnosis
Nun Study—Cognitive Reserve Ho: Elderly nuns (past 100 years old) who were modern and proactive—learned violin, Spanish—this behavior was a life-long pattern for them (because of their journals). They were organ donors. Professionals were able study their brains and they all had Alzheimer’s. Their symptoms were never visible because they started with more cognitive capacity and died before they could be diagnosed. (chart)

Question 7

Other Types of Dementia

Answer 7

Vascular: stair step presentation of decline due to small strokes in the brain
-rapid onset
-varied presentations
Medical Condition
-Pick’s
-Huntington’s (Korea)—has a gene that manifests in 30’s and 40’s
-Creutzfeldt-Jakob—extremely rapid progression/digression
Substance Induced

Question 8

Amnestic Disorder

Answer 8

Symptom: Memory Loss
Etiology
	-Drugs
	-Medical Condition
	-Brain Trauma