PROBLEM 6: LOST IN THE LABYRINTH
Learning Goals:
Case 1:
What is a neurocognitive disorder / dementia? (clinical features, DSM criteria, epidemiology)
What are the causes of the different types of dementia? (aetiology)
Can you treat / decelerate dementia? (treatment)
Case 2:
What is Korsakoff’s syndrome (or amnestic disorder)? (clinical features, DSM criteria,
epidemiology)
What is delirium? (clinical features, DSM criteria, epidemiology)
What causes these disorders? (aetiology)
How can these disorders be treated? (treatment)
Neurocognitive disorders
Executive functions: cognitive skills that involve problem-solving, planning and engaging in goal-
directed behaviour
Rehabilitation Programmes: treatment programmes that usually combine a mixture of group work,
psychological interventions, social skills training and practical and vocational activities
COGNITIVE IMPAIRMENTS IN NEUROCOGNITIVE DISORDERS
Learning and memory Deficits
- Amnesia = common feature of many neurocognitive disorders
o Inability to learn new info
o Failure to recall past events
o Failure to recall most recent past
- if caused by specific traumatic event (head injury)
o may be unable to recall anything from the moment of the injury or to retain
memories of recent events
- Anterograde amnesia/ anterograde memory dysfunction: memory loss for information
acquired after the onset of amnesia
Deficits in attention and arousal
- Signs of lack of attention
o Being easily distracted
o Performing well-learnt activities slower than before
o Difficulty focusing or keeping up with conversation
,Language Deficits
- Individual appears to be rambling during the conversation
- Difficulty conveying what they have to say in coherent manner
- Difficulty reading and understanding speech of others
- Aphasias: speech disorder resulting in difficulties producing or comprehending speech
- Broca’s aphasia: disruption in the ability to speak consisting of difficulties with word ordering,
finding the right words and articulation
o Fluent aphasia: production of incoherent, jumbled speech
- Wernicke’s aphasia: deficit in the comprehension of speech involving difficulties in
recognizing spoken words and converting thoughts into words
o Non-fluent aphasia: inability to initiate speech or respond to speech with anything
other than simple words
Deficits in visual-perceptual functioning
- Agnosia: Unable to recognize everyday objects, persons, sounds, shapes, smells
o No significant memory loss
Motor skills deficits
- Apraxia: loss of ability to execute or carry out learnt movements, despite having the desire
and physical ability to perform the movements
- paralysis
Deficits in executive functions
- Inability to effectively solve problems, plan, initiate, organize, monitor and inhibit complex
behaviours
o Damage in prefrontal cortex (important in maintain the representation of goals and
the means to achieve them)
, - Wisconsin card sorting task: test of executive functioning where individuals must sort cards
for a number of trial using one rule and then sort cards using another rule.
- Deficits in executive functioning are revealed in everyday behaviours
o Poor judgement
o Inappropriate behaviour
o Erratic mood swings
Deficits in higher order intellectual functioning
- Impairment in more abstract, mental tasks
o Unable to make simple mathematical calculations
o Reason deductively
o Draw a general knowledge when doing task or activity
ASSESMENT OF NEUROCOGNITIVE DISORDERS
Neuropsychological tests and brain scans
IMPORTANT FOR:
- determining actual nature of deficits and location of related tissue damage in brain
- Providing info about onset, type, severity and progression of symptoms
- Helping discriminate between neurological deficits that have an organic basis and psychiatric
symptoms that do not
- For helping identify the focus for rehabilitation programmes and to assess the progress
Also supplemented with behavioural observations and info from clients and their families
- Onset, type, severity and progression of symptoms
TESTS:
Neuropsychological tests: accurate in detecting specific deficits and identifying the brain areas
where tissue damage may have led to the deficit
- WAIS-IV: fourth edition of Wechsler adult intelligence scale
o Scales that measure: vocabulary, arithmetic ability, digit span, info comprehension,
letter-number sequencing, picture completion ability, reasoning ability, symbol search
and object assembly ability
o Provide scores on broader indices of ability – verbal comprehension, perceptual
organization, working memory and info processing speech
- Adult memory and Information processing battery
o Two tests of Speed of info processing
o Verbal memory tests
o Visual memory tests
- Halstead Reitan neuropsychological test battery
Learning Goals:
Case 1:
What is a neurocognitive disorder / dementia? (clinical features, DSM criteria, epidemiology)
What are the causes of the different types of dementia? (aetiology)
Can you treat / decelerate dementia? (treatment)
Case 2:
What is Korsakoff’s syndrome (or amnestic disorder)? (clinical features, DSM criteria,
epidemiology)
What is delirium? (clinical features, DSM criteria, epidemiology)
What causes these disorders? (aetiology)
How can these disorders be treated? (treatment)
Neurocognitive disorders
Executive functions: cognitive skills that involve problem-solving, planning and engaging in goal-
directed behaviour
Rehabilitation Programmes: treatment programmes that usually combine a mixture of group work,
psychological interventions, social skills training and practical and vocational activities
COGNITIVE IMPAIRMENTS IN NEUROCOGNITIVE DISORDERS
Learning and memory Deficits
- Amnesia = common feature of many neurocognitive disorders
o Inability to learn new info
o Failure to recall past events
o Failure to recall most recent past
- if caused by specific traumatic event (head injury)
o may be unable to recall anything from the moment of the injury or to retain
memories of recent events
- Anterograde amnesia/ anterograde memory dysfunction: memory loss for information
acquired after the onset of amnesia
Deficits in attention and arousal
- Signs of lack of attention
o Being easily distracted
o Performing well-learnt activities slower than before
o Difficulty focusing or keeping up with conversation
,Language Deficits
- Individual appears to be rambling during the conversation
- Difficulty conveying what they have to say in coherent manner
- Difficulty reading and understanding speech of others
- Aphasias: speech disorder resulting in difficulties producing or comprehending speech
- Broca’s aphasia: disruption in the ability to speak consisting of difficulties with word ordering,
finding the right words and articulation
o Fluent aphasia: production of incoherent, jumbled speech
- Wernicke’s aphasia: deficit in the comprehension of speech involving difficulties in
recognizing spoken words and converting thoughts into words
o Non-fluent aphasia: inability to initiate speech or respond to speech with anything
other than simple words
Deficits in visual-perceptual functioning
- Agnosia: Unable to recognize everyday objects, persons, sounds, shapes, smells
o No significant memory loss
Motor skills deficits
- Apraxia: loss of ability to execute or carry out learnt movements, despite having the desire
and physical ability to perform the movements
- paralysis
Deficits in executive functions
- Inability to effectively solve problems, plan, initiate, organize, monitor and inhibit complex
behaviours
o Damage in prefrontal cortex (important in maintain the representation of goals and
the means to achieve them)
, - Wisconsin card sorting task: test of executive functioning where individuals must sort cards
for a number of trial using one rule and then sort cards using another rule.
- Deficits in executive functioning are revealed in everyday behaviours
o Poor judgement
o Inappropriate behaviour
o Erratic mood swings
Deficits in higher order intellectual functioning
- Impairment in more abstract, mental tasks
o Unable to make simple mathematical calculations
o Reason deductively
o Draw a general knowledge when doing task or activity
ASSESMENT OF NEUROCOGNITIVE DISORDERS
Neuropsychological tests and brain scans
IMPORTANT FOR:
- determining actual nature of deficits and location of related tissue damage in brain
- Providing info about onset, type, severity and progression of symptoms
- Helping discriminate between neurological deficits that have an organic basis and psychiatric
symptoms that do not
- For helping identify the focus for rehabilitation programmes and to assess the progress
Also supplemented with behavioural observations and info from clients and their families
- Onset, type, severity and progression of symptoms
TESTS:
Neuropsychological tests: accurate in detecting specific deficits and identifying the brain areas
where tissue damage may have led to the deficit
- WAIS-IV: fourth edition of Wechsler adult intelligence scale
o Scales that measure: vocabulary, arithmetic ability, digit span, info comprehension,
letter-number sequencing, picture completion ability, reasoning ability, symbol search
and object assembly ability
o Provide scores on broader indices of ability – verbal comprehension, perceptual
organization, working memory and info processing speech
- Adult memory and Information processing battery
o Two tests of Speed of info processing
o Verbal memory tests
o Visual memory tests
- Halstead Reitan neuropsychological test battery
