Cognitive function Flashcards by Hager Meghrawi

How is cognitive attainment and dementia risk influenced?

Mixture of environmental and genetic factors starting at early life

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What can be used to predict dementia risk and cognitive attainment

Educational attainment

Occupational status

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What are the risk factors that increase dementia risk in early life

Less education

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What are the risk factors that increase dementia risk in middle life

Hearing loss
Traumatic brain injury
Hypertension
Alcohol 
Obesity

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What are the risk factors that increase dementia risk in later life

Smoking 
Depression
Social isolation
Physical inactivity 
Air pollution
Diabetes

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What is the frontal lobe responsible for?

Executive function/ Behavioural control

Speech output

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What is the left lateral temporal lobe responsible for?

Speech comprehension

Semantic knowledge

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What is the occipital/parietal lobe responsible for?

Visuoperceptual/spatial processing;

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What is the left parietal lobe responsible for?

calculation

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What are symptoms of disease in the left inferior area of the frontal lobe

Hesitant, effortful telegraphic speech

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What are symptoms of problems with the left lateral temporal lobe

sometimes confused with deafness, 
 fluent empty speech
specific naming 
 problems reliance on jargon or high 
 frequency words

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What is the right lateral temporal lobe responsible for?

Memory for sounds shapes and faces

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What are symptoms of problems with the occipital/parietal lobe

Neglect - Ignores half of space (usually left half) e.g misses food on plate
ignores people on left
Difficulty laying the table.
Fails to recognise objects
Difficulty navigating surroundings-bangs into doorframes etc
Hemianopia- visual loss of one half of space
Dyspraxia: difficulty carrying out practical tasks-dressing, washing

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What is predominately in the medial temporal lobe?

Hippocampus

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What are symptoms of problems with the occipital/parietal lobe

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What is the medial temporal lobe responsible for

Memory and navigation

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What are symptoms of problems with the medial temporal lobes

Classically cannot recall recent events
Will not retain new information
Difficulty navigating surroundings

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How do we assess cognitive decline (early)?

Patient present to their GP initially with mild symptoms

GP will perform tests to look for a reversible cause of cognitive impairment —
such as B12 , thyroid function — and screen for alcohol use

GP will do a brief memory check

Referred to memory clinic of there is a SIGNIFICANT decline

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What stages will a patient go through before having dementia

When are they diagnosed

Cognitively normal
Mild symptoms
Dementia
Early stages, pathological proteins already affecting patients
Diagnosis- Once dementia hits or even later in dementia

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What are the pathological proteins that cause dementia

Ammyloid Beta form plaques

Tau- medicated neural injury and dysfunction

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What are the pathological proteins that cause dementia

Amyloid Beta

Tau

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What does Amyloid beta do

Forms plaques in Alzheimer’s disease

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What does tau do ?

Forms tangles in Alzheimer’s disease

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Damage to what part of the brain causes Alzheimer’s disease

Hippocampus

Medial temporal lobe

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How is Alzheimer's disease caused?

Amylose beta forms around hippocampus then tau tangles clusters around which cause neuronal injury and dysfunction Problems start only when tau accumulates

What treats Alzheimer's disease?

Nothing | Treatment of slow progression of disease at later mild stages

How is Alzheimer's disease diagnosed before A beta start coming in?

Genetic risk Rare genetic mutations polygenic risk

How is Alzheimer's disease diagnosed before A beta start coming in?

Genetic risk Rare genetic mutations polygenic risk

What genes cause alzheimers disease?

PSEN 2 - presenilin 2 PSEN 1- presenilin 1 APP- amyloid precursor protein Rare

What genes from high to low risk can cause alzheimers disease

APOE4- Apolipoprotein E4 - 2 copies pose the highest risk TREM2- Triggering Receptor Expressed On Myeloid Cells 2- mediun risk APOE4- 1 copy

How is Alzheimer's disease diagnosed after A beta start coming in but before any symptoms emerge?

Evidence of amyloid

Why is evidence of amyloid not advised for patients to diagnose Alzheimer's

Evidence of amyloid will not determine at what stage of getting dementia they are Might be at start or close to getting Alzheimer's

How is evidence of amyloid tested?

Lumbar puncture | PET scan

How is Alzheimer's disease diagnosed when clinical signs show before dementia stage?

Cognitive change | Functional impairment

What assessment tests cognition

Montreal cognitive assesment

What are the different parts of the Montreal cognitive assessment

``` Orientation Memory Delayed recall Attention Visuospatial and executive function Language ( this is assessed through all areas however) ```

What does orientation part need from the patient? (Montreal cognitive assessment)

Non specific | Requires intact memory, attention, comprehension and expression language

What does memory part test (Montreal cognitive assessment)

Immediate (working memory) <1 minute Short term memory (a few minutes) Long term memory (over 20 minutes) Very long term memory (over night).

What does attention part need from the patient? (Montreal cognitive assessment)

Non-specific | requires intact language, concentration, executive function.

What is done in the Visuospatial and executive function part (Montreal cognitive assessment)

Follow the dots in the order given by the assesor

What do people with Alzheimer's do with the Visuospatial and executive function part (Montreal cognitive assessment)

They follow the dots in the way they see it works

What does the Montreal cognitive assessment not test?

Behaviour

How can behaviour be tested (Alzheimer's disease)

Taking a history

What can cause cognitive decline?

``` Acute illness (delirium) Fatigue including sleep disorders Metabolic disturbance Thyroid/Liver disease Vitamin deficiencies e.g. B1 (thiamine) Dementia (in later life) Alzheimer's disease Vascular dementia Lewy body dementia Frontotemporal dementia ```

What is the role of B1

Combines with ATP to form thiamine pyrophosphate

What is thiamine pyrophosphate

Co-enzyme

What is the role of thiamine pyrophosphate

Carbohydrate metabolism

What causes B1 deficinecy

-Global health issue: Rice-based diets can be low in thiamine. When food is then rationed (refugee populations or drought), thiamine reserves are low and people quickly become deficient. Alcohol intake leads to thiamine deficiency. Fad diets that are high in carbohydrates and low in thiamine cause deficiency.

What are some thiamine containing foods

Beef, liver, nuts, oats, oranges, pork, eggs, seeds, Fegunnes, peas and yeast

Name syndromes caused by B1 deficiency

Wernicke-Korsakoffs Wet Beri Beri Dry Beri Beri

What are common symptoms of Wernicke's encephalopathy

Ocular abnormalities- double vision, cant move their eyes Mental status changes Incoordination of gait and trunk ataxia

What are uncommon symptoms of Wernicke's encephalopathy

Stupor Hypotension and tachycardia Hypothermia Bilateral visual disturbances and papilloedema Epileptic seizures Hearing loss Hallucinations and behavioural disturbances

What are late-stage symptoms of Wernicke's encephalopathy

Hyperthermia Increased muscular tone and spastic paresis Choreic dyskinesias Coma

What happens if a patient has thiamine deficinecy

Replace thiamine | Use IV tap

What is Korsakoff's syndrome

Chronic neurological sequelae of thiamine deficiency — can follow Wernicke's AKA alcohol-related brain disease

What are the signs of Korsakoff's syndrome

Behavioural and cognitive change — amnesia and confabulation

How is Korsakoff's syndrome treated?

iv/im thiamine (pabrinex) Can check red cell transketolase Do not give dextrose alone

When treating Korsakoff's syndrome why Do not give dextrose alone?

Metabolising dextrose uses thiamine

What is Dry Beri- Beri

peripheral nerve damage-neuropathy | Can accompany Korsakoff's syndrome

Symptoms of Dry Beri- Beri

``` Confusion Wrist drop Inability to speak Great weakness Numbness of feet Loss of tendon reflex Painful, tender muscles Foot/Wrist drop Burning of tingling ```

What is wet Beri Beri

Peripheral vasodilation occurs, leading to a high cardiac output state, retention of salt and water and edema (swelling).

What does wet Beri Beri cause

Injury to leading chest pain

What is the term for rapid form of wet Beri Beri

Acute fulminant cardiovascular beriberi, or Shoshin beriberi.

Why can treatment with thiamine cause low-output cardiac failure

systemic vasoconstriction is reinstated before the heart muscle recovers.

What to do if treatment with thiamine causes low-output cardiac failure

With support, recovery is usually fairly quick and complete if treatment is initiated promptly. However, if no treatment is available, death occurs just as rapidly (within hours or days).

What is the Montreal cognitive assessment abbreviated to

MOCA