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Neuro Cognitive Disorders > 7: Dementia > Flashcards

7: Dementia Flashcards

1
Q

What is the most common type of dementia?

A

Alzheimer’s

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2
Q

In the DSM 5, there is a difference between major and mild neurocognitive disorders. What are the pros and cons of this?

A 
PRO
1) public concern
2) early detection
3) early intervention
CON
1) misdiagnosis
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3
Q

What are the 4 criteria for mild neurocognitive disorder (MCI)?

A

1) evidence of modest cognitive decline from previous level of performance in 1+ domain (based on individuals concern, family/friend, or clinician)
2) measurable memory impairment on standardized testing
3) cognitive deficits are insufficient to interfere with independence but greater efforts/compensatory strategies/accommodation may be required
4) not secondary to delirium/other mental disorder

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4
Q

What is MCI?

A

a transitional zone between normal cognition and dementia, but MCI may not lead to major cognitive impairment

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5
Q

What are 4 characteristics of delirium?

A

1) disturbance in attention and orientation to the environment, confusion
2) disturbance develops over a short period of time (hours to days)
3) fluctuates in severity throughout the day
4) change in additional cognitive domain such as memory, disorientation, language disturbance, etc. that isn’t accounted for by other neurocognitive disorder

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6
Q

What are 7 causes of delirium in the elderly population?

A

1) medications (esp. anti-depressants, anti-psychotics)
2) infections
3) metabolic disorders
4) surgery, anesthesia
5) substance withdrawal
6) kidney or liver disease
7) toxins

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7
Q

What are the 4 diagnostic requirements for Major neurocognitive disorders?

A

1) evidence of substantial cognitive decline from previous level of performance in 1+ cognitive domain (based on individuals concerns, family/friends, or clinician)
2) test performance is in the range of 2+ SD below appropriate norms
3) cognitive deficits are sufficient to interfere with independence
4) not secondary to delirium/other mental disorder

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8
Q

Major neurocognitive impairment must meet the following 6 requirements:

A

1) insidious onset of symptoms
2) not accounted for by delirium, schizophrenia, or major depression
3) must be acquired
4) must be persistent
5) must cross several areas of cognitive function
6) must be severe enough to interfere with life (work, social activities, relationships)

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9
Q

What are 5 risk factors of MCI to AD?

A

1) age
2) APOE carrier status (can be inherited from mother or father, risk factor but not a cause)
3) DM
4) HTN
5) increased cholesterol

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10
Q

What are protective factors for MCI/AD?

A

1) absence of APOE 4 variant
2) lifetime of exercise
3) youth
4) social stimulation
5) controlled cardiovascular risk
6) non-smoking

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11
Q

What are 3 examples of normal aging changes in memory?

A

1) forgetting appointments
2) forgetting a neighbors name
3) forgetting a birthday/anniversary

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12
Q

What are 3 examples of dementia/major CI memory changes?

A

1) forgetting making an appointment
2) not recognizing a neighbor or family member
3) not recognizing a spouse’s birthdate

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13
Q

What are 2 examples of normal aging disorientation?

A

1) forgetting what day of the week it is

2) occasionally getting lost in an unfamiliar place

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14
Q

What are 3 examples of dementia/major CI changes in disorientation?

A

1) routinely don’t know what day it is
2) not recognizing what time of day it is (morning, noon, night)
3) getting lost in their own neighborhood/house

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15
Q

What are 2 examples of normal aging lapses in judgement?

A

1) dressing inappropriately for the weather

2) unintentionally violating social conventions

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16
Q

What are 2 examples of dementia/major CI lapses in judgement?

A

1) wearing a wool coat on a hot day

2) addressing a stranger as close friends

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17
Q

What are 2 examples of normal aging difficulties performing mentally challenging tasks?

A

1) making a mistake balancing the checkbook

2) difficultly programming a new smart phone

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18
Q

What are 2 examples of dementia/major CI difficulties performing mentally challenging tasks?

A

1) inability to perform simple calculations

2) difficulty remembering what a tool is for (e.g. microwave)

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19
Q

What is a normal aging change with misplacing things?

A

occasionally misplacing regularly used items (e.g. keys, purse, phone)

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20
Q

What is a dementia/major CI change with misplacing things?

A

1) putting regularly used items in an odd place (e.g. purse in the refrigerator)

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21
Q

What are normal aging changes in mood?

A

experiencing a wide range of emotions in response to life events

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22
Q

What are dementia/major CI changes in mood?

A

exhibiting rapid changes in mood that occur for no apparent reason or for trivial reasons

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23
Q

What are 5 types of dementia?

A

1) Alzheimer’s (early and late onset)
2) vascular dementia
3) dementia with Lewy Bodies (DLB)
4) frontotemporal lobar degeneration (FTLD)
5) subcortial dementia

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24
Q

What is the most common type of dementia?

A

Alzheimer’s

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25
Q

When does early-onset dementia/AD occur?

A

age 30-60

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26
Q

What is the cause of early-onset dementia/AD?

A

genetics

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27
Q

When does late-onset dementia/AD occur?

A

ages 60+

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28
Q

What is the cause of late-onset dementia/AD?

A

unknown (combo genetic, lifestyle, environmental factors)

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29
Q

Late onset AD typically causes selective changes in ___________ and __________ __________ in the early stages. Why?

A

episodic and working memory

it starts in the hippocampus (medial temporal lobe) and enthorhinal cortex

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30
Q

What is the neuropathy of AD? 1/3

A

3 microscopic changes:

1) neurofibrillary tangles
2) neuritic plaques
3) granulovascular degeneration

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31
Q

What are neurofibrillary tangles?

A

threadlike structures normally found in the cell bodies, dendrites, axons and sometimes in the synaptic endings of neurons in the brain

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32
Q

What happens with neurofibrillary tangles in AD?

A

neurofibrils become twisted, tangled, and clumped together

also found in parkinsons and progressive supranuclear palsy

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33
Q

What are neuritic plaques?

A

minute areas of tissue degeneration consisting of granular deposits, concentrated in the cortical and subcortical regions

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34
Q

What do neuritic plaques cause?

A

significant reduction in neuronal synapses which impact transmission

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35
Q

Neuropathology changes are not _______.

They most frequently affect the ______________-___________ junctions and the ____________ ______________ lobes.

A

diffuse
temporoparietal-occipital junctions
inferior temporal lobes

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36
Q

In AD, the _____________ lobes, ________ and __________ cortex, and the ____________ lobes are usually spared in the beginning.

A

frontal lobes
motor and sensory cortex
occipital

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37
Q

What is typically the earliest/most prominent manifestation of AD?

A

episodic memory issues

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38
Q

What 4 things are typically well reserved in early stages of AD?

A

1) phonology
2) syntax
3) articulation
4) voice quality

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39
Q

What type of word retrieval problems occur in early stage AD?

A

mild, can recognize and try to correctt

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40
Q

Pts with early stage AD have occasional mild __________ _____________ and subtle _______________ impairments

A

verbal paraphasias

comprehension

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41
Q

In functional reading comprehension tasks, early stage AD pts typically have difficulty with what?

A

longer length or more complex information

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42
Q

Early stage AD pts have preserved _________________

A

automatics

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43
Q

Early stage AD pts have decreased _____________ _______________ and ___________ ______________

A

sustained attention

mental flexibility

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44
Q

Early stage AD pts are adequate ________________________ but may have issues with: (4)

A

conversationalists

1) humor
2) sarcasm
3) verbosity
4) topic maintenance

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45
Q

What are the neuropathologic hallmarks of early stage AD?

A

neurofibrillary changes limited to entorhinal and transentorhinal regions

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46
Q

Middle stage AD pts have ______-_____________ problems that become obvious in ____________________ and increased difficulty with _________-______________ of mistakes

A

word-finding
conversation
self-correction

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47
Q

Middle stage AD pts have increased sentence ______________ and ________________ sentences

A

sentence fragments

ungrammatical sentences

48
Q

In middle stage AD pts, reading ______ declines and becomes _____________ for everything by the most ______________ material, so __________ reading is abandoned

A

rate
nonfunctional
familiar
recreational

49
Q

Middle stage AD pts have increased ___________ and withdraw from ____________. They are ____________ conversational partners and offer _________/__________ comments instead of ______________ contributions.

A 
apathy
conversation
passive
trivialities/irrelevant
substantive
50
Q

In middle stage AD pts, comprehension of _____________ material is grossly impaired

A

nonliteral

51
Q

What are 3 neuropathologic hallmarks of middle stage AD?

A

1) severe involvement of transentorhinal regions
2) moderate changes in hippocampus
3) mild changes in some cortical association areas

52
Q

In late stage AD pts, _____________ is severely compromised. Reading is _____________, but they may recognize _________ __________ _______. Writing is _____________ but may be able to do _____ ________ ________.

A 
communication
nonfunctional
highly familiar words
nonfunctional 
over learned items
53
Q

In late stage AD, comprehension is limited to:

A

short words and phrases

54
Q

In late stage AD, what is speech like? What is syntax like? Error correction?

A

single words that are often bizarre and devoid of meaning
syntax breaks down, neologisms increase
unaware of errors and make no attempts to self correct

55
Q

What are 4 key features of late stage AD pts communication?

A

1) nonfunctional conversationalists
2) failure to observe social conventions
3) insensitive to conversational rules
4) dwell on past experiences

56
Q

What are 3 features of very late AD pts?

A

1) mute or echolalic
2) pallilalic
3) loss of all orientation to self and surroundings

57
Q

What is being palilalic mean?

A

endless repeating of self generated works or phrases

58
Q

What are the 2 neuropathologic hallmarks of late stage AD?

A

1) cortical association areas are severely involved

2) only primary sensory and motor areas are spared

59
Q

What is vascular dementia caused by?

A

caused by ischemic cerebrovascular disease or circulatory disturbances

60
Q

What percent of dementia is vascular?

A

15-20%

61
Q

What are 5 risk factors for vascular dementia?

A

1) multiple strokes
2) HTN
3) DM II
4) smoking
5) hypercholesterolemia

62
Q

What are the 2 onset types of vascular dementia?

A

1) acute

2) chronic

63
Q

What type of deterioration occurs with vascular dementia?

A

stepwise

64
Q

What are 3 key features of vascular dementia compared to AD?

A

perform better with memory tasks

and worse with attention and executive function

65
Q

What is the cause of Lewy Body Dementia (DLB)?

A

results from abnormal clumps of neuronal protein in the cortex (related to PD)

66
Q

DLB has symptoms overlapping with AD, but also has these 4 early symptoms:

A

1) visual or other sensory hallucinations
2) visual spatial impairment
3) sleep disturbance
4) fluctuating attention

67
Q

What are some key features of DLB?

A

1) gait imbalances
2) reduced speech rate, fluency
3) preserved memory

68
Q

What percent of dementia is frontotemporal lobar degeneration (FTLD)?

A

10%

69
Q

When is FTLD most diagnosed?

A

before age 60yo (45-60)

70
Q

What does FTLD result in?

A

significant impairment in:

1) behavior
2) personality
3) language impairment
4) motor skills

71
Q

What are the 3 language variants of FTLD?

A

1) semantic variant (fluent speech with loss of semantic knowledge)
2) nonfluent variant
3) logopenic variant

72
Q

What is a prominent feature in the early stages of subcortical dementias?

A

motor impairments

73
Q

What 3 impairments appear months to years after the motor impairments in subcortical dementias?

A

1) memory
2) intellect
3) language

74
Q

What are 3 types of subcortical dementia?

A

1) parkinson’s disease (PD)
2) huntington’s disease
3) progressive supranuclear palsy (PSP)

75
Q

What percent of US population have PD and what gender is it more likely in?

A

1%

more likely in men than women

76
Q

PD is a __________ disease that is caused by:

A

degenerative

deterioration of dopamine producing neurons in the basal ganglia and brain stem (primarily substansia nigra)

77
Q

What are the 3 primary _________ symptoms of PD?

A

motoric

1) muscle rigidity
2) tremor
3) loss of balance

78
Q

What is the evolution of PD?

A

slow progressive deterioration of motor and mental functions

significant dementia in 30% of pts, 50% show some signs of dementia

79
Q

What are 3 common signs of dementia PD pts exhibit?

A

1) memory
2) executive function
3) cognitive impairment

that impacts work and social situations

80
Q

In pts with PD, what 4 areas of cognition are often impaired?

A

1) memory
2) attention
3) visual
4) executive

81
Q

In PD pts, how is memory impaired?

A

new learning

inferencing

82
Q

In PD pts, how is attention impaired?

A

divided
selective
speeded tasks

83
Q

In PD pts, how is vision related cognition impaired?

A

visual discrimination

synthesis

84
Q

In PD pts, how is executive function impaired?

A

1) problem solving
2) working memory
3) planning
4) set-shifting
5) cognitive flexibility
6) verbal fluency (often the first symptom)

85
Q

In pts with PD, what 5 areas are typically normal?

A

1) simple attention
2) memory - recognition
3) language comprehension
4) language expression
5) language naming

86
Q

What is Huntington’s disease?

A

inherited degenerative neurogenic disorder, caused by autosomal dominant neurodegenerative diseases affecting the basal ganglia

87
Q

When is typical onset of HD?

A

30s-40s

88
Q

What are characteristics of HD?

A

1) chorea
2) cognitive decline
3) neurobehavioral symptoms

89
Q

What is chorea?

A

ceaseless, rapid, repeated movements

90
Q

What are 5 neurobehavioral symptoms that might be seen with HD?

A

1) personality changes
2) agitation
3) depression
4) paranoia
5) delusions

91
Q

What is the evolution of HD?

A

appears between ages 40-60 but symptoms can appear before age 20

92
Q

What are 3 symptoms of HD?

A

1) chorea (first symptom)
2) increased personality change (emotional outbursts)
3) cognitive deterioration (memory first, and then slowing intellectual functions and compromised attention)

93
Q

What is the evolution of PSP?

A

begins between 50-80 years of age, peak in early 60s

94
Q

What does PSP resemble, and with what 2 symptoms? and what symptoms is different?

A

Parkinson’s

1) rigidity (neck and trunk vs arms and limbs)
2) slowness of movement

1) absence of tremors in PSP

95
Q

12% of the time pts with PSP are diagnosed with:

A

PD

96
Q

PSP is more common in what gender?

A

males

97
Q

What is the neuropathology of PSP? (4)

A

1) neuronal loss
2) neuronal abnormalities
3) proliferation of glial cells (throughout brainstem and basal ganglia)
4) cortical neurons largely spared

98
Q

What are 7 symptoms of PSP?

A

1) loss of vertical movements of the eyes (and increased risk of falls)
2) loss of lateral movements of the eyes
3) stiff and rigid limbs
4) dysarthria
5) dysphagia
6) depression
7) dementia (in middle and late stages)

99
Q

What is dementia in middle and late stages of PSP like? (3)

A

1) slowing of mental progresses
2) increasing forgetfulness
3) final stages = mute, immobile, dependent

100
Q

When is the onset of FTLD?

A

younger, 40s-50s

101
Q

What type of progression does FTLD have?

A

faster

102
Q

What is frontotemporal lobar degeneration?

A

group of syndromes resulting from a progressive deterioration of the frontal and temporal lobes

103
Q

What are the 3 variants of FTLD?

A

1) behavioral
2) language (PPA)
3) motor

104
Q

What are 6 symptoms of the behavioral variant of FTLD?

A

1) difficulty adjusting behaviors in social context
2) hyperoral behaviors
3) repetitive movements
4) deteriorating personal hygiene
5) hyperactive/impulsive behaviors
6) hypersexual behaviors

105
Q

What are 4 difficulties adjusting behaviors in social context that individuals with the behavioral variant of FTLD?

A

1) inappropriate
2) lack of empathy
3) apathy
4) decreased awareness

106
Q

What is the neuropathology of FTLD?

A

increased tau protein with degeneration in the frontal and temporal lobes

107
Q

What is the language variant of FTLD the same as?

A

primary progressive aphasia

108
Q

What are the 2 types of PPA/FTLD language variant?

A

1) fluent semantic
2) progressive nonfluent
3) logopenic

109
Q

What is the motor variant of FTLD questionably tied to?

A

ALS

110
Q

How is the motor function affected with FTLD motor variant? (3)

A

1) dysphagia
2) dysarthria
3) voice

111
Q

As the motor variant of FTLD progresses what is there a greater risk for?

A

cognitive decline

112
Q

What is another potential cause of dementia?

A

Creutzfeldt-Jakob Disease

113
Q

How rare is Creutzfeldt-Jakob Disease?

A

1 in 1 million

114
Q

What are 3 characteristics of Creutzfeldt-Jakob Disease?

A

1) rapidly progressive
2) fatal (1 year average)
3) dementia almost always present

115
Q

What are symptoms of Creutzfeldt-Jakob Disease?

A

1)

Neuro Cognitive Disorders (13 decks)

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