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PSYC 424: Neuropsychology > Chapter 10 > Flashcards

Chapter 10 Flashcards

1
Q

dementia

A

loss of cognitive ability

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2
Q

Alzheimer’s disease (AD)

A
  • leading cause of dementia
  • degeneration of the brain, especially the cortex and limbic system (hippocampus)
  • sulci especially wide, indicating degeneration of the cortex
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3
Q

preclinical AD

A
  • no symptoms
  • measurable brain changes
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4
Q

mild cognitive impairment due to AD

A
  • very mild symptoms that do not interfere with everyday activities
  • measurable brain changes plus subtle problems with memory and thinking
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5
Q

mild AD

A
  • symptoms interfere with some everyday activities
  • memory problems (especially new memories), word finding difficulties, trouble with planning/organization
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6
Q

moderate AD

A
  • symptoms interfere with many everyday activities
  • memory problems (personal history), feeling moody and/or withdrawn, wandering/getting lost, personality changes (e.g., suspiciousness and delusions)
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7
Q

severe AD

A
  • symptoms interfere with most everyday activities
  • loss of awareness (of recent events and surroundings), difficulty with communication, vulnerable to infections (especially pneumonia)
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8
Q

dementia memory lapses

A
  • not recognizing family members
  • forgetting to serve meal just prepared
  • substituting inappropriate words
  • getting lost in own neighborhood
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9
Q

key characteristics of AD

A
  • cognitive deficits: profound memory loss (anterograde/retrograde), language (anomic, empty, circumlocutory), visuospatial disturbance
  • behavioral deficits: no significant early changes in personality, unawareness or denial of illness, psychosis
  • no sensory or motor deficits
  • age of onset 70s-80s
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10
Q

pathology of AD

A
  • neurofibrillary tangles (tau protein)
  • amyloid plaques (beta amyloid)
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11
Q

beta-amyloid plaques (senile plaques)

A
  • large amyloid precursor proteins (APP) are cut into fragments called beta-amyloid fragments via the enzyme beta-secretase
  • the fragments clump into plaques outside of the cell and destroy dendrites, reducing dendritic branching affecting cognition
  • they also initiate an immune response from the microglia that also increase the spread of plaques killing neurons
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12
Q

neurofibrillary tangles

A
  • inside of the neuron
  • microtubules are bound together with tau proteins
  • if tau proteins change their structure, the microtubules fall apart
  • the tau proteins clumps together in tangles, killing the neuron
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13
Q

cytoskeleton of neuron

A
  • gives the neuron its shape
    “bones” are:
  • microtubules: big, run longitudinally down neurites, made of tubulin, microtuble-associated proteins (MAPs) regulate microtuble assembly and function; changes in MAPs called tau implicated in AD
  • microfilaments: solid, thinner, actin
  • neurofilaments: intermediate filaments, individual long protein molecules
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14
Q

microtubule-associated proteins (MAPs)

A
  • tau/MAPs can function as cross-bridges connecting microtubules
  • can affect microtubule rigidity
  • brain uses a transport system to help move around the nutrients it needs; system is made of proteins like railroad tracks guiding trains guide nutrients where they need to go; proteins that keep the tracks straight are tau proteins
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15
Q

causes of AD

A
  • genetics (likely several genes)
  • immune responses initiated by microglia
  • sleep imbalance
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16
Q

genetics of AD

A
  • amyloid precursor protein (APP) (familiar early onset of AD)
  • presenilin (PS) 1 and 2 (familial early onset of AD)
  • Down’s Trisomy 21
  • ApoE4 increases risk of late onset of AD
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17
Q

microglia and AD

A
  • microglia play a role in the immune system and in the brain
  • release inflammatory proteins
  • attempts to clean up damage caused by beta-amyloid plaques but may contribute to the spread
18
Q

treatment of AD

A
  • cholinergic replacement: treats symptoms
  • anti-amyloid agents: tries to reduce the disease
19
Q

cholinergic hypothesis

A
  • loss of ACh activity correlates with the severity of AD
  • acetylcholinesterase inhibitors: drugs used to treat Alzheimer’s disease, act by inhibiting acetylcholinesterase activity
  • these drugs block the esterase-mediated metabolism of acetylcholine to choline and acetate; this results in: increased acetylcholine in the synaptic cleft, increased availability of acetylcholine for postsynaptic and presynaptic nicotinic (and muscarinic) acetylcholine receptors
20
Q

acetylcholine (ACh)

A

an important neurotransmitter in areas of the brain involved in memory formation

21
Q

fronto-temporal dementia (FTD)

A
  • FTD is an umbrella term that encompasses several types of dementia primarily affecting the frontal and temporal lobes of the brain
  • includes various subtypes, such as behavioral variant FTD (bvFTD), primary progressive aphasia (PPA), and others
22
Q

Pick’s disease

A
  • specific subtype of FTD
  • characterized by presence of abnormal brain cells known as Pick bodies and Pick cells
  • mainly affects the frontal and temporal lobes and typically presents with symptoms similar to behavioral variant FTD
23
Q

pathology of FTD

A
  • can vary widely and may include tau protein inclusions, TDP-43 inclusions, or other forms of cellular degeneration
  • does not always have Pick bodies
24
Q

pathology of Pick’s disease

A

characterized specifically by the presence of Pick bodies, which are abnormal clumps of tau protein inside neurons

25
Q

symptoms of FTD

A
  • can vary depending on the subtype but typically include changes in personality, behavior, language, and sometimes motor skills
  • behavioral variant is most common and can cause disinhibition, apathy, and loss of empathy
26
Q

symptoms of Pick’s disease

A

often similar to the behavioral variant of FTD with early behavioral and personality changes such as impulsivity and lack of social awareness; language difficulties may also be present

27
Q

age of onset of FTD

A

typically occurs in individuals under 65 years, most often in 50s or 60s but can occur earlier

28
Q

age of onset of Pick’s disease

A

often appears in individuals in their 40s to 60s

29
Q

genetics of FTD

A

can have a genetic component, with 1/3 to 1/2 of cases linked to inherited mutations in genes such as MAPTm GRN, C9orf72

30
Q

genetics of Pick’s disease

A
  • less well-understood genetic basis, though it may occasionally run in families
  • not all cases genetically linked
31
Q

some neuropsychological tests used to evaluate executive functions

A
  • Wisconsin card sorting task
  • Tower of Hanoi
32
Q

Wisconsin card sorting task

A
  • cards may be sorted on the basis of color, shape, or number
  • patient not aware of the rules
  • use trial-and0error to infer the rule
  • after 10 accurate trials the rule will shift
  • different types of errors to report: total number errors, perseveration errors (when you keep applying the old rule), non-perseveration errors
33
Q

tower of Hanoi

A
  • three pegs with three different colored rings on one end
  • goal: move the tower from one end of the board to the opposite side with as few moves as possible
  • rules: can only move one piece at a time, a larger piece is not allowed to be placed on top of a smaller piece
34
Q

vascular dementia

A
  • multi-infarct
  • type of dementia caused by reduced blood flow to the brain, often due to strokes or other conditions that damage blood vessels, leading to brain cell death
  • reduced blood flow to the brain can lead to symptoms that impact memory, reasoning, and sometimes movement
35
Q

cause of vascular dementia

A

conditions that block or reduce blood flow to the brain, depriving brain cells of oxygen and nutrients
- may happen due to stroke or small vessel disease

36
Q

small vessel disease

A

narrowing or blocking in the brain’s smaller blood vessels can lead to gradual brain cell damage

37
Q

symptoms of vascular dementia

A
  • vary depending on which parts of the brain are affected
  • memory loss
  • difficulty with problem-solving and organization
  • slowed thinking
  • difficulty with attention and concentration
  • changes in mood or personality
  • movement issues (e.g., unsteady gait)
38
Q

acute dementia

A
  • intoxications: delirium
  • metabolic abnormalities: renal failure, substrate deficiencies (B12/folate deficiency)
  • hypothyroidism
  • depression (pseydodementia)
  • infectious agents: neurosyphilis/fungal meningitis/HIV
39
Q

delirium vs dementia

A

delirium and dementia often occur together in older hospitalized patients

distinguishing signs of delirium:
- acute onset
- cognitive fluctuations over hours or days
- impaired consciousness and attention
- altered sleep cycles

40
Q

depression vs dementia

A

symptoms of depression and dementia often overlap, but patients with primary depression:
- demonstrate decreased motivation during cognitive testing
- express cognitive complaints that exceed measured deficits
- maintain langauge and motor skills

41
Q

work-up of dementia

A
  • careful history
  • complete mental status and neurological exam
  • blood studies CBC, electrolytes, LFTs, B12, folate levels, thyroid function tests, VDRL, FTA, HIV
  • lumbar puncture
  • EEG
  • MRI
  • PET

PSYC 424: Neuropsychology (14 decks)

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