chapter 4 Flashcards
annual incidence of AD
-6-8%
-slightly higher prevalence rate is found in women
-duration ranges from 2-20 years
-accounts for more than half of all patients with dementia
brain changes
-hippocampal atrophy
-atrophy in both hemispheres
-presence of: neuritic plaques, neurofibrillary tangles, granulovacular degeneration
neuritic plaques
complex spherical structures consisting of extracellular depostits of B-amyloid peptide AB42)
neurofibrillary tangles (NFT)
insoluble intracellular aggregates of abnormal hyperphosphorylated microtubule-associated or tau proteins
granulovacular degeneration
fuild-filled spaces which contain granular debris and these interrupt interceullar communication and information processing
diagnostic markers of AD
presence of both neuritic plaques and neurofibillary tangles in large concentrations in different areas of the brain
AD begins ______
in the lower part of the brain and works it way up
-stage 1: transentorhinal region
-stage 2: entorhinal region
-stage 3: limbic regions -stage 4: neocortical sensroy assoc. and prefrontal region
gender risk factors
elderly woman have a higher risk for AD dementia
among all the dementia, mean are at a higher risk for
vascular dementia
associated risk factors with gender
-greater cardiovascular disease
-lower educational or physical activity levels
2 times higher incidence o dementia and AD in
African-American and Hispanic populations
Asian countries have
lower prevalence of dementia
older adults with ______ education are less likely to develop dementia
higher
cardiovascular factors
risk factors for cardiovascular disease (diabetes mellitus, hypertension) are also associated with increased risk of dementia
diabetes mellitus
-older adults with diabetes had approx. a 2-fold increase in dementia
-diabetes more strongly associated with VaD than AD
hypertension if not treated in midlife is associated with
poor congitive function and higher risk for dementia and AD in late life
=both high systolic blood pressure and low diastolic blood pressure have been assoc. with increased risk of dementia and AD
high blood pressure leads to dementia by creating
increased risk for developing ischaemia and stroke
-low blood pressure during late adult life leads to dementia by increasing the risk of cerebral hypoperfusion and hypoxia
behavioral/lifestyle factors
protective factors aganist AD are: mental activity, physical activity, smoking
psychosocial factors
-depression increases risk of dementia
genetics in AD
-majority of individuals with DS tend to develop AD if they survive 40 years
early stages of AD
-anterograde episodic memory impairment
-lang. deficits
-visuospatial deficits
-primary or secondary visual deficits
-executive dysfunction
middle stages of AD
-deficits in orientation
-deficits in foucused attn and easily distracted
-obvious deficits in visuopereception and visuospatial skills
-bladder incontinence
*needs supervison and assistance with basic ADLs
late stages AD
-deficits in all areas of orientation
-global deficits in carrying out basic ADLs
a diagnosis of possible AD requires
moderate neuritic plaques and hipppocampal NFTs
clinical diagnosis
-has an insidious onset
-associated most commonly with episodic memory impairment
-memory deficits correlate with basal forebrain and medial temporal regions
lang deficits AD
-reduced spontaneous speech
-word finding probs
-tendency to use less complex grammar and syntac
-global aphasia or mutism in advanved stages
visuospatial deficits AD
-orientation in their own enviornment
-deficits in self-navigation
other deficits AD
-executive dysfunction
-agnosia
-apraxia
assessment of cognitive functions
-neuropsychological exam
-Mini Metal State Exam
-MOCA, Mattis Dementia Rating Scale, Mini Cog, 7-Min Screen, Clock Drawing Test
early AD
deficits mainly in orientation and memory tasks
early FTD
deficits in speech
early DLB
deficits in visuospatial components
neuropsychiatric inventory 9NPI)
characterizing profiles along 10 behavorial domains and 2 neurovegetative domains
-has a nursing home version
behavorial pathology in alzheimers disease rating scale (BEHAVE-AD)
examines 25 symptoms arranged in 7 behavioral domains
behavorial rating scale for dementia (BRSD)
assessment of 46 behaviors arranged into 6 subscales
MMSE scores
-normal 28-30
-MCI 25-27
mild dementia 20-24
-moderate 13-20
severe less than 12
moca scores
-normal functioning 27+
-mild 21-26
-moderate 11-20
-severe 10 or less
memory tests
-rey auditory verbal learning test (RAVLT) can differentiate between indviduals with AD and those without dementia or between other forms of dementia
-delayed recall subtest has high sensitivty for AD
FTLD and VaD
predominance of deficits in EF compared to AD
primary prevention
prevention of subsequnt dementia in cognitive normal indviduals
-several risk factors have been identified but no clear reccomendations
secondary prevention
prevention of development of AD in non-demented individuals with some evidence of cognitive impairment
symptomatic treatment
2 classes medication have been approved for treatment of cognitive symptoms:
-cholinesterase inhibitors and memantine
cholinesterase inhibitors (ChEIs)
-ChEIs have been reported to show benefits in mild, moderate and severe AD
memantine
found to have an effect on delusions, agitation/aggression and irritability
neuropsychiatric profiles of AD
-mild stages: apathy, depression, irritability and anxiety; fewer behavioral abnormalities reported overall
-moderate to severe stages: agitation, anxiety, motor hyperactivity
neuropsychiatric profiles of VaD
-specific profile is dependent on the persons brain changes
-commonly observed deficits include depression, apathy, and irritability
neuropsychiatric profiles of FTD
-a spectrum of cognitive and behavioral disorders resulting from specific deteration in frontal and temporal regions
-personality, emotional, and behavioral changes
-apathy, motor hyperactivity, disinhibition and hyperphagia
