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Cognitive Disorders
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Thomas Bowers, Ph.D.
Penn State Harrisburg
Contributors
• Samuel Adams, an undergraduate, for assisting in
preparing the pages and synopses.
• Kathy Houseman, laboratory assistant, for helping
with the samples.
• Donna Marie Struck, a graduate assistant in
psychology, for taking the photographs.
• Dr. Jay Towfighi, for providing the neuropathology
samples.
Acknowledgements
• These examples are from the Penn
State Hershey Medical Center's
Neuropathology Laboratory, Hershey,
PA, operated under the direction of Dr.
Jay Towfighi.
Cognitive Disorders
• Two fundamental types
– I. Delirium - relatively acute state, due to
intoxication, withdrawal, poisoning or
similar transient source of impairment of
consciousness
– II. Dementia - more fixed impairment of
memory and other higher cognitive
processes
Dementia
• Multiple sources
– 1.
– 2.
– 3.
– 4.
– 5.
Deteriorating disorders
Disease processes
Head injury
Vascular disorders
Constitutional impairment
Deteriorating Disorders
• I. Alzheimer’s disease
– Remarkably common
• Farmington study estimates incidence of 11%
for those over 85 years of age
• Progressive atrophy of the cortex, with notable
impairment in the hippocampus in particular
• Diagnosis by exclusion, definitive diagnosis
only on autopsy
Deteriorating Disorders
• I. Alzheimer’s disease
– Decrement in recent memory functioning,
probably due to problems in consolidation
– Recent appreciation of the role of
acetylcholine
Example of Alzheimer’s
Disease
Deteriorating Disorders
• II. Pick’s Disease
– Relatively rare
– Selective atrophy of frontal and temporal
regions of the cortex
– Unknown cause and etiology
Example of Pick’s
Disease
Deteriorating Disorders
• III. Huntington’s Disease
– Subcortical impairment, also eventually
impacts on cortical functions
– Grimacing, unusual and eccentric
presentation, gradual deterioration
– Some strong genetic components
Deteriorating Disorders
• IV. Parkinson’s Disease
– Deficiency in dopamine (DA)
– Tremors, as pill rolling tremors, akinesia
(inability to initiate movement)
– Late stages impact on frontal region
functions
Disease Processes
• There is a remarkable array of rare
infectious processes which impact on
the brain
• Sources of impairment
– 1. Encephalopathy
– 2. Encephalitis
Disease Processes
• I. Meningitis - Inflammation of the outer
lining of the brain
– Viral - Most common
– Bacterial - much more problematic
– Relatively common among children, rarer
for adults (and far more serious)
Disease Processes
• II. Herpes Simplex Encephalitis
– Sudden clinical course and presentation
– Many early deaths until late 1980s
– Now largely effectively treated with antiviral
medications (as acyclovir)
Disease Processes
• III. Neurosyphilis
– Now extremely rare
– Initial presentation mild, maybe
asymptomatic
– Later manifestation as severe neurological
disorders
• general paresis - Alzheimer’s like presentation
Disease Processes
• IV. Lyme encephalopathy - documented
memory deficits
• V. Creutfeld-Jakob Disease - slow viral
agent
• VI. Progressive multifocal
leukoencephalopathy - viral
demyelinating disorder
Disease Processes
• VII. HIV and AIDS related dementia
complex
– Both mild and severe cognitive difficulties
could arise
– Focus of considerable new research
interests
AIDS Dementia Complex
Disease Processes
• VIII. Chronic Fatigue Syndrome (CFS)
– Controversial area
– Severe enough to reduce activity more
than 50% below premorbid levels
– At least six months
– Associated low-grade symptoms, memory
dampened
Disease Processes
• VIII. Chronic Fatigue Syndrome (CFS)
– Some (but not all) demonstrate EpsteinBarr virus antibodies
– Important to rule out other disorders
– Often helped by antidepressants and
cognitive behavioral therapy for depression
– Also display problems in memory and
speed of processing not attributable to
depression