08a_Neurocognitive Disorders: Alzheimer's Flashcards
Major Neurocognitive Disorder:
Overview
Subsumes DSM-IV diagnosis of Dementia
Significant decline from previous level of functioning in 1+ cognitive domains
Limits independence in everyday activities
Mild Neurocognitive Disorder:
Overview
Subsumes DSM-IV diagnosis of Cognitive Disorder NOS
Modest decline from previously level functioning in 1+ cognitive domains
*DOES NOT interfere with independence in everyday activities
May require greater effort or compensatory strategies
For Both Major and Mild Neurocognitive disorder:
Various types based on etiology
Alzheimer’s disease
Frontotemporal lobar degeneration
Lewy’s body disease
Vascular disease
Traumatic brain injury
Substance/medication use
HIV infection
Prion disease
Parkinson’s disease
Huntington’s disease
Neurocognitive Disorder Due to Alzheimer’s Disease:
Diagnostic Criteria
Criteria for Major/Mild Neurocognitive disorder are met
Insidious onset of symptoms
Gradual progression of impairment in 1+ cognitive domains
MAJOR Neurocognitive Disorder:
Probable Alzheimer’s
Evidence of causative genetic mutation
Decline in memory and 1+ other cognitive domain
Progressive and gradual decline in cognition
*without extended plateaus
No evidence of a mixed etiology
MILD Neurocognitive Disorder:
Probable Alzheimer’s
Evidence of causative genetic mutation
Decline in memory and learning
(*no other domains needed for Mild dx)
Progressive and gradual decline in cognition
*without extended plateaus
No evidence of a mixed etiology
MILD Neurocognitive Disorder:
Only Difference between Probable and Possible Alzheimer’s
Possible = no evidence of genetic mutation
Alzheimer’s:
Diagnostic considerations
Difficult to obtain direct evidence of Alzheimer’s disease
Usually diagnosed when all other causes of major or mild neurocognitive disorder have been ruled out
Alzheimer’s:
Requirements for definitive diagnosis
Autopsy / Brain biopsy to confirm presence of:
Extensive neuron loss & Amyloid plaques
Alzheimer’s:
Prevalence/Course
Single-most common cause of dementia
60 to 90% of all cases
Gradual onset of symptoms
Slow, progressive decline in cognitive functioning
Late onset: 70s-80s
Alzheimer’s:
Stage 1 (1 to 3 years)
Anterograde amnesia (esp. declarative memory)
Deficits in visuospatial skills (wandering)
Indifference, irritability, and sadness
Anomia
Alzheimer’s:
Stage 2 (2 to 10 years)
Increasing retrograde amnesia
Flat or labile mood
Restlessness and agitation
Delusions
Fluent aphasia
Dyscalculia
Ideomotor apraxia (cannot translate idea into movement)
Alzheimer’s:
Stage 3 (8 to 12 years)
Severely deteriorated intellectual functioning
Apathy
Limb rigidity
Urinary and fecal incontinence
Chromosomal Abnormalities:
Early-Onset Familial Type Alzheimer’s:
Chromosomes 1, 14, 21
Chromosomal Abnormalities:
Later Onset Alzheimer’s
ApoE4 gene on chromosome 19
Alzheimer’s:
Etiology: neurotransmitters
Abnormal levels of several NTs
***Especially Acetylcholine
involved in formation of memories
Alzheimer’s:
Most common treatment combination
Four elements
Group therapy
(emphasis on reality orientation and reminiscence)
Behavioral techniques and antipsychotic drugs to reduce agitation
Antidepressants to alleviate depression
Environmental manipulation and pharmacotherapy to enhance memory and cognitive functioning
Alzheimer’s:
Cholinesterase Inhibitors Overview
Reduce the breakdown of acetylcholine
Reversing cognitive impairment and improve behavioral symptoms in Mild to Moderate Alzheimer’s
- Does not cure the disorder
- Improvements are only temporary
Alzheimer’s:
Cholinesterase Inhibitors: Examples
Tacrine
Donepezil
Galantamine
Rivastigmine
Alzheimer’s:
Factor associated with best outcomes
Patients who remain home with their families
Less likely institutionalized when family is provided with adequate support
e.g. psychoeducation, skills training
