4- Dementia Flashcards by Shannon Keary

Define mild-cognitive impairment

cognitive decline beyond expected for that age and education, without significantly interfering with normal daily function

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what is amnestic MCI?

MCI that primarily affects memory
frequently seen s early stage of Alzheimers disease

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What percentage of patients with MCI progress to dementia annually?

10-15%

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What percentage of patients over the age of 65 are affected by MCI?

5-20%

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What score on the 6CIT qualifies for MCI?

8-9

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List some cognitive deficits of MCI?

memory, language, thinking, attention, visual depth, perception and judgement

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define dementia

the chronic and progressive gradual deterioration of behaviour and higher intellectual function due to organic brain disease.

associated w old age, umbrella term for memory loss impairment

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What score on the 6CIT is used as a screening as a basis of referral?

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What are some typical manifestations of dementia?

memory disorders
personality changes
deterioration in personal care
impaired reasoning ability
disorientation
deterioration in emotional control, sociaal behaviours and motivation

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What are the differences between MCI and dementia?

MCI = normal ageing, doesnt interfere with normal daily function, no approved drug treatment

MCI doesnt always haave causative underlying pathophysiology. dementia = chronic syndrome arising from mnay pathophysiologies

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What are some similarities between MCI and dementia?

both impact a persons cognitive abilities
neither impact a persons consciousness

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What can be done to reduce the risk of developing dementia?

exercise
no smoking/excessive drinking
social activities
engage in cognitive stimulation
prompt treatment of depression
mediterranean diets (high in fruits, veg, low met, sugar, saturated fat)

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What are the score-breakdowns of the 6CIT test?

normal : 0-7
MCI : 8-9
severe cognitive impairment (refer) : 10-28

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What are the advantages and the disadvantages of the 6CIT test?

adv: high sensitivity without compromising specificity
accessible and simple to control

dis: scoring and weighting of test can initially be confusing

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List the members of an MDT and their describe their respective roles

dementia social worker
dietician
carers
volunteer
specialist nurse
consultant
OT
physiotherapist

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what does a dementia social worker do?

makes sure a patient is safe and well supported at home

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what does an occupational therapist do?

optimises the working and living environment of the patient and suggesting modifications to improve patients ADLs

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Define capacity

ability to use and understand information to make a decision and communicate any decision made

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According to MCA when is an individual unable to make a decision for themselves?

can’t:
- understand info relevant to discussion
- retain that info
- use or weigh-up the info as part of the decision-making process

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How can you assess capacity?

Does the person have an impairment of their mind or brain, whether as a result of an illness or external factor?

Does the impairment mean the person is unable to make specific decision when they need to?

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What happens if the patient lacks capacity?

patient’s medical team decides what’s. in their best interest, including input from family and friends

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How many doctors must independently asses and agree capacity should be withdrawn?

What is the most common type of dementia?

Alzheimer’s disease

what is Alzheimer’s disease?

chronic neurogenerative disease with progressive and gradual onset

language deficits, impaired visuospatial skills, loss of judgement and inability to conduct daily activities

give symptoms of Alzheimer's disease

amnesia- loss of short-term memory anomia- inability to name objects apraxia- loss of dexterity agnosia- inability to recognise things, unable to understand the function of objects aphasia- inability to talk

what causes Alzheimer's disease?

extracellular amyloid plaques intracellular neurofibrillary tangles synaptic deterioration and neuronal death

explain synaptic deterioration and neuronal death

neuronal atrophy caused by loss of synapses and neurones (cerebro-spinal atrophy) neurones are rich in acetylcholine, supplying the hippocampus, amygdala and neucortex

in the cell membrane there's a protein called amyloid precursor protein (APP) one end is inside the cell, the other end outside

what does APP do?

helps neuron grow and repair gets used and broken down and recycled

what is meant to breakdown APP?

alpha secretase and gamma secretase

what happens when alpha and gamma secretase breakdown APP?

get a soluble peptide which is taken away

what happens if beta secretase teams up with gamma secretase instead?

leftover fragment isnt ssoluble get a monomer called amyloid beta

describe amyloid beta

sticky, bind together outside the neurone form beta amyloid plaques

how do beta amyloid plaques cause problems?

plaques can get in between neurones, disrupt neuronal communication brain functions like memory impaired plaques can also initiate an immune response, damage surrrounding neurones can deposit around blood vessels in brain, weaken walls of blood vessels, inc risk of haemhoragge

where are tangles found?

inside the cell

what does tau do?

protein that stabilises the internal skeleton of neurons in brain

how can tau proteins cause problems?

beta amyloid plaque build up outside neurone initiates pathways inside the neurone leads to activation of kinase (transfers phosphate to tau protein) tau protein changes shape stops supporting the microtubules clumps up with other tau proteins, gets tangled may undergo apoptosiss, neurronal communication dissurpted

what happens to the brraain when apoptosis of neurones occurs?

atrophy, gyri (ridges) get narrower sulci (grooves) het wider ventricles get larger

what do neurofibrillarry tangles do?

disrupt the microtubular system resulting in impaired neuronal growth, transport and communication deposit in the hippocampus, medial temporal lobe, frontal cortices, lateral parietotemporal regions

what are the symptoms of vascular dementia?

slower thinking personality changes movement problems bladder problems

what is vascular dementia associated with?

cardiovascular diseases

Describe the onset of vascular dementia

stepwise progression

What percentage of people does vascular dementia affect?

5-10%

What is Lewy Body dementia associated with?

abnormal deposits of alpha-synuclein protein within the brain, mostly within primary motor cortex deposits = Lewy bodies

Describe the onset of LBD

progressive and graduaal

What are the symptoms of LBD?

hallucinations, sleep problems (REM sleep affected), memory loss parkinson like features: movement impairments (cogwheel like rigidity) and tremor

What does treatment of LBD involve?

acetylcholinesterase inhibitors

What causes fronto-temporal dementia?

neuronal atrophy of the frontal and temporal lobes due to presence of abnormal proteins within them predominantly phosphorylated tau or TDP-43

Describe the onset of FTD

chronic and progressive disease onset of symptoms can be more rapid than other forms

What are the symptoms of FTD?

frontal lobe: speech problems, behavioural changes, disinhibition, emotional problems temporal lobe: semantic dementia: dont understand language and factual knowledge --> progressive non-fluent aphasia obsessions: unusual beliefs/interests diet: over eating/drinking lack of interest: reduced personal hygiene

What does the limbic system comprise of?

cingulate gyrus, amygdala, hippocampus, mamillary body

whats the function of hippocampus?

Concerned with short-term memory

whats the function of anterior thalamus?

concerned w attention

whats the function of posterior cingulate gyrus?

concerned w orientation (time, place, identity)