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CHAPTER 12
COGNITIVE IMPAIRMENT
DISORDERS
THE BRAIN: AN INTERACTIONAL
PERSPECTIVE
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Brain research helps us understand normal
and abnormal behavior by
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Specifying how the brain grows and maintains
itself.
Identifying the mechanisms by which the brain
acquires, stores, and used information
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at the cellular and molecular levels, and
at the level of behavior and social interaction.
Explaining how the brain monitors and regulates
internal bodily processes.
FACTORS THAT INFLUENCE
VULNERABILITY TO BRAIN DISORDERS
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Age – Infant brain more susceptible to pathological
conditions
Social support – Presence of caring people eases
adjustment to brain conditions
Stress – The greater the stress, the greater the
cognitive and behavioral deficits will be
Personality factors – Some react with intense anxiety,
paranoia, defensiveness to brain conditions
Physical condition – Site of disorder, rate of onset,
duration of disorder, and general health influence the
clinical picture.
PERSONALITY AND COGNITIVE CHANGES
ASSOCIATED WITH FRONTAL LOBE
MALFUNCTION
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Apathy and loss of interest in social interaction
Inattention to personal appearance
Boisterousness; profanity; loud speech
Irritability and violence
Increased risk-taking
Overeating and overdrinking
Reduced capacity to use language, symbols and
logic
Diminished ability to concentrate
Loss of orientation to time or place
ASSESSING BRAIN DAMAGE
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Mental status examination
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Neuropsychological testing
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Information about current behavior and thought including
orientation to reality, memory, and ability to follow
instructions
Assess impairment in awareness of and responsiveness to
sensory stimulation, ability to understand verbal
communication, and ability in verbal and emotional
expression
Brain imaging
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Computerized tomography (CT scan)
Positron emission tomography (PT scan)
Magnetic resonance imaging (MRI)
THREE MAJOR BRAIN SCANNING
TECHNIQUES
MENTAL STATUS EXAMINATION
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Time – “What year is this? What day?”
Place – “What city and state are we in?”
Immediate memory – “Repeat these words….”
Attention – “Subtract 7 from 100 and continue to do
so.”
Recall – “Repeat the words I mentioned earlier.”
Naming – “What is this?” (Show object)
Repetition – “Repeat: East, west, home’s best.”
Following command – “Put this watch on the table.”
Visual construction – “Copy this figure.”
CONDITIONS MAKRED BY COGNITIVE
IMPAIRMENT
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Delirium
Delirium tremens
Dementia
Alzheimer’s disease
Pick’s disease
Huntington’s disease
Parkinson’s disease
AUTOSOMAL DOMINANT DISORDERS
(SUCH AS HUNTINGTON’S DISEASE)
PHASES OF COGNITIVE DECLINE IN
ALZHEIMER’S DISEASE
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Complaints of memory deficit
 Forgets names
Increased cognitive decline and signs of confusion
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Lose, misplace valuable objects.
Moderately severe cognitive decline and intensified confusion
(early dementia)
 Can’t recall names of family members or life events.
Severe cognitive decline and confusion (middle dementia)
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Unaware of recent events and experiences.
Very severe cognitive decline and confusion (late dementia)
 Loss of verbal ability; need assistance in tasks of daily living.
BRAIN OF ALZHEIMER’S PATIENT
BRAINS OF PEOPLE AT RISK FOR ALZHEIMER’S
DISEASE COMPARED WITH NORMAL BRAINS
CORE CRITERIA FOR DEMENTIA
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Memory impairment
 Inability to learn new information and to recall
previously learned information
One or more cognitive disturbances
 Deterioration of language function
 Impaired ability to execute motor activities
despite intact motor function
 Failure to recognize or identify objects despite
intact sensory function
 Disturbance in executive functions such as
planning, organizing, sequencing, and abstracting
BRAIN TRAUMA AND INFECTIONS
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Injuries
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Tumors
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Symptoms depend on the site of the tumor
Sudden onset or slow-growing
HIV-associated cognitive impairment
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Concussions – transient problems
Contusions – diffuse damage
Lacerations – major tears or ruptures
Cortical atrophy caused by AIDS
General Paresis
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Acute onset or slow-acting viral infections like
syphilitic infections
AMNESTIC DISORDERS
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Disturbances of memory
Impairs ability to learn information or recall
previously learned information
Impairment evident in social and
occupational functioning
Impairment apparent in verbal and visual
tasks requiring spontaneous recall
OTHER COGNITIVE IMPAIRMENT DISORDERS
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Cerebrovascular disorders
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Korsakoff’s syndrome
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Cerebrovascular accidents (CVAs) or strokes interrupt
blood flow to the brain
 Symptoms include some paralysis and aphasia (total
or partial loss of speech)
Vascular dementia – series of minor strokes that occur at
different times
Vitamin B1 and thiamine deficiencies that occur in some
chronic alcoholics
Recent and past memories are lost, along with inability
to form new memories
Epilepsy
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Transient change of consciousness resulting from
electrical instability
EPILEPTIC DISORDERS
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Types
 Grand mal seizure
 Two to five minutes; patient cries, falls to
floor unconsciousness, extreme spasms.
 Petit mal seizure
 Common in children; no convulsion, but
lapse of consciousness characterized by blank
staring or lack of responsiveness.
 Psychomotor epilepsy
 Semiautomatic motor responses that show
clouding of consciousness, confused state;
often accompanied by hallucinations.
TREATMENT OF EPILEPSY
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Medical
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Antiepileptic medications
Surgery as a last resort
Antidepressant medication
Psychological
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Operant conditioning
Desensitization and relaxation training
Biofeedback