5.2. Alzheimer's

Question 1

what is alzheimer’s?

Answer 1

• a progressive neurologic disorder that causes the brain to shrink (atrophy) and brain cells to die
• AD is the most common cause of dementia
• no known cause, but there is some genetic risk
  
  • early onset Alzheimer’s is usually genetic, can affect people as young as 40-50

Question 2

what is dementia?

Answer 2

a continuous decline in thinking, behavioural and social skills that affect a person’s ability to function independently

Question 3

how are rates of dementia changing?

Answer 3

• the prevalence of dementia doubles every five years
• rates of dementia are expected to more than double over the next 30 years as the Canadian population ages
• prevalence and incidence rates vary because of different diagnosis of neurocognitive disorders

Question 4

can we treat or cure alzheimer’s? how long can a person live with alzheimer’s?

Answer 4

• there is no known cure but drugs can slow declines in symptoms
  
  • can’t change progression of disease
• people live for 5-20 years after alzheimer’s diagnosis
  
  • on average, 8-10 years, but is eventually fatal
• people usually die from other comorbidities while they have alzheimer’s

Question 5

what are some medical treatments for alzheimer’s?

Answer 5

• some medications target acetylcholinesterase, the enzyme that destroys acetylcholine after it’s release
• activity of the acetylcholinesterase reduces the amount of acetylcholine available to the hippocampal neurons which leads to memory loss
• anti-cholinesterase treatments inhibit this enzyme

Question 6

what are some psychosocial treatments for alzheimer’s?

Answer 6

1. teach behavioural methods
2. adhere to a schedule
3. target problematic behaviours
4. identify when patient becomes disruptive

Question 7

what is the prevalence of alzheimer’s as we get older?

Answer 7

• likelihood of getting alzheimer’s increases with age
• at the oldest age group, 25% of people have alzheimer’s

Question 8

what are some biological markers of alzheimer’s?

Answer 8

Beta-Amyloid Plaques
- in healthy aging, APP molecules are trimmed at the cell membrane
- with AD, APP are trimmed in the wrong places, which forms beta-amyloid
- these beta-amyloids clump together, they are insoluble and may kill neurons

Tau
- help keep the shape of the microtubule
- in AD, they come of the microtubules and turn into neurofibrillary tangles

Question 9

what are some early warning signs of alzheimer’s?

Answer 9

early signs may be difficult to distinguish from normal age-related changes…
- memory loss affecting day-to-day abilities
- difficulty performing familiar tasks
- problems with language
- disorientation in time and space
- impaired judgement
- problems with abstract thinking
- misplacing things in strange places
- changes in mood and behaviour
- changes in personality
- loss of initiative (similar to depressive symptoms)

Question 10

what does the middle stage of alzheimer’s look like?

Answer 10

middle stage is typically the longest, lasting several years…
- memory loss deepens
- mental confusion deepens
- friends and family notice memory lapses
- may become disoriented
- impaired ability to perform even simple arithmetic
- may become more aggressive or passive, suspicious
- difficulty sleeping
- depression

Question 11

what does the late stage of alzheimer’s look like?

Answer 11

individuals lose the ability to respond to their environment, carry on a conversation and control movement
- severe memory loss
- speech impairment
- may repeat conversations over and over
- very poor reasoning ability and judgement
- neglect of personal hygiene
- personality changes
- needs extensive assistance with activities of daily living

Question 12

what is MCI?

Answer 12

Mild Cognitive Impairment
- an intermediate stage between the expected cognitive decline of normal aging and the more-serious decline of dementia
- problems with memory, language, thinking and judgement that are greater than normal age-related changes

Question 13

how does MCI relate to Alzheimer’s?

Answer 13

• about 20-32% of individuals with MCI will develop AD
• initial symptoms of MCI remain constant or sometimes former cognitive function is regained (unlike AD)

Question 14

what are some signs of MCI? how do they differ from the signs of alzheimer’s?

Answer 14

• challenges with balance and coordination
• repeated questions or stories
• difficulties following multi-step directions
• difficulties with mathematical tasks
  *less functional impairment with MCI than AD, most can still continue activities of daily living

Question 15

what impact does alzheimer’s have on families/caregivers?

Answer 15

• caregivers have higher rates of stress
• report substantial burden and loss of freedom
• have higher rates of depression and burnout
• are at greater risk of developing chronic health conditions

Question 16

how do caregivers and families of alzheimer’s patients feel?

Answer 16

• they report sadness and loss, grief, regret and guilt
• they also report a strong sense of yearning for the past and noted the lost aspects of their relationship
• they feel guilt and regret about a failure or difficulty in coping with the challenges of caregiving
• caregivers begin grieving their losses while trying to continue a meaningful relationship with their loved one
• end of caregiving is usually accompanied by a readiness to let go, relief for all people involved
  
  • in some circumstances, some people feel guilt about feeling relieved

Question 17

how do people attribute memory lapses in stories where the subject is either young or old?

Answer 17

• younger participants attributed memory lapses more to mental difficulties and more readily recommended professional evaluation
• older participants attributed memory lapses more to task difficulty
• both young and old participants thought memory lapses in older adults were due to mental difficulties and required memory training
  
  • also thought that in younger targets, lapses were due to tasks difficulty or other attentional demands

Question 18

what is premature cognitive commitment?

Answer 18

we hear stereotypes and believe them, which sets the course for our cognitive decline

Question 19

what is some proof that hearing stereotypes impact our perception of young and old people?

Answer 19

• when we asked young and old people their positive/negative views of aging
• much higher positive views of aging in china compared to the US
• deaf people in US have a more positive view because they hear less stereotypes
• younger people also see aging less positively than older people

Question 20

how do stereotypes on memory affect memory decline?

Answer 20

• older adults with more negative stereotypes showed 30% greater decline in memory performance over 38 years

Question 21

what is stereotype threat and how does it affect performance on memory tasks?

Answer 21

• negative stereotypes about a group may have a detrimental impact on the behaviour of group members when they are put in the position of potentially confirming that stereotype
• older people perform better on a memory task when they are told a positive prime regarding memory beforehand
• older people perform worse on a memory task when they are told a negative prime regarding memory beforehand

Question 22

what is memory self-efficacy (MSE)?

Answer 22

the confidence and/or belief that a person has regarding the effectiveness of his or her own memory function in anticipated situations

Question 23

what is memory self-efficacy impacted by?

Answer 23

• previous experiences with memory success/failure
• vicarious observation of a relevant reference group
• social beliefs
• physiological information such as arousal or anxiety
• low MSE could weaken motivation or undermine performance (via anxiety) on a specific memory task

Question 24

what is vascular neurocognitive disorder?

Answer 24

• people progressively lose cognitive functioning as a result of damage to the arteries supplying the brain
• most common form is multi-infarct dementia (MID) which is caused by transient ischemic attacks
  
  • a number of minor strokes (infarcts) occur in which a clogged or burst artery interrupts blood flow to the brain
  • each infarct is too small to be noticed, but the progressive damage leads the loss of cognitive abilities

Question 25

what is the difference between multi-infarct dementia (MID) and alzheimer’s disease (AD)?

Answer 25

• the development of MID tends to be more rapid than Alzheimer’s disease
  
  • the higher the number of infarcts, the greater the decline in cognitive functioning

Question 26

what are some risk factors of vascular neurocognitive disorder?

Answer 26

related to risk factors that are similar to those for cardiovascular disease
- diabetes mellitus is associated with a higher risk of vascular dementia particularly for people who have a history of stroke or hypertension
- metabolic syndrome is also associated with a higher risk of vascular neurocognitive disorder
- excess fat (adiposity) in the midsection further increases the risk of neurocognitive disorder in late life

Question 27

what is frontotemporal neurocognitive disorder (FTD)?

Answer 27

• neurocognitive disorder that involves specifically the frontal lobes of the brain
  
  • experiences personality changes such as apathy, lack of inhibition, obsessiveness, addictive behaviours, and loss of judgement
  • individual becomes neglectful of personal habits and loses the ability to communicate

Question 28

what is parkinson’s disease? how does it relate to neurocognitive disorders?

Answer 28

• neurocognitive disorder can develop during the later stages of Parkinson’s disease
  
  • patients survive 10-15 years after symptoms appear
• primary medication for Parkinson’s is L-DOPA and deep brain stimulation

Question 29

what are lewy bodies?

Answer 29

• tiny spherical structures consisting of deposits of protein
• found in dying nerve cells in damaged regions within the brains of people with Parkinson’s disease
• neurocognitive disorder with lewy bodies is very similar to Alzheimer’s disease in that it causes progressive loss of memory, language, calculation, and reasoning
  
  • also includes episodes of confusion and hallucinations, not included in AD

Question 30

what is pick’s disease? how does it relate to frontotemporal neurocognitive disorder?

Answer 30

• involves severe atrophy of the frontal and temporal lobes and can cause neurocognitive disorder
  
  • is distinct from frontotemporal neurocognitive disorder because the brain also accumulates unusual protein deposits called Pick bodies
• symptoms of Pick’s disease include disorientation and memory loss in the early stages
  
  • eventually progresses to include pronounced personality changes and loss of social constraints
  • then later involves becoming mute, immobile, and incontinent

Question 31

what is a reversible neurocognitive disorder?

Answer 31

• result from the presence of a medical condition that affects but does not destroy brain tissue
• if the medical condition is left untreated, permanent damage may be done to the central nervous system

Question 32

what are some things that can cause a reversible neurocognitive disorder?

Answer 32

• normal‐pressure hydrocephalus - involves an obstruction in the flow of cerebrospinal fluid, which causes the fluid to accumulate in the brain
  
  • can cause cognitive impairment, dementia, urinary incontinence, and difficulty in walking
• subdural haematoma - a blood clot that creates pressure on brain tissue
  
  • surgical intervention can relieve the symptoms and prevent further brain damage

Question 33

what is delirium?

Answer 33

• an acute cognitive disorder that is characterized by temporary confusion
  
  • can be caused by diseases of the heart and lung, infection, or malnutrition
  • can be caused by substance use, intake of medications, head injury, high fever, and vitamin deficiency
• unlike neurocognitive disorder, however, delirium has a sudden onset

Question 34

what is wernicke’s disease?

Answer 34

• an acute condition caused by chronic alcohol abuse, involving delirium
  
  • also involves eye movement disturbances, difficulties maintaining balance and movement, and deterioration of the nerves to the hands and feet
  • can be reversed with vitamin B1