Untitled Flashcards Set

Stress and Anxiety Disorders 

• Typically characterized by elevated levels of anxiety in the nervous system.

• Differentiated from mood disorders, where the symptoms are more about depressed levels of functionality; however, commonly co-diagnosed.

• Diagnosis will look at biological symptoms within the environmental context and its stressors

• Often reflect excessive biological response of exhaustion within Hans Selye’s General Adaption Syndrome

  • Alarm > Resistance > Exhaustion 

• Effects may be driven by nature of the stressor (good/bad, short-term/long-term) 

Post-Traumatic Stress Disorder 

• AKA “shell shock,” “battle fatigue,” and “combat exhaustion” 

• Today it’s tied not only to military action 

• Triggering event is usually life-threating with a feeling of being trapped and powerless 

  • Controversially, DSM-5 expanded PTSD diagnosis to people who did not directly experience event 

• Stressor 

  • The person was exposed to; death, threatened death, actual or serious injury, sexual violence, as follows; (one required)

    • Direct exposure

    • Witnessing, in-person 

    • Indirectly, by learning that a close person was exposed to trauma. If event involved injury, it must have been violent or accidental. 

    • Repeated or extreme indirect exposure to aversive details of the event, usually in the course of professional duties. Does not include indirect exposure through media. 

• Intrusion Symptoms 

  • The traumatic event is persistently re-experienced (one required)

    • Recurrent, involuntary, and intrusive memories (Children older than 6 may express this in repetitive play)

    • Traumatic nightmares. (Children may have frightening dreams without context to the related traumas) 

    • Dissociative reactions (flashbacks) which may occur on a continuum from brief episodes to complete loss of consciousness (children may reenact the event in play)

    • Intense or prolonged distress after exposure to traumatic reminders 

    • Marked physiologic reactivity after exposer to trauma-related stimuli

• Avoidance

  • Persistent effortful avoidance of distressing trauma-related stimuli after the event (one required)

    • Trauma-related thoughts or feelings 

    • Trauma-related external reminders (people, places, conversations, activities, objects, or situations) 

• Negative alterations in cognition and mood that began or worsened afte the traumatic event (two required) 

  • Inability to recall key features of the traumatic event (usually dissociative amnesia) 

  • Persistent negative beliefs and expectations about oneself or the world 

  • Persistent negative trauma-related emotions

  • Marked diminishes interest in pre-traumatic significant activities 

  • Feeling alienated from others 

  • Constricted affect; persistent inability to experience positive emotions

• Alterations in arousal and reactivity 

  • Trauma-related alterations in arousal and reactivity that began or worsened after the traumatic event (two required) 

    • Irritable or aggressive behavior 

    • Self-destructive or reckless behavior 

    • Hypervigilance

    • Exaggerated startle response 

    • Problems in concentration 

    • Sleep disturbance 

• Challenges surrounding PTSD

  • Fear of appearing weak

  • Expectations of military role

  • Potential undermining of career options 

  • Skepticism about treatment 

  • Lack of local support recourses 

• PTSD and the Pandemic 

  • Risk for healthcare workers 

  • A risk for survivors of near-death Covid 19

Anxiety Disorders 

• Characterized by abnormal levels of arousal, tensions, fear or a sense of foreboding trouble 

  • Symptoms can be physical, emotional, cognitive, behavioral

  • Used to be classified as neuroses; however, that category included many other disorder types no longer grouped with anxiety 

  • Most diagnosed more often in women than men

  • Generalized anxiety disorder 

  • Panic disorder 

  • Phobic disorders 

Panic Disorder 

• Panic attack can feature feelings of losing control or dying 

  • Uncued panic attack - comes out of the blue, no obvious trigger 

  • Situationally bound panic attack - tied to a specific, usually know trigger

  • Can last 10-15 minuets, then last several mins at their worst 

• Additional DSM criterion: 

  • At least one of the attacks has been followed by 1 month or one of the following:

    • Persistent concern about having additional attacks

    • Worry about the implications of the attack or its consequences 

    • A significant change in behavior related to the attacks 

    • Affects 1-4% of Americans 

• Can be driven by a combination of cognitive factors and biological factors 

• Biological factors 

  • Suffocation false alarm theory - minor cues of suffocation lead to disproportionate response from respiratory and alarm systems 

  • Also low levels of GABA

    • Thus, use of antianxiety drugs that raise GABA (Xanax)

Phobic Disorders 

• An irrational fear, disproportionate to or without an objective bias 

  • Powerful or overwhelming enough that it affects the way you live your life 

  • Specific phobias typically have earlier onset 

  • Social phobia and agoraphobia (later in life)

  • An irrational and persistent fear of a specific object or situation 

  • Affects 7-11% of population over the lifespan

• Social Phobia 

• Also called anxiety disorder 

• Fear of social interactions or situations 

• Usually predicted on assumption that others will judge you poorly

• Agoraphobia 

  • Fear of a situation that is “out of proportion to the actual danger in the situation” 

  • Fear of being in a place from which it will be difficult or embarrassing to escape if a panic attack begins 

  • Typical onsent around age 28, after several years of build-up 

  • Often develops as a vicious cycle 

    • Panic attacks make the person scared to go out; when they do go out, they worry about the panic attack, which triggers anxiety and reluctance to go out 

Obsessive-Compulsive Disorder 

• Obsessions (DSM)

  • Recurrent and persistent thoughts, urges or images that are experiences, at some time during the disturbance, as intrusive and unwanted, and accuse marked anxiety and distress

  • The person attempts to suppress or ignore such thoughts, impulses, or images or to neutralize them with some other thought or action 

• Compulsions (DSM)

  • Repetitive behaviors in response to an obsession or according to riled that must be applied rigidly 

  • The behaviors or mental acts are aimed at preventing or reducting distress or preventing some event; however these behaviors are not connected in a way that could realistically neutralize or prevent whatever they are meant to address

• DSM: “The obsessions or compulsions cause marked distress, are time consuming, or significantly interfere with the person’s normal routine, occupational, or usual social activities or relationships 

• Affects 2-3% of the population 

• Often compulsion used to ease anxiety 

• Possible problems in feedback from amygdala. 

Psychodynamic Perspective 

• Anxiety is caused by unconscious fears 

• May impose fear of own impulses onto objects or situations 

  • Fear of suicide and acrophobia 

  • Object may be a symbol for something else one fears 

  • Treatment focuses on freeing the ego by making it aware of the unconscious urges

  • Two-factor model (Mowrer) 

    • Initial association of neutral stimulus with aversive experience; then, avoidance is rewarded with no aversive experience 

    • So panic attacks may be triggered by associational cues, the agoraphobic behavior is reinforced by absence of panic attacks 

    • PTSD symptoms triggered by associational cues 

    • Compulsive behaviors ears reward of relief from obsession  

  • Treatments 

    • Systematic desensitization via gradual exposure to symbolic or actual stimuli 

    • Flooding - overwhelming exposure to strong stimuli 

• Cognitive Perspective 

  • Anxiety disorders are a product of maladaptive cognitions:

    • Overprediction and anticipation of fear 

    • Exaggeration of risks 

    • Oversensitivity to threats 

    • Oversensitivity to own physical cues

    • Low level of self-efficacy

  • Cognitive restructuring seeks to fix thinking 

    • Self-defeating thoughts: 

      • Im sick with worry

      • What if I fail?

      • Ill never make it

    • Coping thoughts 

      • Worrying wont help things 

      • Concentrate on what I am doing 

      • One step at a time 

Prolonged Exposure Therapy 

• A form of CBT used in treatments of PTSD

• Assumes emotions were not properly processed at time of trauma 

• INvolved noth imaginal exposer to traumatic stimuli within therapy and in vivo exposure outside of therapy 

Cognitive Perspective 

• Other cognitive treatments: 

  • Virtual reality therapy - exposure to simulated situations, to help learn to moderate response 

  • Relaxation and breathing training 

    • May make the use of biofeedback, monitoring own physiological reactions 

  • Response prevention in OCD - to see that nothing bad will happen when compulsions are not exercised 

  • Social skills training - teached interpersonal skills and assertiveness to deal with social phobia 

Biological Perspective 

• Anti-anxiety drugs are the most common treatment for anxiety-related symptoms 

• Some success treading PTSD with beta-blocker drug (Propranolol)

  • Does not excise the memory; however, reduces intensity of emotional response at the time of recall, and occurrence of PTSD symptoms over the long-term

Mood Disorders 

• Unusually sever of prolonged disturbances in mood 

• Two DSM categories: 

  • Depressive Disorders 

    • Major depressive disorder 

    • Disruptive mood regulation disorder

    • Premenstrual dysphoric disorder 

    • Persistent depressive disorder (dysthymia)

  • Bipolar and Related Disorders 

    • Bipolar disorder 

    • Cyclothymic disorder

• Affects 7% of Americans in any given year 

Major Depressive Disorder 

• History of depression 

  • Hippocrates discussed problem of melancholy 

  • With few outside symptoms, sufferers generally weren't subjected to asylums in the middle ages 

    • Wealthy sufferers went to spa-like sanitariums for treatment 

    • By the 1930s, psychoanalysis and ECT had become commonplace treatments 

  • Five or more of the following symptoms have been present during the same 2-week period and represents a change from previous functioning at least one of the symptoms is either depressed mood or loss of interest or pleasure 

    • Depressed mood most of the day, nearly every day 

    • Markedly diminished interest tor pleasure in daily activities

    • Significant weight loss or weight gain

    • A slowing down of thought and a reduction of physical movement 

    • Fatigue or loss of energy 

    • Feelings of worthlessness 

    • Diminished ability to think or concentrate, or indecisiveness 

    • Recurrent thought of death, plan or attempt
      
      

• Depression is the most common psychological disorder

• Estimates that is affects 10-25% of woman and 5-12% of men at some point in their lifetime 

  • However, diagnosis is a challenge 

  • Many people think they should be able to snap out of it or its a weakness 

• Many risk factors, both environmental (SES) and biological 

• Tied strongly to coping styles 

  • Problem-focused coping 

  • Emotion-focused coping 

• When tied to or causing self-efficacy problems, can lead to a downward spiral that continues the disorder 

Major Depressive Disorder -Biology 

• Biological focus took over with 1965 catecholamine hypothesis (norepinephrine imbalance) and 1969 indolamine hypothesis (serotonin) 

  • A 1990 study in which people were depleted of serotonin found no change in mood 

  • Meta-analysis call SSRI efficacy into question 

• If not serotonin how might SSRI drugs work?

  • Placebo effect?

  • A sense of certainty may contribute to improved self-efficacy 

• Other theories of depression

  • Social - the stressful circumstances of peoples lives 

• Cognitive - negative or maladaptive habits of thinking and ways of interpreting events 

• Diathesis-Stress model draws on all of these 

  • Person has an underlying biological vulnerability, which is then triggered by stressors in the environment 

  • The diathesis is widely presumed to be genetic 

• Theories of depression - learned helplessness (Seligman)

  • Person leans that they are not effective intaking control over their own life, learns to rely on social support 

  • This leads them to stop trying, which causes further problems, which turns into depression

  • Tied to attributional style and locus of control 

• Interactional theory 

  • At first people receive unconditional support 

  • Over time supporter become angry at lack of progress

  • This leads to rejection, and further depression 

• Research supports broad model, but suggests that social rejection is based less on anger at actions than it is on poor social skills 

• Beck’s Cognitive Triad Theory of Depression 

  • Negative view of oneself, environment, and future.

  • Distorted, maladaptive thinking is manifested via automatic thought

• Treating depression 

  • Today is most commonly treated with SSRIs and talk therapy (cognitive and behavioral)

  • In case of seasonal affective disorder may also be treated with Phototherapy 

  • As population becomes more skeptical, people take less seriously the depression of those who need the drugs.

Are SSRIs overprescribed?

• Perception of minimal side effects led to led to widespread prescription, as SSRIs replaces the tricyclics.

• Usually tested on only a narrow cross-section of patients who meet strict diagnostic criteria 

• However, then prescribes to a abroad cross-section of population without regard to diagnostic criteria 

  • Zimmerman found that 86% of depression patients would have been excluded from trials

  • However, 93% of them were prescribed meds 

Bipolar Disorder 

• Mood disorder characterized by mood swings between depression and mania 

  • Depressive episodes  have diagnostic criteria similar to those in major depression

  • Manic episodes can take many forms

    • A distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently goal directed behavior or energy lasting at least week and present most of the day 

    • During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and are present to a significant degree and represent a noticeable change from usual behavior:

      • Inflated self-esteem or grandiosity 

      • Decreased need of sleep (feels rested after 3 hours)

      • More talkative than usual 

      • Flight of ideas 

      • Distractibility 

      • Increase in goal-directed activities or psychomotor agitation

      • Exessive involvement in activities that have bad consequences (spending, sex, business investments) 

    • The mood disturbance ius sufficient sever to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others 

Bipolar Disorder 

• Two main categories 

  • Bipolar I - includes on full manic episode 

  • Bipolar II - includes mostly depression with at least one hypomanic episode, but no full manic episode 

    • Hypomanic episodes must persist at least 4 days, so shorter than full manic 

• Affects no more than 1-2% of the population, usually appearing in early adulthood 

  • Equally common in men and women, though men usually start with a manic episode and women with a depressive one

• Episodes last from several days to months 

• Individuals cycle between mania and depression 

• Symptoms worsen in first decade; episodes less frequent after 20 years 

• Suicide attempt rate is high - almost 20%

Bipolar Disorder - Biology 

• Mania and depression are reactions to each other 

  • Chemistry of brain is self-correcting 

• Problems in inhibitions/disinhibituation of the pleasures centers of the brain 

  • Relative 5 times more likely to become afflicted than general public 

  • Higher rate for offspring of older fathers 

• Lithium carbonate alleviates all of most symptoms for 80% of individuals 

• Serious side effects if dosage not precise 

• Side effects include damage to heart and kidneys 

• Problematic because patients are often not conscientious about taking their meds 

• Anticonvulsant meds can alsop treat depressive episodes but are costly and need more research 

Broad Theoretical Perspectives

• Psychodynamic Perspective 

  • Depression is based in mourning loss of someone or something to which you had ambivalent feelings 

  • Interpersonal therapy focuses on identifying problems in relationships and unresolved issues 

  • Humanistic perspective 

    • Mood disorders occur when people are unable to find meaning and self fulfillment 

    • Loss of self-esteem drives continuing problems

 What is normal child behavior? 

• Perspectives vary by culture 

• Thai and US adults shown videos of children acting out 

• Asked adults to rate the seriousness of behavior 

• In 2007, meta-analysis found no significant difference in prevalence rates when comparing North America vs Europe and Asia.

The Role of Culture 

• However, formal studies may use diagnostic criteria different from those used in actual practice 

• While prevalence rates for carous disorders might be stable, actual diagnosis rates vary substantially by nation

• Research indicates, however, that drug interventions are on the rise in Euripe, closing the gao with prescription rates in the US

• So, culture and assumptions are a significant component of the category of developmental disorders. 

Autism Spectrum Disorder

• A disorder characterized by any number of various deficits in domains if communication, social behavior, fixated interests and repetitive behaviors 

  • May be classified as mild, moderate, or severe

    • Milder range includes people formerly diagnosed with Asperger’s Syndrome 

  • Usually has intellectual impairment

  • About 70-80% of cases are boys 

Autism Spectrum Disorder - DSM

1. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history 

1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure or normal back and forth conversations, to reduced sharing of interests, emotions, or response to social interactions 

2. Deficits in nonverbal communicative behaviors used for social interactions, ranging, for example from poorly integrated verbal and nonverbal communication, to abnormalities in eye contact and body language or hand gestures, to a total lack of facial expressions 

3. Deficits in developing, maintaining and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing or making friends

B. Restrictive, repetitive behaviors, interests, or activities, as manifested by at least two of the following

1. Stereotyped or repetitive motor movements, use of objects, or speech

2. Insistence on sameness, inflexibility

3. Highly restricted, fixates interests that are abnormal in intensity or focus

4. Hyper- or hypo reactivity to sensory input or unusual interests in sensory aspects 

C. Symptoms must be present in the early developmental period (but may not manifest until social demands exceed limited capacities)

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning 

E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level. 

Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger;s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. 

Autism Spectrum Disorder - Biology 

• Recent research finds amygdala overreacts to faces, processing most gazes as threatening 

  • Lack of eye contact means opaque perception is impaired in development 

    • Fusiform area, needed for face perception, is fine, but doesnt get enough stimulation.

    • Also, amygdala and hippocampus  found to be oversized from a very early age 

  • Research suggests deficits in the right hemisphere 

  • Although something of an oversimplification, the right hemisphere is more attuned to emotional aspects of cognition, and the left is more to logical 

  • Research has found that in various tests of language, people with autism show deficits similar to people who have suffered a right-brain stoke

  • Sperm mutations in older fathers seem to increase rate 

  • Biomarkers for neural inflammation, possibly tied to immune response 

Autism

• Cognitive-Learning Perspective

  • Brain abnormality allows processing of only one stimulus at a time

    • Right hemisphere more integrative

    • So, may have difficulty integrating input from various senses

Autism - Sociobiology 

• Research indicates that part of this is ties to changing diagnostic criteria, but part is tied to environment 

• However, meta-analysis suggests prevalence remained stable from 1990-2010

• Overwhelming evidence indicated MMR vaccine has not affected autisms prevalence 

• Autism “clusters”

  • Typical rate is 4-5 per 10,000

  • Brick Township, NJ - 40 cases in 6,000

  • Granite Bay, CA - 22 in 3,000

  • Chance or caused by environmental pollutants 

Autistic Savantism 

• Savantism has been said to be found in about 10% of people with Autism, though generally not at such a high level of proficiency 

  • This stat is to be considered cautiously, as it is based on self-report data from parents 

Treating Autism

• Treatment options are limited 

  • Most rely on intensive behavioral therapy, known as Applied Behavior Analysis 

    • 40 hrs/week for multiple years improved social and intellectual skills

    • Very costly and labor intensive

    • At mild end may be based on token economies

    • At severe end may require repeated trials for simple behaviors 

Intellectual Disability 

• Formerly known as mental retardation 

• IQ score of 70 or less (2 SD below mean)

• Impaired skills relative to others the same age 

• Development of the disorder before age 18

Levels of Intellectual Disability 

Moderate (IQ 35-49)

• About 10% of cases 

• Noticeable developmental delays 

• Can develop basic communication and maintenance skills, but limited in progress in academic skills

• Can still function alone in limited situations 

Severe (IQ 20-34)

• About 3-4% of cases 

• Marked developmental delays in motor skills

• Little or no communication skills 

• May achieve only simple life skills and certain fixed routines 

• Can walk, but needs lots of support and supervision 

Profound (IQ <20)

• About 1-2% of cases

• Gross impairment, needs nursing care for survival

• Needs close supervision across all circumstances 

• Can show basic emotional response, but may have no communication skills

• No basic life skills 

Intellectual Disability 

• Problems with using IQ score index

  • IQ shifts higher over time (Flynn Effect)

  • When students are tested on a reformed test, they're more likely to be classified as having a disability 

    • In one recent revision, test scored dropped 5.6 points from old version to renormed version 

  • This brings implications for the classroom, death row inmates, and society in general 

ADHD - DSM

• Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level.

• Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities

• Often has trouble holding attention on tasks or play activities

• Often does not seem to listen when spoken to directly 

• Often does not follow through on instructions and fails to finish tasks 

• Often has trouble organizing tasks and activities

• Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time

• Often loses things necessary for tasks and activities

• Is often easily distracted 

• Is often forgetful in daily activities 

• Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive for persons developmental level:

• Often fidgets with or taps hands or feet; or squirms in seat 

• Often leaves seat in situations when remaining seated is expected 

• Often runs about or climbs in situations where not appropriate 

• Often unable to play or take part in activities quietly 

• Is often “on the go” acting as “driven by motor”

• Often talks excessively 

• Often blurts out an answer before a question has been completed 

• Often has trouble waiting turn

• Often interrupts of intrudes on others 

Issues with DSM symptoms 

• Large focus on academic/chore tasks may be problematic in light of american educational structural choices 

• While children mighty outgrow hyperactivity, inattention may persist inti adulthood 

• Potential oversight of issues of emotional dysregulation, especially among adults 

• Most widely diagnosed childhood disorder (about 3-5%) often diagnosed in boys

  • This may reflect inequalities in diagnosis 

  • Most diagnosis tied to hyperactivity symptoms 

  • Girls more likely to experience inattention symptoms without hyperactivity, leading to potential underdiagnosis 

• Many are skeptical about the existence of the disorder 

  • However there seems to be brain-level differences in the attention and motor areas of the brain

  • Increased rated for children of mothers who smoke during pregnancy suggests lowered prenatal blood oxygen levels can play a biological role 

• Diagnosis rates have increased over time

  • The diagnostic criteria have some broadly interpretable language 

  • People doing the diagnosis often use unsuitable or subjective tools 

  • Looks at this checklist to see hoe these criteria might be applied 

Treating ADHD

• Stimulants like Ritalin and Adderall can have an effect of activating the attention areas of the brain 

• Strattera works as a norepinephrine reuptake inhibitor 

• Unfortunately, the typical approach is to use drugs alone

• Placebo can achieve a lot 

• However, drugs do achieve more

• This category is particularly vulnerable to majority judgments of what is normal, and the labeling or variation as abnormal 

Cognitive Disorders 

• Disorders in which cognitive function is impaired via some biological cause

• In DSM-5, many of these are grouped within subcategories of Mild or Major Neurocognitive Disorder, with additional specifier symptoms for specific disorders 

Mild Neurocognitive Disorder 

• Evidence of modest cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition) based on:

  • Concern of the individual, a knowledgeable informant, or the clinician that there has been a mild decline in cognitive function

  • A modest impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment

  • The cognitive deficits do not interfere with capacity for independence in everyday activities

  • The cognitive deficits do not occur exclusively in the context of a delirium

  • The cognitive deficits are not better explained by another mental disorder 

Major Neurocognitive Disorder

• Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor or social cognition) based on:

  • Concern of the individual, a knowledgeable informant, or the clinician that there has been a significant decline in cognitive function

  • A substantial impairment in cognitive performance, preferably documented by standardized neuropsychological testing, or in its absence, another quantified clinical assessment.

  • The cognitive deficits interfere with independence in everyday activities

  • The cognitive deficits occur exclusively in the context of delirium

  • The cognitive deficits are not better explained by another mental disorder 

Alzheimer’s Disease 

• Progressive brain disease characterized by gradual loss of memory and intellectual functioning, personality changes and death

• Affects about 10% over age 65

  • Numbers have gone up as lifespan has increased 

• It is not a natural consequence of aging 

• The criteria are met for major or mild neurocognitive disorder 

• There is insidious onset and gradual progression od impairment in one or more cognitive domains (for major neurocognitive disorder, at least two domains must be impaired)

• The disturbance is not better explained by cerebrovascular disease, another neurodegenerative disease, the effects of a substance, or another mental, neurological, or systematic disorder.

• Criteria are met for either probable or possible Alzhimer’s disease as follows:

Probable Alzhiemer’s disease is diagnosed if either of the following is present; otherwise, possible Alzheimer’s disease should be diagnosed.

• Evidence of a causative Alzheimer’s disease genetic mutation from family history or genetic testing 

• All three of the following are present:

  • Clear evidence of decline in memory and learning and at least one other cognitive domain (based on detailed history or serial neuropsychological testing)

  • Steadily progressive, gradually decline in cognition, without extended plateaus.

  • No evidence of mixed etiology (i.e., absence of other neurodegenerative of cerebrovascular disease, or another neurological, mental, or systemic disease of condition likely contributing to cognitive decline.

Possible Alcheimer’s disease is diagnosed if there is no evidence of a causative Alzheimer’s disease genetic mutation from either genetic testing or family history, and all three of the following are present:

• Clear evidence of decline in memory and learning 

• Steadily progressive, gradual decline in cognition, without extended plateaus

• No evidence of mixed etiology (i.e., absence of other neurodegenerative of cerebrovascular disease, or another neurological, mental, or systemic disease of condition likely contributing to cognitive decline.

• Strong genetic basis 

  • Can be hard to analyze, because some potential cases go undiagnosed if people die before onsent

• Characterized by buildup of beta amyloid plaque and tau protein tangles within neural tissue 

  • However, beta-amyloid hypothesis now being called into question and were trying to figure out what it means 

Diagnosis is difficult 

• People may assume initial symptoms are normal aging 

• People may be scared and reluctant to seek diagnosis 

• No conclusive diagnostic test 

  • Recently developed brain scans may confirm, but generally only used in symptomatic 

  • Blood tests can highlight biomarkers (e.g. amyloid), but those don't necessarily predict dementia

  • This makes it challenging ti treat

    • By the time people become symptomatic, degeneration is already fairly advanced 

• Onset and progress vary 

  • Only about 1% develop before 65

    • Very rare cases or early onset AD can develop in 30s or 40s

  • Speed of progress may depend on level of cognitive activity throughout adulthood 

• Treatments 

  • No cure exists; most treatments are oriented toward slowing the progress

  • Drugs such as Aricept may be used to raise acetylcholine levels in order to slow process

  • Some anti-inflammatory drugs show promise 

  • However, AD has proven stubbornly resistant to breakthroughs in research 

Traumatic Brain Injury 

• Recent years have seen more attention to neurocognitive disorder due to traumatic brain injury 

  • Military service

  • Football, hockey, headers (esp. in womans soccer)

• May develop from a single concussive event, more repeated subconcussive events. 

  • Symptoms cab include amnesia, language problems, depression

  • Can lead to chronic traumatic encephalopathy (CTE)

Covid-19 “Brain Fog”

• A common symptom of long covid is cognitive impairment, loosely labeled “brain fog” 

  • Can include problems with memory, executive function, language, and fatigue under cognitive load 

  • Mechanisms not known, suspects include neural inflammation from immune-response

  • Stronger in first-year strains, longitudinal studies finding equivalent of a 7-point IQ drop

  • Highlights possible underexplored role of infection in cognitive disorders 

Amnestic Disorders 

• Disturbances of memory function as a consequence of a biological cause 

  • This differentiates them from dissociative disorders, such as dissociative fugue or dissociative amnesia, which are psychological in basis 

  • (Eternal Sunshine of the Spotless Mind, 50 First Dates, Memento, Finding Nemo, Amnestic Disorders)

• Two broad categories 

  • Anterograde - inability to acquire new memories 

  • Retrograde - loss of past memories 

• Of these two, anterograde is the more common 

  • Episodic memory is most likely to be lost 

  • Procedural memory is least likely 

    • Carburetor rebuilding 

Amnestic Disorders - Causes 

• Alzheimer's Disease 

• Hypoxia - loss of oxygen to the brain 

• Infarction - blockages of blood supply to the brain 

• Herpes simplex encephalitis 

• Korsakoff’s syndrome

  • Caused by thiamine deficiency in chromic alcoholism

• Clive Wearing 

  • Developed amnesia in 1985 via HSE

  • Developed a profound anterograde and retrograde amnesia 

    • Remembers only limited semantic knowledge about family and childhood 

    • No episodic memories at all 

• Aphasia 

  • Inability to produce or comprehend language 

  • Usually a consequence of stroke or other brain injury 

  • Can be limited or very widespread 

    • Global - person can produce little language and understand almost none 

    • Broca’s - impairment usually limited to production 

    • Wernicke’s – fluent but disorganized output 

• Agnosia

  • Inability to recognize and identify objects 

  • Prosopagnosia -  face blindness 

    • Dr. P could describe features, discuss guesses as to functions, but could not integrate abstract information into understanding.