AGE - COGNITION Flashcards
Donepezil preserves cognition in what condition?
Dementia
Dementia is a decline in memory/cognition and learning new info. What is the awareness of envionment like?
-It is preserved (unlike delerium)
What are the 4 types of Dementia in order of common?
- Alzehimers
- Vascular Dementia
- Dementia with Lewy Bodies
- Frontotemporal dementia
Suggest the diagnosis pathway for dementia following a GP visit:
(as well as investigating reversible causes like b12,folate, thyroid)
- memory clinic referral
- cognitive test e.g. Adam Brookes test /100
- home/care home visit
- history/collateral
Alzheimer’s presentation is usually a 2-3yr decline, scan will show atrophy where? Memory and concentration may be impaired, what is more intact?
Hippocampal atrophy
Language and visuospatial more intact
Name as many of the 7As of Alzheimers:
- Anosognosia
- Aphasia
- Altered perception
- Apathy
- Agnosia
- Apraxia
- Amnesia
List 4 non-cognitive features of Alzheimer’s disease:
- depression, anxiety, psychosis, hallucinations
- agitation, aggression, wandering
- day-night reversal
- personality change, apathy, disinhibition
Give 4 risk factors for developing Alzheimers:
e.g. head trauma..
- increasing age
- vascular risk factors (DM, HT, AF, smoking)
- Family history
- Apo E4 allele
- hypothyroidism
What are the 3 main features contributing to the pathophysiology of Alzheimer’s disease along with Apo E, vascular pathology and inflammation..
- neuronal cell death esp. cholinergic
- B amyloid plaques cleaved from APP
- neurofibrillary tangles with hyperphosphoryl. Tau
Cholinesterase inhibitors e.g. Donepezil and Rivastigme treat early Alzheimers..what is given in later stages?
NMDA receptor antagonists (e.g. Memantine) calms the hyperalertness/anxiety
Vascular Dementia is characterised by what kind of deficits? Give scenarios VD could develop:
- 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
How is Parkinson’s Disease Dementia (PDD) differentiated from Lewy Body Dementia (DLB)? NB: they are a spectrum of exactly the same disease
- PDD is parkinsonian symptoms for 12months+ before dementia
- DLB if both motor and cognitive symptoms develop within 12 months of Parkinsons
Lewy body dementia exhibits neuronal inclusions-abnormally phosphorylated neurofilaments such as?
Ubiquitin
alpha-synuclein
In Lewy body dementia Ubiquitin and alpha-synuclein are found with a marked decrease in ACh in what brain areas?
in paralimbic, neocortical and brainstem areas
Lewy neurites and amyloid plaques are present in what disease?
Lewy Body Dementia
What drug class should be avoided in dementia patients due to there effect on a certain NT?
Antipsychotics as they block DA
Fronto-temporal dementia is aka. whose disease? This name comes from tau inclusions in 40% people with FTD also called..?
- Pick’s disease
- 40% have “Pick bodies” or “Pick cells”
Where is the atrophy in FTD?
-frontal and ANT. Temporal lobes
There are 2 language types of FTD. What are they? and 1 behavioural type-what sorts of features?
- Semantic and Progressive Non-fluent Aphasia
- Behavioural: personality/social conduct changes, disinhibition, apathy, perseveration…
What is the relation of alcohol related brain changes and Dementia?
-frontal lobe changes with the vascular changes, head injuries from falls and poor diet can increase risk
What reversible syndrome associated with alcoholism arises as a result of a vit deficiency causing impaired conciousness, ataxia, opthlamoplegia - what vitamin?
Wernicke’s Encepalopathy
B1/thiamine deficiency
If untreated what can the reversible Wernicke’s Encepalopathy cause which is irreversible, what are the features?
Korsakov’s psychosis - profound amnesia for new learning, confabulation. Good attention/working memory still.
What is usually the cause of “challenging behaviour” (= a manifestation of distress/suffering) ?
-a poorly communicated need
How are challenging behaviours recorded with the ABC charts?..antecedent…b…c…
A-ntecedent - what happened before
B-ehaviour - what happened during
C-onsequence - what happened after
What are dementia patients highly sensitive to which can cause problems in hospital setting and lead to the inappropriate label “acopia” (cant cope)
- change in environment, routine is v important
- 20% hospital patients have dementia
What are the 4 spheres of factors that input to cause challenging behaviours in patients?
- Social Environment (relationships, care)
- Physical Envrionment (layout, lighting)
- Biological (disease, pain, meds, diasabilitys)
- Psychological Factors (life hist, attitudes, habits)
What is the Flynn Effect in relation to IQ?`
-IQ goes up by 9pts as nutrition, environment etc improves, every 30yrs
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?
-processing speed is slower with age but ability is the same
What are the synonymous terms “” for:
- loss of “crystallised intelligence” is less common than loss of “fluid intelligence” with age
loss of “wisdom” is less common than loss of “wit”
What did Bernice Neugarten say about life being bio-socially structured through events and impacts causing destability?
- 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
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?
Neither, both will compromise the adult
-ideal is reasonable traumas with enough time to recover between each
What does Carstenson’s Theory of Socioemotional Selectivity say about change in behaviour motivation with age
-perception of time remaining in life so gaining knowledge motivation shifts towards emotional satisfaction towards end of life
What are the key qualities of an adult according to Eriksons Theory (e.g. being, having, helping and owning…)
- sense of identity
- capacity for intimacy
- experience of generativity
- aquisition of integrity (own responsibility)
What can make older adult assessment difficult in these days? (masked…)
-tend to underreport psychological complaints
-“masked depression” - high suicide risk
(check mental wellbeing)
Brain ages chemically with NT and BBB changes, name 3 ways is changes functionally:
- atrophy
- cerebral blood flow changes
- oxidative stress
- cerebral white matter lesions
- neurofibrillary tangles and plaques
The brain atrophies with age, the occipital lobe is protected, where is most affected?
- Pre-frontal Cx and striatum
- temporal lobe, hippocampus, cerebellum
With brian atrophy by loss of neurones an the connections between them , how is white vs grey matter loss?
More White Matter loss (neurones) vs Grey Matter
What are Neurofibrllary tangles collections of?
Hyperphosphorylated Tau
What are plaques in the brain with age deposition of?
Beta Amyloid
In Alzheimers neurofibrillary tangles and plaques are spread throughout the brain, where are they in normal ageing?
-present in cell bodies in the entorhinal cx only
What are cerebral white matter lesions aka leukoaraiosis thought to be due to in the ageing brain?
-chronic ischaemic damage caused by small perforating arteries/arteriole/venule changes
Accumulation of oxidative stress on DNA, lipic, protein by free radical may be responsible for what in the ageing brain?
-the functional decrease in ability with age
Give 2 ways cerebral blood flow changes with age:
- decreases due to CV risk factors e.g. narrow vessels
- homeostasis balance gets worse
- more fluctuant cerebral BP and perfusion
In the ageing brain there is reduced synthesis, binding sites and #receptors. Suggest effect of less ACg, DA and Seratonin?
- less Ach -> cognitive impairment
- less DA -> reduced arm swing and more rigidity
- less 5HT -> depression, circadian rh. changes
BBB in the ageing brain becomes ..
leading to less transport of glucose, proteins and hormones
- more permeable
- more susceptible to hypoglycaemia
With ageing of the brain, remote memory, vocab and comprehension is preserved, what is affected?
- new memory formation
- problem solving
- verbal fluency
- visuospatial task completion
Delerium/acute confusional state is a clinical syndrome characterised by what?
- disturbed conciousness/cognitive function
- acute onset, fluctuating course
Give 3 risk factors for getting delerium?
- advanced age
- fractured NOF
- severe illness
- dementia
Give 3 indicators of delirium e.g. hallucinating..
- fluctuating cognition/perception/social behaviour
- “sun downing” (worse in evening)
- more confused, poor attention
- agitated, pluck at bedding, v.quiet
How should delirium be assessed?
- history + colaterall
- examination
- cognitive screening tests e..g 4AT, AMTS, Mocha
What are the 4As in the 4AT cognitive screening test? -Clue one is AMT4 (4 questions)..
- Alertness
- AMT4: age, dob, place, year
- Attention
- Acute Change/Fluctuating course
State as many of the AMTS questions of cognitive screening you can (10)
- 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?
Suggest what can cause delirium?
- 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
