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Abnormal Psychology PSY404

Lesson 40

DEMENTIA DELIRIUM AND AMNESTIC DISORDERS

Formerly called organic mental disorders, now the new name according to DSM-IV-TR is cognitive

disorders or cognitive impairment disorders.

Dementia

Dementia is a gradual worsening loss of memory and related cognitive functions, including the use of

language, as well as reasoning and decision making.

Delirium

Delirium is a state of confusion and disorientation that develops over a short period of time and is often

associated with agitation and hyperactivity.

Amnesia

People with Amnesia disorders experience memory impairments that are more limited than those seen in

dementia or delirium.

Examples

· Miss A looks pretty and physically healthy even in her late seventies. She has always been sweet and

a patient person but now she has become verbally abusive, suspicious, and forgetful.

· Mr. B was injured in a car accident, he had a head injury. His whole life has changed its sad to

watch the decline of a successful and intelligent man.

· Miss. C was shot as an innocent bystander in a robbery. She is physically fine but has almost no

ability to recall recent events.

· Muhammad Ali one of the greatest heavy weight boxing champions of all times suffers from

Parkinson disease caused by repeated blows to the head during his boxing career.

· Two term U.S. president and famous handsome actor Ronald Regan suffered from Alzhemeir's

which altered his life preventing the public appearances that ex- presidents enjoy.

Research on brain and its role on psychopathology have increased in recent years. The term organic mental

disorder was dropped and the term cognitive mental disorder was adopted.

Cognitive disorders signify the impairment of cognitive abilities such as

1. memory

2. attention

3. perception

4. thinking

Cognitive disorders generally first appear during the patient's 50's or 60's and accelerate after the age of 70.

Cognitive Impairment Disorders

Cognitive impairment disorders include

1. Dementia

2. Delirium

3. Amnesia

Degenerative Brain Diseases

Some degenerative brain diseases include

1-Alzheimer's dementia

2-Parkinson's disease

3-Huntington's disease

4-Pick's disease

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Causes of Cognitive Impairment Disorders

1- Old age

2- Improper use of medications

3- Head injuries

4- Various types of brain traumas.

Treatment of Cognitive Impairment Disorders

There are two types of treatments one for patients and other for caregivers

1-Treatment for patients

a- Psychotropic Medications

b- Behavioral Programs

c- Cognitive Rehabilitation

2-Treatment of Caregivers

DELIRIUM

· Delirium is a confusional state that develops over a short period of time and is often associated

with agitation and hyperactivity.

· Delirium the primary symptom of delirium is clouding of consciousness in association with a

reduced ability to maintain and shift attention.

· The person's thinking appears disorganized, and he or she may speak in a rambling, incoherent

fashion.

· Fleeting perceptual disturbances, including visual hallucinations, are also common in delirious

patients.

· The symptoms of delirium follow a rapid onset--from a few hours to several days--and

typically fluctuate throughout the day.

· The person may alternate between extreme confusion and periods in which he or she is more

rational and clearheaded.

· Symptoms are usually worse at night.

If the condition is allowed to progress, the person's senses may become dull and he or she may

eventually lapse into a coma.

It isn't always easy to recognize the difference between dementia and delirium, especially when they

appear simultaneously in the same patient.

Difference between dementia and delirium

These are four in number

· One important consideration involves the period of time over which the symptoms appear.

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Abnormal Psychology PSY404

1. Delirium has a rapid onset, whereas dementia develops in a slow, progressive manner.

2. In dementia, the person usually remains alert and responsive to the environment.

3. Speech is most often coherent in demented patients, at least until the end stages of the

disorder, but it is typically confused in delirious patients.

4. Finally, delirium can be resolved, whereas dementia cannot.

Causes of Delirium

1- Medical conditions

· It has been observed that many medical conditions impair brain function such as

intoxication by drugs, poisons, alcohol.

· Head injuries

· Various types of brain traumas

2- Factors other than medical conditions can trigger delirium which include

· Age the older people are more at risk for developing delirium than young people.

· Sleep deprivation, immobility and excessive stress can also cause delirium.

3- Delirium can also be brought on by improper use of medication it can be a particular problem for

older people because they tend to use prescription medication more than any other age group. The risk

of the problem in the elderly is increased further because they tend to eliminate drugs from their

systems less efficiently than younger people.

4- Delirium may be experienced by children who have high fevers or who are taking certain

medications and they are mistaken for noncompliance.

· The underlying mechanisms responsible for the onset of delirium undoubtedly involve

neuropathology and neurochemistry.

· Delirium can be caused by many different kinds of medication.

· Delirium also develops in conjunction with a number of metabolic diseases as well as

endocrine diseases.

· Various kinds of infection can lead to the onset of delirium.

Example

· An old gentleman was brought to the hospital he did not know his name and at times he

did not recognize his daughter. He appeared confused, disoriented and agitated.

· He could not focus his attention to answer even the most basic questions.

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DEMENTIA

· Dementia appears in people whose intellectual abilities have previously been unimpaired.

· Dementia is a gradual worsening loss of memory and related cognitive functions, including the use

of language, as well as reasoning and decision making.

· The earliest signs of dementia include difficulty remembering recent events and the names of

people and familiar objects.

· The distinguishing features of dementia include cognitive problems in a number of areas, ranging

from impaired memory and learning to deficits in language and abstract thinking.

· By the final stages of dementia, intellectual and motor functions may disappear almost completely.

· The diagnostic hallmark of dementia is memory loss.

· Retrograde amnesia refers to the loss of memory for events prior to the onset of an illness or the

experience of a traumatic event.

· Anterograde amnesia refers to the inability to learn or remember new material after a particular

point in time.

· Anterograde amnesia is usually the most obvious problem during the beginning stages of dementia.

Language functions can also be affected in dementia.

1- Aphasia is a term that describes various types of loss or impairment in language that are caused

by brain damage.

2- In addition to problems in understanding and forming meaningful sentences, the demented

person may also have difficulty in performing purposeful movements in response to verbal

commands, a problem known as apraxia.

3- Some patients with dementia have problems identifying stimuli in their environments.

· The technical term for this phenomenon is agnosia, which means "perception without meaning."

· The person's sensory functions are unimpaired, but he or she is unable to recognize the source of

stimulation.

4- Another manifestation of cognitive impairment in dementia is loss of ability to think in abstract

ways.

· Related to deficits in abstract reasoning is the failure of social judgment and problem-solving skills.

Causes of Dementia

The common causes of dementia include

1- Medications

2- Vitamin B1 deficiency

3- Chronic alcoholism

4- Tumors or infections of brain

5- Metabolic imbalances resulting from kidney, thyroid and liver.

6- Age

7-Twin studies confirm that genetic factors play an important role in the development of dementia.

· Three genes (located on chromosomes 21, 14, and 1) have been identified that, when mutated, cause

early-onset forms of Alzheimer's disease.

· A fourth gene, located on chromosome 19, serves as a risk factor for late-onset forms of the disorder.

Degenerative Brain Diseases

Some degenerative brain diseases include

1- Alzheimer's dementia

2- Parkinson's disease

3- Huntington's disease

4- Pick's disease

5- Stroke

6- Head traumas

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1- Alzheimer's Dementia

· The speed of onset serves as the main feature to distinguish Alzheimer's disease from the other

types of dementia listed in DSM-IV-TR.

· In this disorder, the cognitive impairment appears gradually, and the person's cognitive

deterioration is progressive.

· In Alzheimer disease there is both behavioral and cognitive impairment.

· Patients display problems in memory and language. People forget important events and lose

objects.

2- Parkinson's Disease

· A disorder of the motor system, known as Parkinson's disease, is caused by a degeneration of a

specific area of the brain stem known as the substantia nigra and loss of the neurotransmitter

dopamine, which is produced by cells in this area.

· Typical symptoms include tremors, rigidity, postural abnormalities, and reduction in voluntary

movements.

· Unlike people with Huntington's disease, most patients with Parkinson's disease do not

become demented.

3- Huntington's Disease

· Unusual involuntary muscle movements known as chorea represent the most distinctive feature

of Huntington's disease.

· These movements are relatively slow at first, with the person appearing to be merely restless or

fidgety.

· As the disorder progresses, sustained muscle contractions become difficult.

· Movements of the face, trunk, and limbs eventually become uncontrolled.

4- Pick's Disease

It is a rare type of neurological disorder and its cause is not known but it produces a dementia

like Alzheimer's.

5- Stroke

A stroke, the severe interruption of blood flow to the brain, can produce various types of brain

damage, depending on the size of the affected blood vessel and the area of the brain that it

supplies.

There are instances, however, in which the stroke affects only a very small artery and may not

have any observable effect on the person's behavior.

6- Head Trauma

Head trauma, injury to the head and therefore to the brain is typically caused by accidents and can lead

to cognitive impairments in all (memory loss).

Example

Mrs. D at the age of 45 was a successful legal assistant, wife, mother but she began to experience

memory lapses and she thought it was being caused by tension at work. Her medical examination and

MRI revealed damage to the brain caused by stroke causing dementia.

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