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s4 - Repro, Develop, Ageing, Pharm > AGE - COGNITION > Flashcards

AGE - COGNITION Flashcards

1
Q

Donepezil preserves cognition in what condition?

A

Dementia

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2
Q

Dementia is a decline in memory/cognition and learning new info. What is the awareness of envionment like?

A

-It is preserved (unlike delerium)

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3
Q

What are the 4 types of Dementia in order of common?

A
  • Alzehimers
  • Vascular Dementia
  • Dementia with Lewy Bodies
  • Frontotemporal dementia
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4
Q

Suggest the diagnosis pathway for dementia following a GP visit:
(as well as investigating reversible causes like b12,folate, thyroid)

A
  • memory clinic referral
  • cognitive test e.g. Adam Brookes test /100
  • home/care home visit
  • history/collateral
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5
Q

Alzheimer’s presentation is usually a 2-3yr decline, scan will show atrophy where? Memory and concentration may be impaired, what is more intact?

A

Hippocampal atrophy

Language and visuospatial more intact

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6
Q

Name as many of the 7As of Alzheimers:

A
  • Anosognosia
  • Aphasia
  • Altered perception
  • Apathy
  • Agnosia
  • Apraxia
  • Amnesia
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7
Q

List 4 non-cognitive features of Alzheimer’s disease:

A
  • depression, anxiety, psychosis, hallucinations
  • agitation, aggression, wandering
  • day-night reversal
  • personality change, apathy, disinhibition
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8
Q

Give 4 risk factors for developing Alzheimers:

e.g. head trauma..

A
  • increasing age
  • vascular risk factors (DM, HT, AF, smoking)
  • Family history
  • Apo E4 allele
  • hypothyroidism
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9
Q

What are the 3 main features contributing to the pathophysiology of Alzheimer’s disease along with Apo E, vascular pathology and inflammation..

A
  • neuronal cell death esp. cholinergic
  • B amyloid plaques cleaved from APP
  • neurofibrillary tangles with hyperphosphoryl. Tau
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10
Q

Cholinesterase inhibitors e.g. Donepezil and Rivastigme treat early Alzheimers..what is given in later stages?

A

NMDA receptor antagonists (e.g. Memantine) calms the hyperalertness/anxiety

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11
Q

Vascular Dementia is characterised by what kind of deficits? Give scenarios VD could develop:

A
  • patchy deficits e.g. language, attention..
  • post stroke/large vessel infarct
  • multiple cortical grey matter infarcts (MID)
  • extensive small vessel disease e.g. lacunar infarcts, deep perforating artery occlusion
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12
Q

How is Parkinson’s Disease Dementia (PDD) differentiated from Lewy Body Dementia (DLB)? NB: they are a spectrum of exactly the same disease

A
  • PDD is parkinsonian symptoms for 12months+ before dementia

- DLB if both motor and cognitive symptoms develop within 12 months of Parkinsons

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13
Q

Lewy body dementia exhibits neuronal inclusions-abnormally phosphorylated neurofilaments such as?

A

Ubiquitin

alpha-synuclein

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14
Q

In Lewy body dementia Ubiquitin and alpha-synuclein are found with a marked decrease in ACh in what brain areas?

A

in paralimbic, neocortical and brainstem areas

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15
Q

Lewy neurites and amyloid plaques are present in what disease?

A

Lewy Body Dementia

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16
Q

What drug class should be avoided in dementia patients due to there effect on a certain NT?

A

Antipsychotics as they block DA

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17
Q

Fronto-temporal dementia is aka. whose disease? This name comes from tau inclusions in 40% people with FTD also called..?

A
  • Pick’s disease

- 40% have “Pick bodies” or “Pick cells”

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18
Q

Where is the atrophy in FTD?

A

-frontal and ANT. Temporal lobes

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19
Q

There are 2 language types of FTD. What are they? and 1 behavioural type-what sorts of features?

A
  • Semantic and Progressive Non-fluent Aphasia

- Behavioural: personality/social conduct changes, disinhibition, apathy, perseveration…

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20
Q

What is the relation of alcohol related brain changes and Dementia?

A

-frontal lobe changes with the vascular changes, head injuries from falls and poor diet can increase risk

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21
Q

What reversible syndrome associated with alcoholism arises as a result of a vit deficiency causing impaired conciousness, ataxia, opthlamoplegia - what vitamin?

A

Wernicke’s Encepalopathy

B1/thiamine deficiency

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22
Q

If untreated what can the reversible Wernicke’s Encepalopathy cause which is irreversible, what are the features?

A

Korsakov’s psychosis - profound amnesia for new learning, confabulation. Good attention/working memory still.

23
Q

What is usually the cause of “challenging behaviour” (= a manifestation of distress/suffering) ?

A

-a poorly communicated need

24
Q

How are challenging behaviours recorded with the ABC charts?..antecedent…b…c…

A

A-ntecedent - what happened before
B-ehaviour - what happened during
C-onsequence - what happened after

25
Q

What are dementia patients highly sensitive to which can cause problems in hospital setting and lead to the inappropriate label “acopia” (cant cope)

A
  • change in environment, routine is v important

- 20% hospital patients have dementia

26
Q

What are the 4 spheres of factors that input to cause challenging behaviours in patients?

A
  • Social Environment (relationships, care)
  • Physical Envrionment (layout, lighting)
  • Biological (disease, pain, meds, diasabilitys)
  • Psychological Factors (life hist, attitudes, habits)
27
Q

What is the Flynn Effect in relation to IQ?`

A

-IQ goes up by 9pts as nutrition, environment etc improves, every 30yrs

28
Q

What accounts for the effect of IQ results being lower in elderly in a controlled environment but same as a young person in their own comfort?

A

-processing speed is slower with age but ability is the same

29
Q

What are the synonymous terms “” for:

- loss of “crystallised intelligence” is less common than loss of “fluid intelligence” with age

A

loss of “wisdom” is less common than loss of “wit”

30
Q

What did Bernice Neugarten say about life being bio-socially structured through events and impacts causing destability?

A
  • the more predictable and event the less demand for adjustment e.g. widow at 60+
  • the less predictable e.g. loss of child the greater risk of destabilising
31
Q

Is it good to have no trauma in childhood or to have a large amount of trauma in childhood in terms of coping as an adult?

A

Neither, both will compromise the adult

-ideal is reasonable traumas with enough time to recover between each

32
Q

What does Carstenson’s Theory of Socioemotional Selectivity say about change in behaviour motivation with age

A

-perception of time remaining in life so gaining knowledge motivation shifts towards emotional satisfaction towards end of life

33
Q

What are the key qualities of an adult according to Eriksons Theory (e.g. being, having, helping and owning…)

A
  • sense of identity
  • capacity for intimacy
  • experience of generativity
  • aquisition of integrity (own responsibility)
34
Q

What can make older adult assessment difficult in these days? (masked…)

A

-tend to underreport psychological complaints
-“masked depression” - high suicide risk
(check mental wellbeing)

35
Q

Brain ages chemically with NT and BBB changes, name 3 ways is changes functionally:

A
  • atrophy
  • cerebral blood flow changes
  • oxidative stress
  • cerebral white matter lesions
  • neurofibrillary tangles and plaques
36
Q

The brain atrophies with age, the occipital lobe is protected, where is most affected?

A
  • Pre-frontal Cx and striatum

- temporal lobe, hippocampus, cerebellum

37
Q

With brian atrophy by loss of neurones an the connections between them , how is white vs grey matter loss?

A

More White Matter loss (neurones) vs Grey Matter

38
Q

What are Neurofibrllary tangles collections of?

A

Hyperphosphorylated Tau

39
Q

What are plaques in the brain with age deposition of?

A

Beta Amyloid

40
Q

In Alzheimers neurofibrillary tangles and plaques are spread throughout the brain, where are they in normal ageing?

A

-present in cell bodies in the entorhinal cx only

41
Q

What are cerebral white matter lesions aka leukoaraiosis thought to be due to in the ageing brain?

A

-chronic ischaemic damage caused by small perforating arteries/arteriole/venule changes

42
Q

Accumulation of oxidative stress on DNA, lipic, protein by free radical may be responsible for what in the ageing brain?

A

-the functional decrease in ability with age

43
Q

Give 2 ways cerebral blood flow changes with age:

A
  • decreases due to CV risk factors e.g. narrow vessels
  • homeostasis balance gets worse
  • more fluctuant cerebral BP and perfusion
44
Q

In the ageing brain there is reduced synthesis, binding sites and #receptors. Suggest effect of less ACg, DA and Seratonin?

A
  • less Ach -> cognitive impairment
  • less DA -> reduced arm swing and more rigidity
  • less 5HT -> depression, circadian rh. changes
45
Q

BBB in the ageing brain becomes ..

leading to less transport of glucose, proteins and hormones

A
  • more permeable

- more susceptible to hypoglycaemia

46
Q

With ageing of the brain, remote memory, vocab and comprehension is preserved, what is affected?

A
  • new memory formation
  • problem solving
  • verbal fluency
  • visuospatial task completion
47
Q

Delerium/acute confusional state is a clinical syndrome characterised by what?

A
  • disturbed conciousness/cognitive function

- acute onset, fluctuating course

48
Q

Give 3 risk factors for getting delerium?

A
  • advanced age
  • fractured NOF
  • severe illness
  • dementia
49
Q

Give 3 indicators of delirium e.g. hallucinating..

A
  • fluctuating cognition/perception/social behaviour
  • “sun downing” (worse in evening)
  • more confused, poor attention
  • agitated, pluck at bedding, v.quiet
50
Q

How should delirium be assessed?

A
  • history + colaterall
  • examination
  • cognitive screening tests e..g 4AT, AMTS, Mocha
51
Q

What are the 4As in the 4AT cognitive screening test? -Clue one is AMT4 (4 questions)..

A
  • Alertness
  • AMT4: age, dob, place, year
  • Attention
  • Acute Change/Fluctuating course
52
Q

State as many of the AMTS questions of cognitive screening you can (10)

A
  • age
  • time to nr, hr
  • address for recall
  • year
  • name of place
  • identify 2 people
  • dob
  • year of WW1
  • name of present monarch
  • count backwards 20–> 1
  • address?
53
Q

Suggest what can cause delirium?

A
  • less Ach, more DA
  • mediated by acute stress response, hormone spike crosses BBB more causing neuronal inflam/dysreg.
  • less cognitive reserve
  • medication e.g. benzo, anticholinergics, opiods

s4 - Repro, Develop, Ageing, Pharm (14 decks)

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