PSYC 407 1st Edition Lecture 25 Outline of Last Lecture I. Nature of Developmental PsychopathologyII. Disorders Usually Diagnosed in Infancy, Childhood, and Adolescencea. Attention deficit hyperactivity disorder (ADHD)b. Learning disordersc. AutismIII. Pervasive Developmental Disorders: An Overviewa. Autistic disorderb. Asperger’s syndromeIV. Nature of Cognitive Disorders V. DeliriumOutline of Current Lecture I. DementiaII. Dementia of the Alzheimer’s Type: An Overview III. Cognitive Reserve HypothesisIV. Vascular Dementia: An OverviewV. Causes of DementiaVI. Medical and Psychosocial Treatment of DementiaVII. Prevention of DementiaVIII. Amnestic Disorder: An OverviewCurrent LectureDementia: An Overview• Nature of dementia– Gradual deterioration of brain functioning– Deterioration in judgment and memory– Deterioration in language / advanced cognitive processesThese notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.– Shows a gradual progression of sx. depending on individual and on cause. Eventually all aspects are affected.Dementia: Initial and Later Stages• Initial stages– Memory: inability to register ongoing events• Can remember how to do things and distant memories– Visuospatial skills impairment• Can’t find how to get home• Agnosia – inability to recognize and name objects • Facial agnosia – inability to recognize familiar faces– Deterioration of intellectual function• Abstract reasoning, judgment, planning– Emotional symptoms:• Some awareness of deterioration• Delusions• Depression• Agitation• Aggression• Apathy– It is uncertain how much behavioral change a direct result of brain damage and how much is frustration and discouragement.– Later stages– Cognitive functioning continues to deteriorate– Total support is needed to carry out day-to-day activities– Death due to inactivity and onset of other illnesses Dementia: Facts and Statistics• Onset and prevalence– Can occur at any age, but most common in the elderly (rare before 45)– Affects 1% of those between 65-74 years of age– Affects over 10% of persons 85 years and olderDSM-IV-TR Classes of Dementia• Dementia of the Alzheimer’s type (50%)• Vascular dementia• Dementia due to other general medical conditions• Substance-induced persisting dementia• Dementia due to multiple etiologiesDementia of the Alzheimer’s Type: An Overview• Alois Alzheimer (1907)• DSM-IV-TR criteria and clinical features– Multiple cognitive deficits– Develop gradually and steadily– Memory• Can’t integrate new information so can’t make new associations. Forget events. Interests narrow.– orientation, judgment, and reasoning deficitsDementia of the Alzheimer’s Type– Additional symptoms may include • Agitation, confusion, or combativeness• Depression and/or anxiety– “Sundowner syndrome”• Difficulties more pronounced later in the day.– ? fatigue– ? disturbance in brain biological clockDementia of the Alzheimer’s Type: Extent of Deficits• Range of cognitive deficits– Aphasia – difficulty with language– Apraxia – impaired motor functioning– Agnosia – failure to recognize objects– Difficulties with • Planning• Organizing• Sequencing• Abstracting information– Negative impact on social and occupational functioning • Researching people w/mild cognitive impairment to understand early brain changes. • Nun’s study: nuns who wrote passages w/low idea density had Alzheimer’s disease• An autopsy is required for a definitive diagnosisAlzheimer’s Disease: Some Facts and Statistics• Nature and progression of the disease– Deterioration is slow during the early and later stages– Deterioration is rapid during middle stages– Average survival time is about 8 years– Onset usually occurs in the 60s or 70s– 50% are DAT– May occur in 40’s and 50s; Called presenile dementia• Prevalence of Alzheimer’s disease– About 4 million Americans and many more worldwide– Prevalence greater in • Poorly educated persons and females– More females• Longer life• Estrogen ?Cognitive Reserve HypothesisThe more synapses that develop earlier in life, the more neuronal death must occur before signsof DAT develop.Vascular Dementia: An Overview• Nature of vascular dementia– Caused by blockage or damage to blood vessels– Second leading cause of dementia next to Alzheimer’s – Onset is often sudden (e.g., stroke)– Patterns of impairment are variable; may be more abnormalities (than in DAT) in walking and weakness in limbs.– Most require formal care in later stages– DSM-IV-TR criteria and incidence– Cognitive disturbances – identical to dementia– Obvious neurological signs of brain tissue damage– Incidence is about 4.7% of men and 3.8% of womenOther Causes of Dementia: HIV and TraumaHIVCauses neurological impairments and dementiaHead traumaAccidents are leading causeMemory loss is the most common symptomOther Causes of Dementia:Parkinson’s disease Motor problems – central featureCaused by damage to dopamine pathways• Stooped posture, slow body movements, jerkiness in walking, tremors, muscle weaknessHuntington’s DiseaseInvoluntary limb movementsAutosomal dominant disorderPick’s diseaseRare neurological conditionProduces a cortical dementia like Alzheimer’sAlso occurs later in life (around 40s or 50s)Little is known about what causes this disease Creutzfeldt-Jakob diseaseAffects 1 out of 1,000,000 personsLinked to mad cow diseaseOther Dementias: Substance-Induced Dementia• Substance-induced persisting dementia– Results from drug use in combination with poor diet(alcohol, hypnotics, sedatives, inhalants)– Resulting brain damage may be permanent– Dementia is similar to that of Alzheimer’sCauses of Dementia: The Example of Alzheimer’s Disease (continued)• Current neurobiological findings– Neurofibrillary tangles – Amyloid plaques (amyloid protein core that causes cell death)– Brains of Alzheimer’s patients tend to atrophyGenes– Polygenic influence– Genes on 21, 19, 14, 12 involved.• Each linked to certain forms of DAT– Ex: # 14 linked to presenile forms– Some genes are deterministic genes• Assoc. w/100% chance of developing disease– The role of susceptibility genes • Only a slight chance of developing diseaseThe Contributions of Psychosocial