Opioid Use Disorder Treatment

Treatment for Opioid-Use Disorder

• Early detoxification and therapy are critical for treatment, which becomes more difficult with prolonged use
• Synthetic opioids can reduce cravings without producing euphoria, but a critical drawback is tolerance development
• Improved outcomes are achieved through behavioral-oriented counseling and contingency management with incentives for abstinence
• Family counseling also improves treatment outcomes
• Vaccine development is underway to help with opioid abuse, where antibodies prevent opioids from reaching the brain

Treatment for Stimulant-Use Disorder

• No effective pharmacological interventions are available
• Incentives for stimulant-free toxicology reports improve rates of continuous abstinence
• Teaching people who use cocaine to cope with temptations and high-risk situations is beneficial
• Vaccine development is underway to help individuals dependent on cocaine, where antibodies prevent cocaine from reaching the brain

Treatment for Cannabis-Use Disorder

• No information provided

Treatment for Gambling Disorder and Other Addiction

• Treatment approaches include group therapy, CBT, and improving financial management skills
• fMRI imaging may provide insight into which treatments increase impulse control

Internet Gaming Disorder

• A condition involving excessive and prolonged engagement in computerized or internet games
• Criteria are similar to gambling disorder
• Most common among adolescent males
• A significant concern in Asian countries
• Cognitive behavioral treatment approaches include a focus on behavioral change and treating underlying emotions such as anxiety and depression

Symptoms of Schizophrenia Spectrum Disorder

• Four categories of symptoms: positive, psychomotor abnormalities, cognitive, and negative
• Positive symptoms include delusions, hallucinations, disorganized thinking, and incoherent communication
  • Delusions are a lack of insight, false personal beliefs held despite evidence or logic
  • Delusional themes include grandeur, control, persecution, reference, and thought withdrawal
• Psychomotor abnormalities include catatonia, extremes in activity level, and agitated/hyperactive behavior
• Cognitive symptoms include disorganized thinking, communication, and speech
• Negative symptoms include decreased ability to initiate actions or speech, express emotions, or feel pleasure

Understanding Schizophrenia

• Diagnosis involves the presence of at least two symptoms, including delusions, hallucinations, disorganized speech, gross motor disturbance, and negative symptoms
• Deterioration from a previous level of functioning, with symptoms present for at least one month and persisting for at least six months

Phases of Schizophrenia

• Prodromal phase: onset and buildup of symptoms
• Active phase: full-blown symptoms
• Residual phase: sometimes occurs, but not always, with symptoms no longer prominent

Long-Term Outcome Studies

• Increased optimism regarding the course of the disorder

Etiology of Schizophrenia

• Primarily a genetic disorder
• Biological factors: genetics and heredity play a role, with interactions among multiple genes
• Correlation to brain structures and function: endophenotypes, neurostructures, and biochemical influences

Treatment of Schizophrenia

• Antipsychotic medication can reduce the intensity of symptoms, but does not help negative symptoms
• Cognitive enhancement therapy aims to ameliorate neurocognitive deficits
• Psychosocial therapy focuses on direct teaching of conversational, behavioral, and social skills
• CBT teaches coping skills to manage positive and negative symptoms
• Interventions focusing on family communication and education aim to normalize family experience and strengthen communication skills### Lecture 13: Neurocognitive Disorders

Types of Neurocognitive Disorders

• Major
• Minor
• Delirium
  • More short-lived, comes and leaves abruptly
  • Structural and chemical changes result in impaired thinking, memory, or perception
  • Caused by transient or permanent brain dysfunction

The Assessment of Brain Damage and Neurocognitive Functioning

• Gather background information
• Evaluate overall mental functioning, personality, and coping skills
• Rule out sensory or emotional factors
• Assess mental status, including memory, attention, and orientation
• Test to pinpoint cognitive difficulties
• Medical professionals identify and treat any underlying physical conditions
  • Tests include blood tests, EEG, CT, MRI, PET
• Comprehensive baseline assessment to monitor progress or decline (e.g. Trail-Making Test)

Major Neurocognitive Disorder

• Significant decline in one or more cognitive areas, often multiple regions
• Decline in ability to independently meet daily living demands
• Clinicians specify the underlying medical reason if known

Mild Neurocognitive Disorder

• Modest decline in at least one main cognitive area
• Individuals able to participate in everyday activities, may require extra time
• Often an intermediate stage between aging and major neurocognitive disorder
• Can sometimes be downgraded from major disorder after recovery

Delirium

• Acute state of confusion with disorientation and impaired attention
• Abrupt onset, develops over hours/days, can be mild or severe
• Psychotic symptoms may be present
• Treatment involves identifying and addressing the underlying cause
• Increased risk for hospitalized individuals and the elderly

Dementia

• Decline in mental function and self-help skills
• Examples include memory, problem-solving, and impulse control
• Agitation due to confusion or frustration is common
• Gradual onset and continuing cognitive decline
• Age is the strongest risk factor
  • Women have greater lifetime risk as they tend to live longer
  • White and well-educated tend to develop it later in life
  • People of color and less educated have earlier onset and higher lifetime risk

13-2 Etiology of Neurocognitive Disorders

• Result from a variety of medical conditions
• Some involve specific events like stroke or head injury
• Some become worse over time through neurodegeneration involving progressive brain damage

Neurocognitive Disorder due to Traumatic Brain Injury (TBI)

• TBI can result from a bump, jolt, or blow to the head
• Occurs most frequently in young children, older adolescents, and older adults
• Persistent cognitive impairment due to the brain injury
• Effects can be temporary or permanent

Concussion

• Most common type of TBI
• Trauma-induced changes in brain functioning
• Symptoms include headache, dizziness, nausea, and sensitivity to light
• Usually temporary but sometimes last much longer
• Physicians recommend rest and minimizing stimulation

Cerebral Contusion and Cerebral Laceration

• Cerebral contusion is bruising of the brain from force striking the skull
• Cerebral laceration is an open head injury where brain tissue is torn or ruptured

Chronic Traumatic Encephalopathy (CTE)

• Progressive, degenerative condition with abnormal tau protein deposits
• Diagnosed in individuals with multiple head injury episodes
• Associated with psychological symptoms and increased risk of dementia
• Four stages: headache/concentration, depression/memory, cognitive impairment, dementia

Vascular Neurocognitive Disorders

• Can result from a one-time stroke or ongoing cardiovascular disruptions
• Found in about 40% of brain autopsies of individuals with dementia
• Often begins with atherosclerosis
• Ischemic stroke (85% of cases) and hemorrhagic stroke (15% of cases)

Stroke

• Obstruction of blood flow to the brain, leading to loss of brain function
• A leading cause of death and disability in the US, can occur at any age
• Risk factors include smoking, stress, poor lifestyle, and depression
• Vascular dementia can result from a series of small strokes

Neurocognitive Disorder Due to Substance and Alzheimer's Disease

• Substance use can result in delirium or chronic brain dysfunction
• Mild neurocognitive disorder common with history of heavy substance use
• Alzheimer's Disease affects over 5 million Americans
  • Progressive cognitive and behavioral decline
  • Age is a significant risk factor
  • Requires clear physiological indicators to predict progression from mild impairment

Characteristics of Alzheimer's Disease

• Progressive decline in cognitive and behavioral functioning
• Early symptoms include memory dysfunction, irritability, cognitive impairment
• Other common symptoms include social withdrawal, depression, delusions, impulsive behaviors
• No cure exists, involves shrinkage of brain tissue and abnormal structures like neurofibrillary tangles and beta-amyloid plaques
• Brain changes appear years before dementia symptoms

Types of Alzheimer's

1. Early Onset (5-10%): Typically more genetic factors
2. Late Onset (80-90%): Average age of diagnosis is 74, life expectancy 7-9 years

Etiology of Alzheimer's Disease

• Believed to be influenced by hereditary and environmental factors
  • Genetically-based Alzheimer's tends towards early onset
  • Stress, smoking, lifestyle factors tend towards late onset

Treatment

• Only available treatments can slow down progression, such as medication

Dementia with Lewy Bodies (DLB)

• Second most common form of dementia
• Characteristics include fluctuations in attention/alertness, visual hallucinations, psychiatric symptoms, and motor impairment
• Lewy bodies deplete acetylcholine, resulting in perceptual, cognitive, and behavioral symptoms
• Depletion of dopamine results in unique motor dysfunction

Parkinson's Disease (PD)

• Four primary symptoms: tremor, rigidity, slowness initiating movement, impaired balance
• Motor symptoms evident at least one year prior to cognitive decline
• Mild cognitive impairment affects 27% of those with PD
• Symptoms result from buildup of Lewy body proteins
• Occupational exposure to toxins may increase PD risk

13-3 Treatment Considerations

• Approaches vary widely based on cause, symptoms, and dysfunction
• First, address any underlying medical conditions
• Major interventions include:
  • Rehabilitative services
  • Biological interventions like medication
  • Cognitive and behavioral treatment
  • Lifestyle changes
  • Environmental support

Rehab

• Primarily for stroke, must be comprehensive and sustained
• Physical, occupational, speech, and language therapy
• Commitment and participation is important, depression can stall progress
• Neuroimaging used to document brain changes from rehabilitation

Biological Treatment

• Medications like L-dopa, specific vitamins, deep brain stimulation, gene therapy
• Help prevent recurrence of stroke, treat underlying conditions

Cognitive and Behavior Treatment

• Psychotherapy to enhance coping, reduce problem behaviors
• Teach strategies like social skills, simplifying tasks
• Meditation and mindfulness-based approaches can reduce brain atrophy

Lifestyle Changes

• Can help prevent or minimize progression
  • Cardiovascular fitness, smoking cessation, weight reduction
  • Control of blood sugar, cholesterol, blood pressure
  • Increased social interaction and mental stimulation

Environmental Support

• Crucial for disorders involving dementia
• Bright lighting, labeling, family visits to improve sleep, decrease agitation

Treatment for Opioid-Use Disorder

• Early detoxification and therapy are critical for treatment, which becomes more difficult with prolonged use
• Synthetic opioids can reduce cravings without producing euphoria, but a critical drawback is tolerance development
• Improved outcomes are achieved through behavioral-oriented counseling and contingency management with incentives for abstinence
• Family counseling also improves treatment outcomes
• Vaccine development is underway to help with opioid abuse, where antibodies prevent opioids from reaching the brain

Treatment for Stimulant-Use Disorder

• No effective pharmacological interventions are available
• Incentives for stimulant-free toxicology reports improve rates of continuous abstinence
• Teaching people who use cocaine to cope with temptations and high-risk situations is beneficial
• Vaccine development is underway to help individuals dependent on cocaine, where antibodies prevent cocaine from reaching the brain

Treatment for Cannabis-Use Disorder

• No information provided

Treatment for Gambling Disorder and Other Addiction

• Treatment approaches include group therapy, CBT, and improving financial management skills
• fMRI imaging may provide insight into which treatments increase impulse control

Internet Gaming Disorder

• A condition involving excessive and prolonged engagement in computerized or internet games
• Criteria are similar to gambling disorder
• Most common among adolescent males
• A significant concern in Asian countries
• Cognitive behavioral treatment approaches include a focus on behavioral change and treating underlying emotions such as anxiety and depression

Symptoms of Schizophrenia Spectrum Disorder

• Four categories of symptoms: positive, psychomotor abnormalities, cognitive, and negative
• Positive symptoms include delusions, hallucinations, disorganized thinking, and incoherent communication
  • Delusions are a lack of insight, false personal beliefs held despite evidence or logic
  • Delusional themes include grandeur, control, persecution, reference, and thought withdrawal
• Psychomotor abnormalities include catatonia, extremes in activity level, and agitated/hyperactive behavior
• Cognitive symptoms include disorganized thinking, communication, and speech
• Negative symptoms include decreased ability to initiate actions or speech, express emotions, or feel pleasure

Understanding Schizophrenia

• Diagnosis involves the presence of at least two symptoms, including delusions, hallucinations, disorganized speech, gross motor disturbance, and negative symptoms
• Deterioration from a previous level of functioning, with symptoms present for at least one month and persisting for at least six months

Phases of Schizophrenia

• Prodromal phase: onset and buildup of symptoms
• Active phase: full-blown symptoms
• Residual phase: sometimes occurs, but not always, with symptoms no longer prominent

Long-Term Outcome Studies

• Increased optimism regarding the course of the disorder

Etiology of Schizophrenia

• Primarily a genetic disorder
• Biological factors: genetics and heredity play a role, with interactions among multiple genes
• Correlation to brain structures and function: endophenotypes, neurostructures, and biochemical influences

Treatment of Schizophrenia

• Antipsychotic medication can reduce the intensity of symptoms, but does not help negative symptoms
• Cognitive enhancement therapy aims to ameliorate neurocognitive deficits
• Psychosocial therapy focuses on direct teaching of conversational, behavioral, and social skills
• CBT teaches coping skills to manage positive and negative symptoms
• Interventions focusing on family communication and education aim to normalize family experience and strengthen communication skills### Lecture 13: Neurocognitive Disorders

Types of Neurocognitive Disorders

• Major
• Minor
• Delirium
  • More short-lived, comes and leaves abruptly
  • Structural and chemical changes result in impaired thinking, memory, or perception
  • Caused by transient or permanent brain dysfunction

The Assessment of Brain Damage and Neurocognitive Functioning

• Gather background information
• Evaluate overall mental functioning, personality, and coping skills
• Rule out sensory or emotional factors
• Assess mental status, including memory, attention, and orientation
• Test to pinpoint cognitive difficulties
• Medical professionals identify and treat any underlying physical conditions
  • Tests include blood tests, EEG, CT, MRI, PET
• Comprehensive baseline assessment to monitor progress or decline (e.g. Trail-Making Test)

Major Neurocognitive Disorder

• Significant decline in one or more cognitive areas, often multiple regions
• Decline in ability to independently meet daily living demands
• Clinicians specify the underlying medical reason if known

Mild Neurocognitive Disorder

• Modest decline in at least one main cognitive area
• Individuals able to participate in everyday activities, may require extra time
• Often an intermediate stage between aging and major neurocognitive disorder
• Can sometimes be downgraded from major disorder after recovery

Delirium

• Acute state of confusion with disorientation and impaired attention
• Abrupt onset, develops over hours/days, can be mild or severe
• Psychotic symptoms may be present
• Treatment involves identifying and addressing the underlying cause
• Increased risk for hospitalized individuals and the elderly

Dementia

• Decline in mental function and self-help skills
• Examples include memory, problem-solving, and impulse control
• Agitation due to confusion or frustration is common
• Gradual onset and continuing cognitive decline
• Age is the strongest risk factor
  • Women have greater lifetime risk as they tend to live longer
  • White and well-educated tend to develop it later in life
  • People of color and less educated have earlier onset and higher lifetime risk

13-2 Etiology of Neurocognitive Disorders

• Result from a variety of medical conditions
• Some involve specific events like stroke or head injury
• Some become worse over time through neurodegeneration involving progressive brain damage

Neurocognitive Disorder due to Traumatic Brain Injury (TBI)

• TBI can result from a bump, jolt, or blow to the head
• Occurs most frequently in young children, older adolescents, and older adults
• Persistent cognitive impairment due to the brain injury
• Effects can be temporary or permanent

Concussion

• Most common type of TBI
• Trauma-induced changes in brain functioning
• Symptoms include headache, dizziness, nausea, and sensitivity to light
• Usually temporary but sometimes last much longer
• Physicians recommend rest and minimizing stimulation

Cerebral Contusion and Cerebral Laceration

• Cerebral contusion is bruising of the brain from force striking the skull
• Cerebral laceration is an open head injury where brain tissue is torn or ruptured

Chronic Traumatic Encephalopathy (CTE)

• Progressive, degenerative condition with abnormal tau protein deposits
• Diagnosed in individuals with multiple head injury episodes
• Associated with psychological symptoms and increased risk of dementia
• Four stages: headache/concentration, depression/memory, cognitive impairment, dementia

Vascular Neurocognitive Disorders

• Can result from a one-time stroke or ongoing cardiovascular disruptions
• Found in about 40% of brain autopsies of individuals with dementia
• Often begins with atherosclerosis
• Ischemic stroke (85% of cases) and hemorrhagic stroke (15% of cases)

Stroke

• Obstruction of blood flow to the brain, leading to loss of brain function
• A leading cause of death and disability in the US, can occur at any age
• Risk factors include smoking, stress, poor lifestyle, and depression
• Vascular dementia can result from a series of small strokes

Neurocognitive Disorder Due to Substance and Alzheimer's Disease

• Substance use can result in delirium or chronic brain dysfunction
• Mild neurocognitive disorder common with history of heavy substance use
• Alzheimer's Disease affects over 5 million Americans
  • Progressive cognitive and behavioral decline
  • Age is a significant risk factor
  • Requires clear physiological indicators to predict progression from mild impairment

Characteristics of Alzheimer's Disease

• Progressive decline in cognitive and behavioral functioning
• Early symptoms include memory dysfunction, irritability, cognitive impairment
• Other common symptoms include social withdrawal, depression, delusions, impulsive behaviors
• No cure exists, involves shrinkage of brain tissue and abnormal structures like neurofibrillary tangles and beta-amyloid plaques
• Brain changes appear years before dementia symptoms

Types of Alzheimer's

1. Early Onset (5-10%): Typically more genetic factors
2. Late Onset (80-90%): Average age of diagnosis is 74, life expectancy 7-9 years

Etiology of Alzheimer's Disease

• Believed to be influenced by hereditary and environmental factors
  • Genetically-based Alzheimer's tends towards early onset
  • Stress, smoking, lifestyle factors tend towards late onset

Treatment

• Only available treatments can slow down progression, such as medication

Dementia with Lewy Bodies (DLB)

• Second most common form of dementia
• Characteristics include fluctuations in attention/alertness, visual hallucinations, psychiatric symptoms, and motor impairment
• Lewy bodies deplete acetylcholine, resulting in perceptual, cognitive, and behavioral symptoms
• Depletion of dopamine results in unique motor dysfunction

Parkinson's Disease (PD)

• Four primary symptoms: tremor, rigidity, slowness initiating movement, impaired balance
• Motor symptoms evident at least one year prior to cognitive decline
• Mild cognitive impairment affects 27% of those with PD
• Symptoms result from buildup of Lewy body proteins
• Occupational exposure to toxins may increase PD risk

13-3 Treatment Considerations

• Approaches vary widely based on cause, symptoms, and dysfunction
• First, address any underlying medical conditions
• Major interventions include:
  • Rehabilitative services
  • Biological interventions like medication
  • Cognitive and behavioral treatment
  • Lifestyle changes
  • Environmental support

Rehab

• Primarily for stroke, must be comprehensive and sustained
• Physical, occupational, speech, and language therapy
• Commitment and participation is important, depression can stall progress
• Neuroimaging used to document brain changes from rehabilitation

Biological Treatment

• Medications like L-dopa, specific vitamins, deep brain stimulation, gene therapy
• Help prevent recurrence of stroke, treat underlying conditions

Cognitive and Behavior Treatment

• Psychotherapy to enhance coping, reduce problem behaviors
• Teach strategies like social skills, simplifying tasks
• Meditation and mindfulness-based approaches can reduce brain atrophy

Lifestyle Changes

• Can help prevent or minimize progression
  • Cardiovascular fitness, smoking cessation, weight reduction
  • Control of blood sugar, cholesterol, blood pressure
  • Increased social interaction and mental stimulation

Environmental Support

• Crucial for disorders involving dementia
• Bright lighting, labeling, family visits to improve sleep, decrease agitation

Treatment for Opioid-Use Disorder

• Early detoxification and therapy are critical for treatment, which becomes more difficult with prolonged use
• Synthetic opioids can reduce cravings without producing euphoria, but a critical drawback is tolerance development
• Improved outcomes are achieved through behavioral-oriented counseling and contingency management with incentives for abstinence
• Family counseling also improves treatment outcomes
• Vaccine development is underway to help with opioid abuse, where antibodies prevent opioids from reaching the brain

Treatment for Stimulant-Use Disorder

• No effective pharmacological interventions are available
• Incentives for stimulant-free toxicology reports improve rates of continuous abstinence
• Teaching people who use cocaine to cope with temptations and high-risk situations is beneficial
• Vaccine development is underway to help individuals dependent on cocaine, where antibodies prevent cocaine from reaching the brain

Treatment for Cannabis-Use Disorder

• No information provided

Treatment for Gambling Disorder and Other Addiction

• Treatment approaches include group therapy, CBT, and improving financial management skills
• fMRI imaging may provide insight into which treatments increase impulse control

Internet Gaming Disorder

• A condition involving excessive and prolonged engagement in computerized or internet games
• Criteria are similar to gambling disorder
• Most common among adolescent males
• A significant concern in Asian countries
• Cognitive behavioral treatment approaches include a focus on behavioral change and treating underlying emotions such as anxiety and depression

Symptoms of Schizophrenia Spectrum Disorder

• Four categories of symptoms: positive, psychomotor abnormalities, cognitive, and negative
• Positive symptoms include delusions, hallucinations, disorganized thinking, and incoherent communication
  • Delusions are a lack of insight, false personal beliefs held despite evidence or logic
  • Delusional themes include grandeur, control, persecution, reference, and thought withdrawal
• Psychomotor abnormalities include catatonia, extremes in activity level, and agitated/hyperactive behavior
• Cognitive symptoms include disorganized thinking, communication, and speech
• Negative symptoms include decreased ability to initiate actions or speech, express emotions, or feel pleasure

Understanding Schizophrenia

• Diagnosis involves the presence of at least two symptoms, including delusions, hallucinations, disorganized speech, gross motor disturbance, and negative symptoms
• Deterioration from a previous level of functioning, with symptoms present for at least one month and persisting for at least six months

Phases of Schizophrenia

• Prodromal phase: onset and buildup of symptoms
• Active phase: full-blown symptoms
• Residual phase: sometimes occurs, but not always, with symptoms no longer prominent

Long-Term Outcome Studies

• Increased optimism regarding the course of the disorder

Etiology of Schizophrenia

• Primarily a genetic disorder
• Biological factors: genetics and heredity play a role, with interactions among multiple genes
• Correlation to brain structures and function: endophenotypes, neurostructures, and biochemical influences

Treatment of Schizophrenia

• Antipsychotic medication can reduce the intensity of symptoms, but does not help negative symptoms
• Cognitive enhancement therapy aims to ameliorate neurocognitive deficits
• Psychosocial therapy focuses on direct teaching of conversational, behavioral, and social skills
• CBT teaches coping skills to manage positive and negative symptoms
• Interventions focusing on family communication and education aim to normalize family experience and strengthen communication skills### Lecture 13: Neurocognitive Disorders

Types of Neurocognitive Disorders

• Major
• Minor
• Delirium
  • More short-lived, comes and leaves abruptly
  • Structural and chemical changes result in impaired thinking, memory, or perception
  • Caused by transient or permanent brain dysfunction

The Assessment of Brain Damage and Neurocognitive Functioning

• Gather background information
• Evaluate overall mental functioning, personality, and coping skills
• Rule out sensory or emotional factors
• Assess mental status, including memory, attention, and orientation
• Test to pinpoint cognitive difficulties
• Medical professionals identify and treat any underlying physical conditions
  • Tests include blood tests, EEG, CT, MRI, PET
• Comprehensive baseline assessment to monitor progress or decline (e.g. Trail-Making Test)

Major Neurocognitive Disorder

• Significant decline in one or more cognitive areas, often multiple regions
• Decline in ability to independently meet daily living demands
• Clinicians specify the underlying medical reason if known

Mild Neurocognitive Disorder

• Modest decline in at least one main cognitive area
• Individuals able to participate in everyday activities, may require extra time
• Often an intermediate stage between aging and major neurocognitive disorder
• Can sometimes be downgraded from major disorder after recovery

Delirium

• Acute state of confusion with disorientation and impaired attention
• Abrupt onset, develops over hours/days, can be mild or severe
• Psychotic symptoms may be present
• Treatment involves identifying and addressing the underlying cause
• Increased risk for hospitalized individuals and the elderly

Dementia

• Decline in mental function and self-help skills
• Examples include memory, problem-solving, and impulse control
• Agitation due to confusion or frustration is common
• Gradual onset and continuing cognitive decline
• Age is the strongest risk factor
  • Women have greater lifetime risk as they tend to live longer
  • White and well-educated tend to develop it later in life
  • People of color and less educated have earlier onset and higher lifetime risk

13-2 Etiology of Neurocognitive Disorders

• Result from a variety of medical conditions
• Some involve specific events like stroke or head injury
• Some become worse over time through neurodegeneration involving progressive brain damage

Neurocognitive Disorder due to Traumatic Brain Injury (TBI)

• TBI can result from a bump, jolt, or blow to the head
• Occurs most frequently in young children, older adolescents, and older adults
• Persistent cognitive impairment due to the brain injury
• Effects can be temporary or permanent

Concussion

• Most common type of TBI
• Trauma-induced changes in brain functioning
• Symptoms include headache, dizziness, nausea, and sensitivity to light
• Usually temporary but sometimes last much longer
• Physicians recommend rest and minimizing stimulation

Cerebral Contusion and Cerebral Laceration

• Cerebral contusion is bruising of the brain from force striking the skull
• Cerebral laceration is an open head injury where brain tissue is torn or ruptured

Chronic Traumatic Encephalopathy (CTE)

• Progressive, degenerative condition with abnormal tau protein deposits
• Diagnosed in individuals with multiple head injury episodes
• Associated with psychological symptoms and increased risk of dementia
• Four stages: headache/concentration, depression/memory, cognitive impairment, dementia

Vascular Neurocognitive Disorders

• Can result from a one-time stroke or ongoing cardiovascular disruptions
• Found in about 40% of brain autopsies of individuals with dementia
• Often begins with atherosclerosis
• Ischemic stroke (85% of cases) and hemorrhagic stroke (15% of cases)

Stroke

• Obstruction of blood flow to the brain, leading to loss of brain function
• A leading cause of death and disability in the US, can occur at any age
• Risk factors include smoking, stress, poor lifestyle, and depression
• Vascular dementia can result from a series of small strokes

Neurocognitive Disorder Due to Substance and Alzheimer's Disease

• Substance use can result in delirium or chronic brain dysfunction
• Mild neurocognitive disorder common with history of heavy substance use
• Alzheimer's Disease affects over 5 million Americans
  • Progressive cognitive and behavioral decline
  • Age is a significant risk factor
  • Requires clear physiological indicators to predict progression from mild impairment

Characteristics of Alzheimer's Disease

• Progressive decline in cognitive and behavioral functioning
• Early symptoms include memory dysfunction, irritability, cognitive impairment
• Other common symptoms include social withdrawal, depression, delusions, impulsive behaviors
• No cure exists, involves shrinkage of brain tissue and abnormal structures like neurofibrillary tangles and beta-amyloid plaques
• Brain changes appear years before dementia symptoms

Types of Alzheimer's

1. Early Onset (5-10%): Typically more genetic factors
2. Late Onset (80-90%): Average age of diagnosis is 74, life expectancy 7-9 years

Etiology of Alzheimer's Disease

• Believed to be influenced by hereditary and environmental factors
  • Genetically-based Alzheimer's tends towards early onset
  • Stress, smoking, lifestyle factors tend towards late onset

Treatment

• Only available treatments can slow down progression, such as medication

Dementia with Lewy Bodies (DLB)

• Second most common form of dementia
• Characteristics include fluctuations in attention/alertness, visual hallucinations, psychiatric symptoms, and motor impairment
• Lewy bodies deplete acetylcholine, resulting in perceptual, cognitive, and behavioral symptoms
• Depletion of dopamine results in unique motor dysfunction

Parkinson's Disease (PD)

• Four primary symptoms: tremor, rigidity, slowness initiating movement, impaired balance
• Motor symptoms evident at least one year prior to cognitive decline
• Mild cognitive impairment affects 27% of those with PD
• Symptoms result from buildup of Lewy body proteins
• Occupational exposure to toxins may increase PD risk

13-3 Treatment Considerations

• Approaches vary widely based on cause, symptoms, and dysfunction
• First, address any underlying medical conditions
• Major interventions include:
  • Rehabilitative services
  • Biological interventions like medication
  • Cognitive and behavioral treatment
  • Lifestyle changes
  • Environmental support

Rehab

• Primarily for stroke, must be comprehensive and sustained
• Physical, occupational, speech, and language therapy
• Commitment and participation is important, depression can stall progress
• Neuroimaging used to document brain changes from rehabilitation

Biological Treatment

• Medications like L-dopa, specific vitamins, deep brain stimulation, gene therapy
• Help prevent recurrence of stroke, treat underlying conditions

Cognitive and Behavior Treatment

• Psychotherapy to enhance coping, reduce problem behaviors
• Teach strategies like social skills, simplifying tasks
• Meditation and mindfulness-based approaches can reduce brain atrophy

Lifestyle Changes

• Can help prevent or minimize progression
  • Cardiovascular fitness, smoking cessation, weight reduction
  • Control of blood sugar, cholesterol, blood pressure
  • Increased social interaction and mental stimulation

Environmental Support

• Crucial for disorders involving dementia
• Bright lighting, labeling, family visits to improve sleep, decrease agitation