CHAPTER

15

M

rs. B. was an 87-year-old woman at the time that she

was referred for neuropsychological testing. Mrs. B.

wasn’t always able to get to the toilet in time to uri-

nate, her hearing and vision weren’t as good as they had

been, and, because of an inner-ear problem, she sometimes

felt off-balance and fell. A neuropsychologist was asked to

determine the nature of Mrs. B.’s problems—specifi cally the

extent to which a cognitive disorder might account for at

least some of her diffi culties. The neuropsychologist noted

that Mrs. B. required

“... assistance in several self-care activities (meal preparation, shop-

ping, transportation, ambulation [moving around], dressing, and

bathing), principally because of gait, balance, and sensory changes.

... [She] had moved from another state several months earlier at the
urging of her daughter, who had been receiving reports from neigh-
bors and relatives that she was unable to care for herself or her home
and was increasingly suspicious and argumentative. Her fi rst residence
in her new community was... a nursing home, but it soon became
apparent that she was functioning at a higher level than other residents
and she moved to a small board-and-care home [a small residential
facility for elders who need round-the-clock help with daily functioning
and personal care]. With only a few persons in the home and a low
resident-to-staff ratio, this seemed a good arrangement for an older
person who needed an intermediate level of assistance. Mrs. B. apparently
thought otherwise.
“She often refused to admit staff to her room or to accept assistance
with activities such as bathing, despite an unsteady gait and several
recent falls. She had arguments with other residents that sometimes
escalated into shouting matches. A private-duty companion was hired
to assist her for several hours a day and to take her on excursions
outside of the home. This was helping somewhat, but accusations and
arguments continued at an unsettling rate. Mrs. B. sometimes seemed
to forget plans that she had agreed to and was occasionally tearful
and sad.”
(LaRue & Watson, 1998, pp. 6, 10)
What might account for Mrs. B.’s disruptive behavior and
memory problems? One possibility is some type of cognitive disor-
der. According to DSM-IV-TR, cognitive disordersare a category of
psychological disorders in which the primary symptom is signifi cantly
reduced mental abilities, relative to a prior level of functioning.
Impaired cognitive abilities are not unique to cognitive disor-
ders. Many of the disorders discussed in previous chapters involve a
change in cognitive functioning: People who are depressed or anxious

681

Cognitive Disorders

Chapter Outline

Normal Versus Abnormal Aging and

Cognitive Functioning

Cognitive Functioning in Normal Aging

Psychological Disorders and Cognition

Medical Factors That Can Affect Cognition

Delirium

What Is Delirium?

Understanding Delirium: A Side Effect?

Treating Delirium: Rectify the Cause

Amnestic Disorder

What Is Amnestic Disorder?

Understanding Amnestic Disorder

Treating Amnestic Disorder

Dementia

What Is Dementia?

Distinguishing Between Dementia and

Other Psychological Disorders

Understanding Dementia

Treating Dementia

Diagnosing Mrs. B.’s Problems

Cognitive disorders

A category of psychological disorders in which

the primary symptom is signifi cantly reduced

mental abilities, relative to a prior level of

functioning.

Dave Cutler