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Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 15: Cognitive Disorders
Chapter 15
Cognitive Disorders
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 15: Cognitive Disorders
Nature of Cognitive Disorders: An Overview
 Perspectives on Cognitive Disorders
 Affect cognitive processes such as learning, memory, and
consciousness
 Most develop later in life
 Three Classes of Cognitive Disorders
 Delirium – Often temporary confusion and disorientation
 Dementia – Degenerative condition marked by broad cognitive
deterioration
 Amnestic disorders – Memory dysfunctions caused by disease,
drugs, or toxins
 Shifting DSM Perspectives
 From “organic” mental disorders to “cognitive” disorders
 Broad impairments in memory, attention, perception, and
thinking
 Profound changes in behavior and personality
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 15: Cognitive Disorders
Delirium: An Overview
 Nature of Delirium
 Central features – Impaired consciousness and cognition
 Impairments develop rapidly over several hours or days
 Examples include confusion, disorientation, attention,
memory, and language deficits
 Facts and Statistics
 Affects 10% to 30% of persons in acute care facilities
 Most prevalent in older adults, AIDS patients, and medical
patients
 Full recovery often occurs within several weeks
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 15: Cognitive Disorders
Medical Conditions Related to Delirium
 Medical Conditions
 Drug intoxication, poisons, withdrawal from drugs
 Infections, head injury, and several forms of brain
trauma
 Sleep deprivation, immobility, and excessive
stress
 DSM-IV and DSM-IV Subtypes of Delirium
 Delirium due to a general medical condition
 Substance-induced delirium
 Delirium due to multiple etiologies
 Delirium not otherwise specified
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 15: Cognitive Disorders
Treatment and Prevention of Delirium
 Treatment
 Attention to precipitating medical problems
 Psychosocial interventions include reassurance,
coping strategies
 Prevention
 Address proper medical care for illnesses
 Address proper use and adherence to therapeutic
drugs
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 15: Cognitive Disorders
Dementia: An Overview
 Nature of Dementia
 Gradual deterioration of brain functioning
 Affects judgment, memory, language, and advanced
cognitive processes
 Dementia has many causes and may be reversible or
irreversible
 Progression of Dementia: Initial Stages
 Memory impairment, visuospatial skills deficits
 Agnosia – Inability to recognize and name objects (most
common symptom)
 Facial agnosia – Inability to recognize familiar faces
 Other symptoms – Delusions, depression, agitation,
aggression, and apathy
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 15: Cognitive Disorders
Dementia: An Overview (cont.)
 Progression of Dementia: Later Stages
 Cognitive functioning continues to deteriorate
 Person requires almost total support to carry out
day-to-day activities
 Death results from inactivity combined with onset
of other illnesses
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 15: Cognitive Disorders
Dementia: Facts and Statistics
 Onset and Prevalence
 Can occur at any age, but most common in the elderly
 Affects 1% of those between 65-74 years of age
 Affects over 10% of persons 85 years and older
 47% of adults over the age of 85 have dementia of the
Alzheimer’s type
 Incidence of Dementia
 Affects 2.3% of those 75-79 years of age and 8.5% of persons
85 and older
 Rates of new cases appear to double with every 5 years of age
 Gender and Sociocultural Factors
 Dementia occurs equally in men and women
 Dementia occurs equally across educational level and social
class
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 15: Cognitive Disorders
DSM-IV and DSM-IV-TR Classes of Dementia
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


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Dementia of the Alzheimer’s type
Vascular Dementia
Dementia Due to Other General Medical Conditions
Substance-Induced Persisting Dementia
Dementia Due to Multiple Etiologies
Dementia Not Otherwise Specified
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 15: Cognitive Disorders
Dementia of the Alzheimer’s Type: An Overview
 DSM-IV-TR Criteria and Clinical Features
 Multiple cognitive deficits that develop gradually
and steadily
 Predominant impairment in memory, orientation,
judgment, and reasoning
 Can include agitation, confusion, depression,
anxiety, or combativeness
 Symptoms are usually more pronounced at the
end of the day
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 15: Cognitive Disorders
Dementia of the Alzheimer’s Type: An Overview (cont.)
 Range of Cognitive Deficits
 Aphasia – Difficulty with language
 Apraxia – Impaired motor functioning
 Agnosia – Failure to recognize objects
 Difficulties with planning, organizing, sequencing,
or abstracting information
 Impairments have a marked negative impact on
social and occupational functioning
 An Autopsy Is Required for a Definitive Diagnosis
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 15: Cognitive Disorders
Alzheimer’s Disease: Some Facts and Statistics
 Nature and Progression of the Disease
 Deterioration is slow during the early and later stages, but
rapid during middle stages
 Average survival time is about 8 years
 Onset usually occurs in the 60s or 70s, but may occur
earlier
 Prevalence of Alzheimer’s Disease
 Affects about 4 million Americans and many more
worldwide
 Prevalence is greater in poorly educated persons and
women
 Prevalence rates are low in some ethnic groups (e.g.,
Japanese, Nigerian, Amish)
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 15: Cognitive Disorders
Vascular Dementia: An Overview
 Nature of Vascular Dementia
 Progressive brain disorder 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, and most require
formal care in later stages
 DSM-IV and DSM-IV Criteria and Incidence
 Cognitive disturbances that are identical to dementia
 Unlike Alzheimer’s, obvious neurological signs of brain
tissue damage occur
 Incidence is believed to be about 4.7% of men and 3.8% of
women
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 15: Cognitive Disorders
Dementia Related to Human
Immunodeficiency Virus-Type 1 (HIV-1)
 Overview and Clinical Features
 HIV causes neurological impairments and dementia
 Cognitive slowness, impaired attention, and forgetfulness,
clumsiness
 Repetitive movements (e.g., tremors/leg weakness), apathy,
and social withdrawal
 Progression of HIV-Related Cognitive Impairments
 Tend to occur during the later stages of HIV infection
 Impairments are observed in 29% to 87% of people with AIDS
 Sub-cortical dementia – Refers to deficits that affect inner
brain regions
 Aphasia is uncommon in sub-cortical dementia, but anxiety
and depression occur
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 15: Cognitive Disorders
Other Causes of Dementia:
Head Trauma and Parkinson’s Disease
 Head Trauma
 Accidents are leading causes of such cognitive
impairments
 Memory loss is the most common symptom
 Parkinson’s Disease
 Degenerative brain disorder
 Affects about 1 out of 1,000 people worldwide
 Motor problems are characteristic of this disorder
 Damage to dopamine pathways is believed to
cause motor problems
 Pattern of impairments are similar to sub-cortical
dementia
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 15: Cognitive Disorders
Other Causes of Dementia:
Huntington’s and Pick’s Disease
 Huntington’s Disease
 Genetic autosomal dominant disorder (i.e.,
chromosome 4)
 Manifests initially as chorea, usually later in life
(around 40s or 50s)
 About 20% to 80% of persons go on to display
dementia of the sub-cortical pattern
 Pick’s Disease
 Rare neurological condition that produces a
cortical dementia like Alzheimer’s
 Also occurs later in life (around 40s or 50s)
 Little is known about what causes this disease
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 15: Cognitive Disorders
Other Dementias: Creutzfeldt-Jakob Disease
and Substance-Induced Dementia
 Creutzfeldt-Jakob Disease
 Affects 1 out of 1,000,000 persons
 Linked to mad cow disease
 Substance-Induced Persisting Dementia
 Results from drug use in combination with poor
diet
 Examples include alcohol, inhalants, sedative,
hypnotic, and anxiolytic drugs
 Resulting brain damage may be permanent
 Dementia is similar to that of Alzheimer’s
 Deficits may include aphasia, apraxia, agnosia, or
disturbed executive functioning
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 15: Cognitive Disorders
Causes of Dementia: The Example of
Alzheimer’s Disease
 Early and Largely Unsupported Views
 Implicated aluminum and smoking
 Current Neurobiological Findings
 Neurofibrillary tangles – Occur in all brains of
Alzheimer’s patients
 Amyloid plaques – Accumulate excessively in
brains of Alzheimer’s patients
 The role of amyloid proteins (apoE-2, apoE-3, and
apoE-4)
 Brains of Alzheimer’s patients tend to atrophy
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 15: Cognitive Disorders
Causes of Dementia: The Example of
Alzheimer’s Disease (cont.)
 Current Neurobiological Findings
 Multiple genes are involved in Alzheimer’s disease
(chromosomes 21, 19, 14, 12, 1)
 Chromosome 14 – Associated with early
onset Alzheimer’s
 Chromosome 19 – Associated with a late
onset Alzheimer’s
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 15: Cognitive Disorders
The Contributions of Psychosocial Factors in
Dementia
 Psychosocial Factors
 Do not cause dementia directly, but may influence
onset and course
 Lifestyle factors – Drug use, diet, exercise, stress
 Cultural factors – Risk for certain diseases and
accidents vary by ethnicity and class
 Psychosocial factors – Educational attainment,
coping skills, social support
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 15: Cognitive Disorders
Medical and Psychosocial Treatment of
Dementia
 Medical Treatment: Best if Enacted Early
 Few medical treatments exist for most types of dementia
 Most medical treatments attempt to slow progression of
deterioration
 Examples include glial cell-derived neurotrophic factor, Cognex,
vitamin E, aspirin
 Medical treatments do not stop progression of dementia
 Psychosocial Treatments
 Focus on enhancing the lives of dementia patients and their
families/caregivers
 Teach adaptive skills
 Use memory enhancement prosthetic devices (e.g., memory
wallet)
 Main emphasis of psychosocial interventions appears to be on
the caregivers
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 15: Cognitive Disorders
Prevention of Dementia
 Reducing Risk of Dementia in Older Adults Via
 Estrogen-replacement therapy – Reduces risk of
Alzheimer’s dementia in women
 Proper treatment of cardiovascular diseases
 Use of anti-inflammatory medications
 Other Targets of Prevention Efforts
 Increasing safety behaviors to reduce head
trauma
 Reducing exposure to neurotoxins and use of
drugs
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 15: Cognitive Disorders
Mike
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 15: Cognitive Disorders
Amnestic Disorder: An Overview
 Nature of Amnestic Disorder
 Circumscribed loss of memory
 Inability to transfer information into long-term memory
 Often results from medical conditions, head trauma, or
long-term drug use
 DSM-IV and DSM-IV-TR Criteria for Amnestic Disorder
 Cover the inability to learn new information
 Inability to recall previously learned information
 Memory disturbance causes significant impairment in
functioning
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 15: Cognitive Disorders
Amnestic Disorder: An Overview (cont.)
 The Example of Wernicke-Korsakoff Syndrome
 Caused by thalamic damage resulting from stroke
or chronic heavy alcohol use
 Attempt to restore thiamine deficiency in the case
of chronic alcohol abuse
 Research on Amnestic Disorders Is Scant
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 15: Cognitive Disorders
Summary of Cognitive Disorders
 Cognitive Disorders Span a Range of Deficits
 Attention, memory, language, and motor behavior
 Causes include medical conditions, drug use, or
environmental factors
 Most Cognitive Disorders Result in Progressive
Deterioration of Functioning
 Few Treatments Exist to Reverse Pattern of Damage
and Resulting Deficits