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BIOL0027 > Cognitive and Dementia Epidemiology > Flashcards

Cognitive and Dementia Epidemiology Flashcards

1
Q

What are the characteristics of mild cognitive impairment?

A

Before dementia
Awareness of cognitive decline
Preserved everyday function
Amnestic/non-amnestic

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2
Q

What are the predictors of MCI progression to AD?

A

Degree of cognitive impairment at MCI classification
APOE ε4 allele
Neuroimaging markers - hippocampal atrophy, amyloid, temporal and parietal hypometabolism
Increased CSF AB and tau
Nutrition and metabolism - diabetes, low folate
Psychiatric symptoms - e.g. depression

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3
Q

What is the main neuropathological change in MCI?

A

Enlarged sulci and ventricles

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4
Q

What does the cognitive impairment used to diagnose dementia include?

A

Impaired memory
Impaired reasoning and complex task-handling
Impaired recognition
Behavioural and personality changes

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5
Q

Name 5 causes of delirium

A 
Infection
Trauma
CNS pathology
Deficiencies
Hospitalisaton
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6
Q

Name 5 rare causes of dementia

A 
Metabolic - folate deficiency
Inflammation/infection - e.g. autoimmune diseases
Degenerative disease - e.g. HD
Alcohol
Brain tumours
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7
Q

What are the diagnostic investigations conducted for dementia?

A

Blood tests - exclude some reversible causes
Profile cognitive domains - see change
Brain imaging - exclude brain tumour
EEG - exclude seizures

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8
Q

What are the symptoms of AD?

A

Prominent deficits in episodic memory, language, recognition, executive function
Parietal lobe functions affected early
Global cognitive deficits
Preserved personality

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9
Q

What are the key diagnostic investigations for AD?

A

MRI - hippocampal atrophy - then global cerebral atrophy
EEG - loss of alpha rhythm
Neuropsychology - impaired episodic memory and other cognitive domains

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10
Q

What is the pathology of AD?

A

Neurofibrillary tau tangles
AB plaques
ACh deficiency

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11
Q

How is AD treated?

A

Non-pharmacological
ChE inhibitors
Memantine - NMDAR blocker

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12
Q

What is the cause of vascular cognitive impairment (VCI)?

A

Small vessel disease

Some large vessel strokes

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13
Q

What are the symptoms of vascular cognitive impairment (VCI)?

A

Depend on brain area of stroke

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14
Q

What are the key diagnostic investigations for VCI?

A

Imaging - for infarcts, small vessel disease
EEG - excess slow activity
Neuropsychology - impaired executive function

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15
Q

What is the progression pattern of VCI?

A

Step-like

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16
Q

What are the symptoms of dementia with Lewy bodies?

A

Executive function, parietal lobe, visual deficits
Visual hallucinations
Parkinsonian motor features
REM sleep disorder
Neuroleptic sensitivity - as neuroleptics decrease DA - worsen Parkinsonian symptoms

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17
Q

What are the treatments for VCI?

A

Non-pharmacological

ChE inhibitors

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18
Q

Name the 3 types of FTD and their main symptom

A

Behavioural variant FTD - inappropriate behaviour
Semantic dementia - inability to understand language
Progressive non-fluent aphasia - speech difficulty

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19
Q

Which genes are implicated in FTD?

A

MAPT
GRN
C9orf72

20
Q

What is the main pathology in FTD?

A

Frontal and temporal lobe atrophy

21
Q

What is ACE-III?

A

Mental state test - attention, verbal fluency, memory, language, visuospatial function

22
Q

How does APOE ε4 affect ACE-III at 69yrs old?

A

Small negative effect

23
Q

In the NSHD what is the effect of homozygous APOE ε4?

A

Highest verbal memory impairment risk

24
Q

How does childhood cognition affect ACE-III at 69yrs old?

A

Via midlife reading ability

Independently

25
Q

Which factors are considered by an elaborated life-course framework for cognitive ageing?

A 
Early life
Childhood cognition
Education
Midlife factors
Cognitive ageing
26
Q

Which factors do early life events independently affect?

A

Childhood cognition
Education
Midlife factors

27
Q

Name the key early life events

A 
Foetal and infant skeletal and neural growth
Nutrition
Obstretic insult
Positive nurturing
Parental involvement
Early adversity
28
Q

What is the importance of foetal and infant skeletal and neural growth?

A

Linked to cognitive development - endocrine processes driving skeletal growth in utero also drive brain development

29
Q

What is the importance of early life nutrition?

A

Breast milk n-3 PUFAs directly increase offspring IQ

Infant diet high in fruit and vegetables linked to higher IQ

30
Q

What is the importance of obstretic insult and what are the limitations of this?

A

Alcohol and drug use during pregnancy linked to offspring behavioural and cognitive problems
Could be confounded by maternal genetics selecting these behaviours
Difficult to tell which behaviours due to prenatal exposure - which due to postnatal learning - as continuity in exposure

31
Q

What is the importance of parental involvement?

A

Higher parental interest in education correlates with higher offspring reading scores

32
Q

What is the importance of early adversity?

A

Poor material home conditions in childhood linked to decreased visual search speed in adulthood

33
Q

Which factors does childhood cognition independently affect?

A

Education

Cognitive ageing

34
Q

What is the strongest single factor affecting cognitive ageing?

A

Childhood cognition

35
Q

What was the grammatical complexity of autobiographies written by nuns a strong predictor of?

A

Later life cognitive function and AD risk

36
Q

Which type of dementia is childhood IQ associated with?

A

Vascular dementia

37
Q

Which factors does education independently affect?

A

Midlife factors

Cognitive ageing

38
Q

What is the link between childhood cognition, education, and adult cognition?

A

Childhood cognition independently affects education

Education independently affects adult cognition

39
Q

Name the key midlife factors

A

Physical activity

Tobacco use

40
Q

How does physical activity affect AD risk?

A

Decreases

41
Q

How is the rate of verbal memory decline altered in those who exercise in midlife?

A

Slower

42
Q

What are the possible mechanisms behind the effect of physical activity on cognitive decline?

A

Exercise promotes hippocampal neurogenesis
Increased capillary density in cerebellum - linked to frontal cortex
Decreases cardiovascular disease - prevents cerebrovascular disease

43
Q

How does smoking affect dementia risk?

A

Increases

44
Q

In the NSHD which measure of cognition was worse in heavy smokers than light smokers?

A

Verbal memory decline

45
Q

What are the possible mechanisms behind the effect of tobacco use on cognitive decline?

A

Oxidative stress
Inflammation
Atherosclerosis
White matter damage

BIOL0027 (20 decks)

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