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Neuro Disease and Disorders > Cognitive Disorders > Flashcards

Cognitive Disorders Flashcards

1
Q

Benign Senescent Forgetfulness

A
  • A mild decline in short-term memory
  • Age-relaed
  • Does not progress to other mental impairments
  • NOT dementia
  • **Difficult to partition from memory impairments secondary to polypharmacology [pt is on too many drugs]
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2
Q

Dementia

A

A decline in intellectual function (memory and other mental abilities) severe enough to interfere with a person’s relationships and ability to carry out daily activities

  • cognitive impairments affecting memory and orientation plus one or more of the following problems:
  • -Abstract thinking
  • -Judgment/problem solving
  • -Language – reduction in frequency
  • -Personality
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3
Q

Alzheimer’s dementia

A

The most common dementia among older adults (50-70% of cases)

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4
Q

Vascular dementia

A
  • multi-infarct or “mini” strokes
  • An insidiously, subtly-progressive worsening of memory and cognition
  • Due to chronic, reduced blood flow in the brain as a result of age-related vascular changes
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5
Q

Dementia with Lewy bodies (DLB)

A
  • third most common cause of dementia after Alzheimer’s disease and vascular dementia
  • accounting for 10-25% of cases
  • Lewy bodies are also found in other brain disorders, including Alzheimer’s disease dementia and Parkinson’s disease dementia
  • DLB & Parkinson’s disease dementia may be linked to the same underlying abnormalities in how the brain processes the protein alpha-synuclein
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6
Q

Causes of Irreversible Dementia

A 
Alzheimer’s Disease
Vascular dementia 
Dementia with Lewy bodies
Parkinson’s Disease
Huntington’s Disease
HIV
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7
Q

Treatable, Reversible conditions that can cause dementia-like symptoms

A 
Depression
Medication side effects 
Drug interactions
Hypothyroidism
Chronic alcoholism
Vitamin B12 deficiency
Benign brain tumor
Brain infection
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8
Q

Alzheimer’s Disease def

A
  • most common form of dementia among older adults.
  • involves parts of the brain that control thought, memory, and language & can seriously affect a person’s ability to carry out daily activities
  • definitive diagnosis is not possible till autopsy
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9
Q

AD Epidemiology

A
  • Prevalence: ~ 5 million Americans
  • 7th leading cause of death in US
  • ~5% older adults age 65-74 have AD
  • Nearly ½ of those age 85 & older may have the disease
  • Time from onset to death is typically 7-11 years
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10
Q

AD Lesion Site

A

Cerebral cortex
-Accumulation of fibrous material called amyloid
Amyloid forms “senile plaques”

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11
Q

AD: Histology

A

Amyloid Plaques

Neurofibrillary tangles

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12
Q

Amyloid Plaques

A

Abnormal clumps of protein fragments, build up between nerve cells
Found throughout the cortex

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13
Q

Neurofibrillary tangles

A
  • Twisted strands of protein inside dead and dying nerve cells
  • Most common in the temporal lobe structures, such as the hippocampus and amygdala
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14
Q

In the Alzheimer’s brain…

A
  • The cortex “shrinks”, damaging areas involved in thinking, planning and remembering (executive functions)
  • Shrinkage is especially severe in the hippocampus, an area of the cortex that plays a key role in formation of new memories
  • Damage to hippocampus explains memory loss and inability to learn new things
  • Ventricles become larger
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15
Q

Executive Functions

A
  • used to explain certain higher-level cognitive abilities that enable an individual to successfully engage in independent goal-directed behavior
  • Frontal or pre-frontal cortex: complex behavior
  • Executive Functions include: Organization & Regulation
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16
Q

AD Progression through the brain

A
  • Plaques and tangles tend to spread through the cortex in a predictable pattern
  • The rate of progression varies-People w/ AD live an average of 7-8 years after Dx, but some may survive up to 20 years.
  • The course of the disease depends in part on age at diagnosis and whether a person has other health conditions.
17
Q

Early AD

A

-May not be detected in this stage
-Slight changes in thinking and planning & learning and memory
-before symptoms
can be detected with current tests,
plaques and tangles begin to form in
brain areas involved in higher cortical functions

18
Q

Mild to Moderate AD

A
  • generally lasts for 2-10 years
  • Often definitive diagnosis in this stage
  • Develop problems with memory or thinking serious enough to interfere with work or social life
  • May also get confused and have trouble handling money, expressing themselves and organizing their thoughts
  • Experience changes in personality and behavior & have trouble recognizing friends and family members
19
Q

Mild to Moderate AD- Speech and Sensory

A

-Speech impairments: Speaking and comprehension
-Sensory integration: association cortex
Somatosensation deficits -> perception issues
-Visual-spatial deficits

20
Q

Severe (Advanced) AD

A
  • may last from 1-5 years
  • Most of the cortex is seriously damaged
  • Brain shrinks dramatically due to widespread cell death
  • Individuals lose their ability to communicate, to recognize self, family and loved ones and to care for themselves
21
Q

Total # of AD Stages

A

7

Death is often secondary to dehydration or infection

22
Q

AD: Medical Diagnosis

A
  • Physical exam
  • MRI
  • -Rule out other reversible causes of dementia
  • -Difficult to see tangles and plaques (rather see atrophy)
  • Rate of cognitive change: Progressive decline without improvement or fluctuation
  • Cognitive screening test
  • -Mini-Mental State Examination (MMSE)
  • -Clock drawing test
  • Neuropsychological testing: extremely detailed, but lengthy
23
Q

Mini-Mental State Exam (MMSE)

A

Score: < 20/30 indicates cognitive impairment

24
Q

Clock Drawing Test

A

Normal: If all numbers are present in the correct sequence and position, and the hands readably display the requested time

25
Q

Temporal Lobe structures

A

Hippocampus and amygdala: STM, LTM, and working memory

26
Q

AD Intervention

A
  • No cure
  • Anti-cholinesterase (may improve memory)
  • Antioxidants, vitamin E to control free radical damage
  • Anti-inflammatory drugs (NSAIDs)
  • Experimental: Hormone replacement
  • Experimental: Immunotherapy
  • -Drugs may slow down the progression, but do not stop or reverse progression
27
Q

PT Considerations

A
  • Over-simplification of interventions for now
  • Fall prevention
  • General exercises - decreases restlessness and wandering
  • Periodic intervention as decline
  • pts lose motor skills ~ increased rigidity and muscle weakness

Neuro Disease and Disorders (9 decks)

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