I. Formerly Organic Mental Disorders
II. Overview
III. Four classes:
A. Delirium
B. Dementia
C. Amnestic Disorders
D. Cognitive disorders NOS
IV. Delirium--basically, an acute confusional state
A. Criteria are:
1. Disturbance in consciousness with reduced ability to focus, sustain, or shift attention.
2. Change in cognition or perceptual disturbances
3. Disturbance develops over a short period of time
4. Specific criteria concerning etiology: general medical condition, substance-induced
B. Typically transient (one-several days)
V. Dementia--basically a severe loss of intellectual abilities
A. Misconceptions:
1. Progressive & irreversible
2. insidious onset
B. Symptoms include:
1. The development of multiple cognitive deficits manifested by both:
a. Memory Impairment, either (or both)
(1) Short-term memory deficits
(2) Long-term memory deficits
b. one (or more) of other cognitive disturbances:
(1) Executive functioning
(2) aphasia
(3) apraxia
(4) agnosia
2. The cognitive deficits cause significant impairment in social or occupational functioning and represent a significant decline from previous functioning
3. Specific criteria concerning etiology
4. Not seen solely during course of Delirium
C. May coexist with delirium
D. Differential diagnosis of Delirium and Dementia
1. Delirium is acute
2. Folks with dementia tend to be less disoriented initially
3. Delirium - disorganized thinking; Dementia - impoverished thinking
4. Delirium has clear attentional disturbance
5. Delirium -- fluctuating state within the day or hour
6. Delirium - sleep/wake problems
VI. Etiological Types of dementia
A. Dementia of the Alzheimer's Type (DAT)
1. Dementia with insidious onset and a generally progressive deteriorating course
2. Autopsy/Biopsy is only sure dx
a. neurofibrillary tangles
b. Senile Plaques
B. Vascular (formerly Multi-infarct) Dementia
1. Must be evidence of focal cerebrovascular disease: focal neurological signs and symptoms or imaging data
2. Dementia typically with an abrupt onset and a stepwise deteriorating course with "patchy' distribution of deficits
C. Dementia due to Parkinson's Disease
D. Dementia due to Huntington's disease (Chorea)
E. There also exist Dementias due to: HIV disease, Head Trauma, Pick's disease, Creutzfeldt-Jakob disease, other general medical conditions (e.g., hydrocephalus, tumor)
VII. Not to be confused with pseudodementia--a dementia of functional origin, most commonly depression
A. Pseudodementia can be differentiated from dementia:
1. Dementia--int'l deficits precede depression
2. Pseudodementia--date of onset more easy to pinpoint
3. Folks with pseudodementia complain and emphasize problems; dementia, cover up
4. Dementia--generally more consistent deficits over time
5. Antidepressants tend to clear symptoms in pseudodementia
B. Important to look for pseudodementia in elderly--it is treatable!
VIII. Note (in passing), DSM-IV allows for dx of many other "organic mental disorders" (DSM-III term) that symptomatically mimic functional disorders, but have a known organic etiology:
A. disorder x due to a general medical condition (e.g., delirium, psychotic disorder, amnestic disorder, dementia, mood disorder, anxiety disorder);
B. substance-induced delusional syndrome, substance-induced mood syndrome, substance-induced hallucinosis, substance-induced anxiety syndrome.