Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Special Populations > Cognitive Issues in Older Adults Part 1 > Flashcards

Cognitive Issues in Older Adults Part 1 Flashcards

1
Q

list the neurocognitive domains that make up cognition

A
  1. complex attention
  2. executive function
  3. learning and memory
  4. language
  5. perceptual-motor function
  6. social cognition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what makes up perceptual-motor function?

A
  1. visual perception
  2. visuoconstructional reasoning
  3. perceptual-motor coordination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what makes up language?

A
  1. object naming
  2. word finding
  3. fluency
  4. grammar and syntax
  5. receptive language
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what makes up learning and memory?

A
  1. free recall
  2. cued recall
  3. recognition memory
  4. semantic and autobiographical
  5. long-term memory
  6. implicit learning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what makes up social cognition?

A
  1. recognition of emotions
  2. theory of mind
  3. insight
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what makes up complex attention?

A
  1. sustained attention
  2. divided attention
  3. selective attention
  4. processing speed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what makes up executive function?

A
  1. planning
  2. decision-making
  3. working memory
  4. responding to feedback
  5. inhibition
  6. flexibility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

list the various types of memory

A
  1. sensory
    1. iconic (visual)
    2. echoic (auditory)
    3. haptic (touch)
  2. short-term
    1. working
  3. long-term
    1. implicit (procedural)
    2. explicit (declarative-semantic)
    3. explicit (declarative-episodic)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what factors help differentiate between delirium and dementia?

A
  1. onset → delirium has quicker onset
  2. duration → delirium has shorter duration
  3. attention
  4. consciousness
  5. speech
  6. cause → delirium is caused by something else
  7. other features
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

list the 3 types of delirium

A
  1. hyperactive
  2. hypoactive
  3. mixed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

T/F: delirium is not associated with any complications

A

FALSE

associated with:

  1. increased LOS
  2. Prolonged recovery times
  3. institutionalized care
  4. increased morbidity and mortality rates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

describe the pathophysiology behind delirium

A
  1. brain structural changes (cortical atrophy, white matter lesions, etc.)
  2. neurotransmitter disturbances in central cholinergic and adrenergic pathways
  3. elevated inflammatory cytokines (IL-6, IL-8)
  4. multifactorial in older adults
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

prevention and management of delirium

A
  1. at least 30-40% of cases are preventable
  2. determine cause and remediate ASAP
  3. drugs linked to delirium
    1. psychoactive agents
    2. narcotics
    3. anticholingerics
  4. nonpharmacologic interventions
    1. cognitive orientation
    2. early mobility
    3. enabling adequate hearing and vision
    4. promoting a normal sleep-wake cycle
    5. proper nutrition/hydration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

define dementia

A

a global impairment impacting intellectual functioning, memory, and at least one of the following:

  1. abstract thinking
  2. judgement and language
  3. identification of people and objects
  4. personality changes
  5. ability to use object appropriately
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how is dementia diagnosed?

A

diagnosed through a semi-structured interview, detailed medical and neurological examination, neurocognitive testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how does the DSM-V define dementia?

A

a neurocognitive disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

list the types of Dementia

A
  1. Alzheimer disease (AD)
  2. Vascular dementia (VaD)
  3. Dementia with Lewy bodies (DLB)
  4. Frontotemporal dementia (FTD)
  5. Mixed pathologies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

list the levels of cognitive impairment associated with dementia

A
  1. subjective cognitive impairment
  2. mild cognitive impairment
  3. moderate cognitive impairment
  4. severe cognitive impairment
  5. amnestic vs nonamnestic cognitive impairment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

vascular dementia accounts for _______

A

20-30% of cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Key features of vascular dementia

A
  1. associated with cerebrovascular disease
  2. more often abrupt onset, but can be gradual with small vessel disease
  3. memory loss usually less severe than AD
  4. mood changes and apathy common
  5. can occur in conjunction with AD = mixed dementia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

T/F: multi-infarct dementia has not relationship with vascular dementia

A

FALSE

it is a subset form

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

affected brain areas in vascular dementia

A
  1. medial temporal atrophy
  2. cortical and subcortical lesions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Clinical symptoms of vascular dementia

A
  1. impaired attention, planning
  2. difficulties with complex activities
  3. disorganized thought
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

dementia with Lewy Bodies accounts for ________

A

8% of dementia cases

accepted to be highly underdiagnosed and misdiagnosed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

key features of DLB

A
  1. complex visual hallucinations
  2. Parkinsonism
  3. sleep disturbances
  4. autonomic symptoms (i.e. hypotension)
  5. fluctuating cognition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

DLB can occur in conjunction with _______

A

Parkinson’s Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

affected brain areas in DLB

A
  1. less severe medial temporal lobe atrophy than AD
  2. FDG-PET shows occipital hypoperfusion and hypometabolism
  3. loss of dopaminergic neurons in substantia nigra
  4. limbic
  5. brainstem
  6. neocortex
28
Q

3 primary presentations of Lewy Body Disease

A
  1. Parkinson’s disease dementia (PDD)
  2. Dementia with Lewy Bodies (DLB)
  3. Neuropsychiatric symptoms → DLB
29
Q

Frontotemporal dementia accounts for ______

A

3-10% of dementia

30
Q

key features of FTD

A
  1. more common in younger groups (50-60 yo)
  2. memory often intact in early stage
  3. sig changes in behavior and personality
  4. disinhibition and impulsiveness are common
31
Q

types of FTD

A
  1. Pick’s disease
  2. Progressive supranuclear palsy
  3. corticobasal degeneration
32
Q

affected brain areas in FTD

A
  1. frontal and temporal lobes
  2. specific areas of atrophy dependent on type of variant
33
Q

Alzheimer’s disease accounts for _______

A

50-60% of dementia cases

34
Q

Key features of AD

A
  1. gradual loss of memory and function leading to total dependence on caregivers
  2. eventual inability to recognize family/friends/self
35
Q

how is a diagnosis of AD made?

A

through interview/history, diagnostic testing

36
Q

affected brain regions in AD

A
  1. entorhinal area
  2. hippocampus
  3. amygdala
  4. regions of neocortex
37
Q

describe neurobiological changes of cognitive dysfunction in dementia

A
  1. these changes can occur before symptoms appear in AD and other dementia
  2. asymptomatic to mild cognitive impairment stages
    1. amyloid markers are most prominent changes
    2. shifts to more prominent structural changes once MCI stage begins
      1. the degree of atrophy of medial temporal structures can be a potential diagnostic marker for mild cog impairment stage of AD
38
Q

how accurate are structural MRIs for diagnosing early dementia due to AD in people with MCI?

A

not very, a Cochrane review has inconclusive evidence

39
Q

list the diagnostic markers for AD

how many must be present?

A

(one of 3 must be present)

  1. medial temporal atrophy
    1. 75% sensitivity, 81% specificity
  2. temporoparietal hypometabolism
  3. abnormal neuronal CSF markers (tau and/or Abeta)
40
Q

less common forms of dementia

A
  1. Creutzfeldt-Jakob disease
  2. HIV-related cognitive impairment
  3. Huntington’s chorea
  4. MS
  5. Normal pressure hydrocephalus
  6. Niemann-Pick disease Type C (NPC)
41
Q

describe the normal aging brain

A
  1. recent memory for important events, affairs, and conversations not impaired
  2. does not get lost in familiar territory, may have to pause momentarily to remember way
  3. able to operate common appliances even if unwilling to learn how to operate new devices
  4. normal performance on mental status examinations, taking education and culture into account
42
Q

describe a brain with dementia

A
  1. notable decline in memory for recent events, decline in ability to converse
  2. gets lost in familiar territory while walking or driving, may take hrs to eventually remember
  3. becomes unable to operate common appliances, unable to learn to operate even simple appliances
  4. abnormal performance on mental status exams not accounted for by education or cultural differences
43
Q

how does the cellular environment differ between normal aging and dementia?

A
  1. normally there are diminished communication signals between brain cells diminish
  2. in dementia
    1. metabolism impaired with development of neurofibrillary tangles
    2. repair disabled by amyloid plaques
    3. plaques and tangles produce mistakes throughout the brain resulting in cell death
44
Q

list AD diagnostic guidelines

A
  1. 2011 guidelines for diagnostic criteria
  2. disease progresses on a spectrum of 3 stages
    1. preclinical
    2. mild cognitive impairment (MCI)
    3. Alzheimer’s dementia
  3. potential use of biomarkers
    1. AB42
    2. tau and p-tau in the CSF
45
Q

describe the Amyloid hypothesis

A

amyloid beta derived from larger protein: amyloid precursor protein (APP)

B-secretase and gamma-secretase cut APP in two places → create peptide fragment

gene mutation causes longer fragments that are more likely to clump together

amyloid beta aggregates forming tau-tangles resulting in inflammation and synapse dysfunction and cell death

manifesting as dementia

46
Q

what is the connection between sleep and amyloid-beta?

A

sleep deprivation results in increased amyloid-beta build up and thus puts you at higher risk for developing AD

47
Q

what is the function of amyloid-beta?

A
  • it is present throughout lifespan in humans
  • found in all vertebrae with high degree of conservation in molecular sequence
  • suggests AB serves a beneficial role in human physiology
  • evidence shows that a depletion of endogenous AB has adverse consequences (in animal studies)
48
Q

Beneficial roles of amyloid-beta

A
  1. antimicrobial activity
  2. tumor suppression
  3. sealing leaks in the BBB
  4. promoting recovery from brain injury
  5. regulating synaptic function
49
Q

what is the relationship between plaque burden and dementia?

A
  1. not all plaques are equal
  2. in some cases plaques appear to have protective function
  3. cognitive symptoms linked more closely to number/location of tau tangles
  4. post-mortem exams have shown tangles in absence of plaques
  5. beta amyloid appears to be driving force behind AD
50
Q

list drugs that have undergone drug trials for treatment of dementia

A
  1. immunotherapy
  2. gamma-secretase inhibitor
  3. monoclonal antibody
  4. beta-secretase inhibitor
51
Q

what do the results from drug trails mean in relationship to dementia?

A
  1. amyloid is a disease trigger for tau and inflammation to drive the disease
  2. drugs are being given at wrong point in progression of AD
  3. plaques can form decades before cognitive symptoms appear
  4. beta amyloid levels may have plateaued by time pt enters trial
  5. Beta amyloid is a match that starts bush fires of tau tangles, leading to a forest fire of inflammation in brain
    1. by the time the drug is given there is simply too much damage done
52
Q

list biomarkers for dementia

A
  1. FDA-approved diagnostic tests for AD (PET neuroimaging scans)
    1. Amyvid
    2. Vizamyl
    3. Neuraseq
  2. FDA-approved at-home genetic test
    1. 23andME saliva swab to ID APOE gene variant
53
Q

APOE4 affect on brain function

A

increased risk of dementia thought to be linked to toxic “gain of function”

  • increased response to stress and injury
  • normal healthy brain function also appears to diminish
54
Q

what is the purpose of Apolipoprotein E gene in the brain?

A

synthesized in the brain to regulate:

  1. level amyloid-beta
  2. brain lipid transport
  3. glucose metabolism
  4. neuronal signaling
  5. neuroinflammation
  6. mitochondrial function
55
Q

describe drug treatment options for dementia

A
  1. emerging and not yet effective
    • disease modifying drugs
    • aim to slow or prevent onset of disease
  2. Current drugs on the market
    1. neurotransmitter-based drugs
    2. treat symptoms, attempt to delay progression
56
Q

description the drug options that focus on neurotransmitter depletion

A
  1. Acetylcholine
    1. dramatic reduction from neuron degeneration
    2. loss of 60-90% of acetylcholine activity = memory impairment
  2. Other neurotransmitters
    1. serotonin, somatostatin, norepinephrine
  3. Symptomatic treatment
    1. blocking acetylcholinesterase
    2. meds targeting NMDA pathway
57
Q

general drug treatment approach for mild dementia

A

cholinesterase inhibitor

58
Q

general treatment approachs for moderate dementia

A
  1. cholinesterase inhibitor + memantine more likely to delay progression
  2. address behavioral and psychological symptoms
59
Q

general treatment approaches for severe dementia

A
  1. consider if meds will provide a benefit, possibly do a med-free trial
  2. may continue cholinesterase inhibitor approved for late-stage disease or memantine
60
Q

T/F: there is no cure for dementia

A

TRUE

can only attempt to delay progression

61
Q

Alzheimer’s disease drug concerns

A
  1. Be aware of potential AE with meds
    1. cholinergic meds → GI issues most common
    2. Memantine → may cause dizziness, watch for falls
  2. communicate behavioral issues to healthcare providers
  3. Timing of PT
    1. provide structure to reduce behavioral issues
    2. reduce behavioral issues related to sun-downing
    3. utilize time of day when pt most alert
62
Q

describe the drug option → Amyloid beta-directed antibody

A

aka aducanumb (Aduhelm)

approved under accelerated approval pathway

post-approval trial must verify clinical benefit or approval will be withdrawn

63
Q

AEs of amyloid beta-directed antibody

A
  1. ARIA-edema
  2. HA
  3. ARIA-microhemorrhage
  4. ARIA-H superficial siderosis
  5. diarrhea
  6. confusion/delirium
  7. falling

ARIA = amyloid-related imaging abnormalities

64
Q

downside of amyloid beta-directed antibody

A

VERY expensive

65
Q

Controversy surrounding amyloid beta-directed antibody

A
  1. FDA advisory committee voted that there was insufficient evidence showing clinical efficacy
  2. does clearance of amyloid plaques actually slow disease progression?
  3. labeling does not match trial criteria
  4. may inhibit participation in needed post-trial
  5. may inhibit development of a better drug

Special Populations (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions