Cognitive Disorders 713
with her daughter and staff to improve the most bothersome aspects of the situation.
Written reports were provided to the daughter (who is Mrs. B.’s legal guardian) and
other medical professionals involved in her care. Feedback was also provided by tele-
phone to the daughter and the referring psychiatrist to answer questions about results
and to further discuss approaches to care. Recommendations included continuing psy-
chotherapy and antidepressant medication, negotiating brief written contracts between
Mrs. B. and staff members at the board-and-care home to clarify mutual expectations
in problem areas, and considering low-dose antispychotic medication in the event that
aggressive and accusatory behaviors escalated despite behavioral intervention. Neither
returning home nor moving into the daughter’s home was recommended....
“For Mrs. B., things got worse before they got better. Her “fi t” in the board-and-
care home continued to deteriorate, and after much discussion, she moved back to a
nursing home. For a time, she was taking multiple psychoactive medications and her
cognitive function deteriorated at a rapid rate. [She was taken off her medications] and
her [cognitive functioning] rebounded. A year later, after an intervening small stroke,
her memory function is slightly worse, but her mood is brighter, she communicates
well, and she has fewer complaints about staff and other residents than she did in the
board-and-care home.”
(LaRue & Watson, 1998, p. 11)Key Concepts and Facts About Dementia
- Dementia is the umbrella term for a set of cognitive disorders
that involve defi cits in memory and aphasia, apraxia, agnosia,
or problems with executive functions. - Dementia can give rise to hallucinations and delusions. Con-
versely, defi cits in memory and other cognitive functions may
resemble symptoms of dementia but actually arise from mental
retardation, schizophrenia, depression, delirium, or amnestic
disorder. - All types of dementia are caused by neurological factors. The
most common type of dementia—that due to Alzheimer’s dis-
ease—is a progressive disorder characterized by neurofi brillary
tangles and amyloid plaques in the brain. Although symptoms
may emerge before age 65 (early onset, which is highly herita-
ble), the late-onset form (which also has a genetic basis but is
less heritable) is much more common. Patients with Alzheimer’s
may or may not exhibit behavioral disturbances. - Vascular dementia is caused by reduced or blocked blood fl ow
to the brain, usually because of narrowed arteries or strokes.
Vascular dementia can be caused by a series of ministrokes
(gradual onset) or a single large stroke (rapid onset); contribu-
tory medical problems such as high blood pressure and high
cholesterol are often treated aggressively to decrease the likeli-
hood of further brain damage. - Other types of dementia are caused by medical conditions:
- Parkinson’s disease is a progressive disorder that affects
motor functions. - Lewy bodies build up inside certain types of neurons and
cause the neurons to die, leading to progressive, irrevers-
ible dementia.- HIV disease can eventually destroy white matter and sub-
cortical brain areas; in some cases, this type of demen-
tia can be arrested and even reversed with antiretroviral
medication. - Huntington’s disease is a progressive disease that involves
death of neurons in brain areas that are involved in cogni-
tion, emotion, and motor control. - Head trauma is caused by accidents or incurred as part of an
athletic sport. - Substance use or dependence can lead to temporary or per-
sistent dementia.
- HIV disease can eventually destroy white matter and sub-
- Parkinson’s disease is a progressive disorder that affects
- Treatments for dementia that target neurological factors in-
clude medications that affect the levels of acetylcholine and
glutamate. Behavioral disturbances that do not decrease
with behavioral treatment may be targeted with antipsychotic
medications. - Psychological and social interventions for people with dementia
are designed to improve the patients’ quality of life. Methods in-
clude the use of memory aids, reality orientation therapy, remi-
niscence therapy, and restructuring the environment.
Making a Diagnosis
- Reread Case 15.4 about Diana Friel McGowin, and determine
whether or not her symptoms meet the criteria for dementia.
Specifically, list which criteria apply and which do not. If you
would like more information to determine her diagnosis, what
information—specifi cally—would you want, and in what ways
would the information infl uence your decision?