CCC- Memory loss in old age, dementia (not finished!)

Question 1

How is dementia more than a memory loss?

Answer 1

It also affects cognitions and behaviour

Question 2

What is dementia?

Answer 2

Dementia describes a collection of symptoms associated with impaired cognitive abilities and the ability to carry out day to day tasks/ activities.

Question 3

What are some symptoms of dementia?

Answer 3

Memory loss
Difficulty sustaining attention
Language
Disorientation in space & time
Mood, social & behavioural changes

Question 4

What are some examples of mood, social & behavioural changes for an individual with dementia?

Answer 4

Can withdraw from social situations.
Become depressed.
Have anxiety/ agitiation/ socially inhibited- gambling.

Question 5

What is tip of the tongue phenomenon?

Answer 5

The phenomenon of failing to retrieve a word or term from memory.

Question 6

What is dementia caused by?

Answer 6

Caused by a number of biological diseases- especially chronic & long lasting diseases.

Dementia isn’t a diagnosis in its own right.

Question 7

Is dementia a normal part of ageing?

Answer 7

NO

Question 8

What are some causes of dementia?

Answer 8

Chronic diseases- e.g. parkinson’s- neurodegenerative diseases.
Traumatic brain injuries, alcoholism, deficient in certain vitamins
Alzheimer’s disease.
Huntington’s disease.

Question 9

How prevalent is dementia?

Answer 9

UK- estimated 850,000 people living with dementia.

Roughly 1 in 14 people over the age of 65.

Expected that 2 million people will have dementia by 2050

Question 10

What is the most common cause of dementia & what is the percentage?

Answer 10

Alzheimer’s disease.
60-70% of cases.

Question 11

What are other common pathologies which cause dementia?

Answer 11

cerebrovascular disease
Neocortical lewy body disease

Question 12

If you have multiple pathologies together- are you more/ less likely to experience dementia?

Answer 12

More likely!

Question 13

What is Alzheimers disease?

Answer 13

Neurodegenerative disease: progressive, irreversible deterioration in cognitive abilities & daily function.

In most people- symptoms of Alzheimer’s disease appear after the age of 60.

Question 14

What are possible risk factors for dementia?

Answer 14

Stress & anxiety & psychiatric conditions.

Question 15

How are there individual differences in symptom progression for Alzheimer’s disease?

Answer 15

The way a person experiences the disease- depend on many factors including genes, physical health, personality, emotional resilience, medication they take & support they rely on.

Question 15

How are there individual differences in symptom progression for Alzheimer’s disease?

Answer 15

The way a person experiences the disease- depend on many factors including genes, physical health, personality, emotional resilience, medication they take & support they rely on.

Question 16

What is atrophy?

Answer 16

Neuronal loss, reduction in grey & white matter volume.

Question 17

Topographical disease progression?

Answer 17

Topographical disease progression, starts off in medial temporal lobe, wider temporal regions, parietal & frontal areas, then widespread atrophy (with visual and motor areas spared until late disease stages.

Question 18

How do you commonly look at atrophy?

Answer 18

Through structural magnetic resonance imaging.

Question 19

Over the course of Alzhemiers disease- the mass that can be lost can be the size of what?

Answer 19

An orange

Question 20

Where is a key area that atrophy occurs?

Answer 20

Hippocampus (which has a key role in encoding & memory)

Question 21

Neurotransmitter production & function is impaired.

How can this be explained?

Answer 21

Synaptic dysfunction- altered communication between neurons.
Loss of cell bodies in Nucleus Basalis of meynert- very early marker of Alzheimers.
These cell bodies are involved in the production of acetylecholine (cholinergic neurotransmitter system)
Medications to reduce dementia symptoms boost brains supply of acetylcholine (which alleviates some of the cognitive symptoms.)

Question 22

What do medications which reduce dementia symptoms do?

Answer 22

Boost brains supply of acetylcholine (which alleviates some of the cognitive symptoms.)

Question 23

What abnormalities develop in the proteins required for the maintenance & repair of neurons?

Answer 23

Senile plaques- excess B amyloid protein

Neurofibrillary tangles- misformed tau protein

Question 24

What do the senile plaques do?

Answer 24

Beta-amyloid protein involved in Alzheimer’s comes in several different molecular forms that collect between neurons. It is formed from the breakdown of a larger protein, called amyloid precursor protein. One form, beta-amyloid 42, is thought to be especially toxic. In the Alzheimer’s brain, abnormal levels of this naturally occurring protein clump together to form plaques that collect between neurons and disrupt cell function

Question 25

What are neurofibrillary tangles & what do they do?

Answer 25

They are abnormal accumulations of a protein called tau that collect inside neurons. In Alzheimer’s disease, however, abnormal chemical changes cause tau to detach from microtubules and stick to other tau molecules, forming threads that eventually join to form tangles inside neurons. These tangles block the neuron’s transport system, which harms the synaptic communication between neurons. Lead to cell death

Question 26

How do you measure in vivo Quantification & localisation of amyloid & tau?

Answer 26

cerebrospinal fluid bloods Pet scans (Positron emission tomography)

Question 27

capturing proteins How can you quantify the proteins in the spinal fluid?

Answer 27

Doing a lumbar puncture (needle) spinal cord- allows to quantify it.(unpleasant)

Question 28

Capturing proteins What do the PET scans do- how do they work?

Answer 28

Inject radioactive tracer into arm Developed to be specific shape- goes in bloodstream to brain & binds to protein specified When scan someone- can see where the radioactive substances deposited- shows how much & where the proteins we are trying to target are.

Question 29

Localisation of amyloid B-amyloid deposition- where does it first occur? What are amyloids associated with?

Answer 29

In structures of the default mode network: the posterior cingulate cortex, precuneus, & medial prefrontal cortex. Cognitive deficits & altered brain activity.

Question 30

Lifespan approach What is this ? What does it aim to do?

Answer 30

Reducing the impact of Alzheimers disease. - Characterizing risk -Prevention -Early detection - Monitoring & lifestyle management

Question 31

Which types of memory are affected by Alzheimers disease?

Answer 31

Episodic memory (short-term, long term) Semantic memory Lexicon (vocabulary) Working memory (flexibility of mental representations) Spatial memory

Question 32

How do we assess memory impairment?

Answer 32

Can do quick 10 min pen & paper tests. Benefits of in clinic memory assessment (quick, easy to administer, widespread adoption) Novel methods e.g. VR tests of spatial memory, smartphone-based measures.

Question 33

What is mnemonic discrimination?

Answer 33

Ability to encode & retrieve distinct memories from among events which share common features. Mnemonic discrimination is a valuable marker of early Alzheimer's disease.

Question 34

What are mnemonic discrimination errors?

Answer 34

Are increased in individuals with a diagnosis of mild cognitive impairment. Correlate with covert alzheimers pathology in older adults without a diagnosis. Are caused by altered brain functions in memory regions of the medial temporal lobes.

Question 35

Capturing changes in real word settings- what are the ways we can capture detection's of alzheimers?

Answer 35

Language- how are they speaking/ are they fluent in their language/ is it declining? Look at how people walk & their navigation (life space- are they going to new areas or not.) Sleep-

Question 36

Everyday life- making tea What is involved in making a cup of tea?

Answer 36

Multiple cognitive processes. e.g. semantic memory- what is tea? Spatial memory- where is the sugar? Autobiographic memory- dad likes two sugar? Working memory- what have I just done?

Question 37

Making tea- what are the most common errors made by stroke & closed head injury patients?

Answer 37

Omission- missing out steps in the sequence.

Question 38

Rusted & Sheppard (2002) What did their study do?

Answer 38

Longitudinally monitored individuals living with dementia- on their tea making abilities over 5 years. Different approaches measures tea making abilities. - Verbal description from memory. - Observation in own kitchen. - Observation in novel environment. - Instructing someone else how to make tea.

Question 39

Rusted & Sheppard (2002) What were the results from the study?

Answer 39

People with dementia showed a decrease in the number of steps they could recall- verbally. When asked to perform- relatively preserved tea making abilities in novel setting & own kitchen. Shows memories aren't lost- just difficult to access,

Question 40

What is the biggest risk factor of Alzheimers disease?

Answer 40

Age

Question 41

How do our genes play a role in Alzheimers?

Answer 41

Deterministic genes- tied to early onset Alzheimers- account for less than 1% of cases. (chromosome 21, chromosome 14) Risk genes- associated with higher incidence of Alzheimers - but not sufficient to cause it- linked to sporadic alzheimers disease.

Question 42

What is APOE e4 associated with?

Answer 42

Substantially greater risk of future Alzheimers disease & poorer cognitive ageing in healthy older adulthood. Cognitive, structural & functional brain differences from youth. If have apoe 4 gene - likely to get it at an early age & symptoms will progress quickly, Changes brains structure & function from childhood & cognitive differences from youth.

Question 43

What are modifiable risk factors of Alzheimers disease?

Answer 43

Less education Hypertension obesity hearing loss Smoking depression physical inactivity social isolation diabetes

Question 44

How can dementia be prevented/ slowed down?

Answer 44

Lifestyle changes! e.g. Adherence to meditteranian diet reduced brain inflammation stop smoking, obesity education cognitive training rich social network

Question 45

Summary of Dementia & Alzheimers?

Answer 45

Alzheimers- biological disease- not part of healthy ageing. (pathologies- amyloid, tau, neurodegeneration) Memory deficits- key component-not all have it. Age & genetic factors play a huge role in likelihood of developing dementia- environmental & lifestyle changes can reduce risk- as much as 40%