Chapter 6 Flashcards
Introduction
• Older ppl less likely to suffer from mental health than any other
Mild cognitive impairment
- Mild cognitive impairment (MCI): no dementia, but decline in everyday life
- cognitive impairment, not dementia (CIND) CNID: all cases of impairment, regardless of whether individual has sought medical attention
- MCI just prodromal dementia?
- Smoking gun symptom: symptom that unambiguously indicates one illness and one illness only
Dementia
- Decline in intellectual functioning must include decline in memory plus at least one other cognitive skill
- Early-onset dementia (EOD): before age 60
- Doubling of cases every 5 years
- 50 types of dementia, not only Alzheimers
Functional impairment
- Blessed dementia scale (BDS)
- Mental Status Questionnaire (MSQ)
- Mini-Mental State Examination (MMSE)
- FAST (Stages, Reisberg)
- Clinical Dementia Rating (CDR)
- Agitation increases in dementia patients
- Aetiologies different types of dementia
Alzheimer’s Disease
• Senile dementia of the Alzheimers type (SDAT), primary degenerative dementia (PDD), dementia of the Alzheimers type (DAT)
• Short term memory decline
• Apraxia, visual agnosia (inability to recognize by sight)
• Aphasia (Broca/Wernicke)
• Demented dyslexia
• Parkinsonism
• Kluver-Bucy syndrome: hyperorality (put everything in mouth) bulimia, hypermetamorphosis (urge to touch everything), loss of affect
• NINCDS-ADRDA criteria: probable, possible, definite
• Diagnosis by default just ruling out other symptoms
• Senile dementia
• Senile plaques in brain with AD
• Neurofibrillary tangles Axons keep structure thanks to tau, in AD tau becomes distorted, axons form tangles, communication between neurons lost
Cell loss in cortex amygdala, hippocampus, brain stem
• Loss of neurons in cholinergic system
• Cholinergic hypothesis: suppressing cholinergic activity impairs memory, therefore has role in AD
• Cognitive reserve
• Apolipoprotein E (ApoE): gene that increases risk for AD
• Amyloid precursor protein (APP), presenilin-1, presenilin-2
• No genetic cause twin studies
• Threshold model of dementia: persons genetic make-up may predispose them to develop DAT, but requires environmental triggere.g. vascular disease, aluminium
• Kuru
Vascular dementia
- Vascular dementia (VaD): umbrella term, caused by damage to blood vessels in brain
- Thrombosis, embolism, haemorrhage infarct
- Single-infarct/multi-infarct dementia multi= majority
- Mixed dementia
- Cortical atherosclerotic dementia, subcortical…
- Lacunar strokes
- Binswangers disease
- Hachinski Ischaemic Score (IS)
- Characteristic of VaD: stepwise: sudden decline, no change or recovery, another sudden decline…
Other dementias
- Frontotemporal dementia –> subtype: Pick’s disease (behavioral variant frontotemporal dementia), neurons degenerate into Pick’s bodies
- Confabulating: making up stories to cover up gaps in memory
- Semantic dementia (temporal variant frontotemporal dementia)
- Creutzfeldt-Jakob disease (CJD): first movement, then intellectual deteriorationBSE
- Huntingtons disease
- Parkinsons disease (PD)
- Dementia with Lewy bodies (DLB)
- Normal pressure hydrocephalus
Cortical and subcortical dementias
• Cortical: AD, Pick,
Sub: PD, Huntingtons (VaD: both grops)
Illnesses that can be confused with dementia
• Reversible dementias: pseudodementia ( depression), Delirium (acute confusional state ACS) hypoactive/hyperactive/mixed delirium short attention span, illusionsDelirium Rating Scale Delirium also occurs in demented patients
Incidence rates for subtypes of dementia
- AD much more common than VaD
- Late onset dementia (LOD)
- AD more commo in women, VaD more common in men
Memory changes in dementia
- LTM: deficit in encoding
- Phonological loop unscathed in early stage of disease, later becomes impaired
- Key deficit in central executivefrontal lobe
- Autonoetic consciousness: awareness of oneself in memories and the ability to travel back in time through memories impoverished in dementia patients
- Temporal gradient: memories from one time of life better remembered than others
- Anxiety
Linguistic skills
- Anomia: failure to name objectscommon first symptom of AD
- Intrusions (inserting inappropriate words)
- Perseverations (repeating same word)
- Circumlocution (talking around subject)
- Phonology and morphology well preserved
Visuo-spatial skills
- Decline in early stage of AD
- Closing-in: drawing something which is supposed to be copied on or close to the target
- Clock-drawing test (CDT)
Olfaction
- Worsens
* Poorer memory for smells
The effect on caregivers
• Depression, suicide risk, elder abuse
A person-centered approach
• D=P+B+H+NI+SP D= demented patient as they present themselves P=personality B=life experience H=physical health NI=neurological impairment SP=social psychology • Malignant social psychology: surrounding is intimidating, no sense of personal identity • Dementia care mapping
Dementia- a summary
• Progressive loss of memory, intellectual skill and linguistic skills
Learning disabilities
- Older with learning disabilities: higher levels of depression and anxiety
- Higher risk of dementia
Depression
- Far less common in later life
* Except: institutionalized patients, dementia patients
Anxiety
- 10% of elders have anxiety disorder, majority phobia
- Agoraphobia very common
- A little anxiety can be useful
Substance abuse
- Risk of gambling
- Heavy consumers of hypnotic and sedative (sleep inducing) drugs
- 11% of old Americans abuse drugs
- Neuroleptic drugs often prescribed wrongly
- Old drug-addicts numbers will increase with baby boomers
- Not as much heavy drinkers in older generations but also cohort effects
- 5% of old Americans living independently have alcohol problemmeasuring problems
- Men more likely to have drinking problem than women
- Alcohol consumption can be beneficial
- Alcohol abuse in old lowest for any age group
Personality disorder
- Lower chance of getting diagnosed
- Most common: dependent and avoidant
- Numbers might be higher
- Cofounded with depression and self-harm
- Cultural differences
Schizophrenia
- Early onset schizophrenia (EOS)
* Late onset schizophrenia (LOS) ¼ of cases
Overview
• Mental illness in older patients lower than for population as a whole
