degradarea in imbatranire Flashcards by lex v

what is the typical cognitive decline

since the age of 20 there is cognitive decline in most cognitive functions
e.g.
memory
reasoning
spatial visualisation
perceptual speed

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what is pathological ageing

not all people age as well

modifications which take place due to age based illness, as independent from modifications correlated with typical healthy ageing

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what is dementia

significant cognitive decline
Affects cognitive abilities
Dementia is heterogenous - different types of dementia will lead to different cognitive difficulties

Also associated with behavioural and psychological symptoms

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What is the prevalence of dementia

7.1% of all ppl will develop dementia in their lifetime
There will be 1 million by 2025 and 2 million by 2050

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what are risks for developing dementia

age
genetic facotrs
male
ethnicity
smoking

depression
high blood pressure
lack of excercise
diet/eight

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what are the cognitive difficulties associated with different dementias

Alzheimer’s disease
-episodic memory

Vascular Dementia
-executive function
-attention and processing speed

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what is the background of how Alzheimer’s disease was discovered

one of his patients has gone through 7 years of memory problems and confusion

he identified plaques and tangles after autopsy

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what is AD

most common form of dementia

neurodegenerative - loss of neurones in the brain

slow, progressive, fatal, incurable

prominent episodic memory deficit - loss of personal unique recollection of experiences

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What is the prevalence of AD

increases with age
84 year+ is 42% prevalance

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How do you get a diagnosis of definite AD

you can’t be sure until autopsy until you look at the number of plaques and tangles

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How do you get a diagnosis of probable AD?

Dementia observed
Cognitive impairment in memory and 1 other area
Decline progressive
Onset between ages 40-90
No other cause for symptoms

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where does AD start

in hippocampus

atrophy of hippocampal formation

Study found that atrophy 2.5 times greater in AD than controls

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what are causes of AD?

not fully understood

associated with age

plaques and tangles are present in temporal lobe which contains the hippocampus

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what are plaques

-they form outside of neurones
-clusters of beta amyloid proteins
-plaques are not broken down normally and become insoluble
-they build up between neurones which affects
functioning
-block communication between neurones

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how to plaques form

they form around amyloid precursor protein - which helps neurones grow and repiar

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what are tangles

twisted fibres of protein tau within neurones

in a healthy CNS tau has important role for stabilising microtubules which transport nutrients around neurone

in AD tau protein is abnormal and microtubule collapses

cell dies due to lack of nutrients

what was found about brain in people with dementia

People with dementia had reduced blood flow in entorhinal cortex

Blood flow in entorhinal cortex is associated with memory tasks

They demonstrated cognitive difficulties primarily in memory

Memory is a hippocampal related task

what is vascular dementia

second most common type of dementia

150,000 ppl in UK

progression of symptoms

problems with blood supply to the brain

neurones rely on blood for oxygen and glucose
without they die

associated with damage to white matter and deep grey matter structures

symptoms of VAD

Memory loss not necessarily main presentation

main problems is executive function and attention deficits

What is the vascular dementia criteria

cognitive decline is due to decline from previous functioning

in diagnoses we are looking for impairment in 2 or more cognitive domains: executive function, attention, language, visuospatial, motor control, memory

physiological: evidence for cardiovascular disease, with or without stroke

what are causes of vascular dementia

based on damage to large OR small vessel disease

narrowing of blood vessels deep in the brain

gradual slowing of thinking and problem solving

What is the progression of vascular dementia

Progression from risk factors through cardiovascular disease to vascular dementia

Therefore preventable

what are the precursors of dementia

dementia is a gradual process

there are many steps preceding a dementia diagnosis

what is mild cognitive impairment (MCI)

Transitional stage before dementia
Not always converts to dementia

whats the conversion from MCI to dementia

not always studies 105 patients with MCI over the course of 3 years 22% of them diagnosed with dementia 38% cognitive decline but not dementia 32% stable 8% showed cognitive improvement

What are the sub types of MCI?

Amnestic MCI Non-amnestic MCI

What is Amnestic MCI

when memory is primary deficit precursor to alzheimers

What is non-amnestic MCI?

memory is not major diagnoses there is a decline in cognitive function but memory is not primary one precursor to vascular dementia where executive function and attention is impaired

Why is much of the research conducted on people who have MCI rather than dementia

They are able to give consent Actively take part in research - complete cognitive tasks Have brain scans without sedation

How can we identify likelihood of conversion from MCI to AD?

compared resting state in fMRI machine compared patients with AD, MCI and healthy adults 2.4 years later they followed up to see who has AD fMRI distinguished MCI who converted to AD versus those who don't

what are the early stages of vascular dementia

VaD is the result of cardiovascular damage Usually referred to as small vessel disease (SVD) A common presentation of SVD is a stroke

What is cardiovascular damage (SVD)

when there is major disruption of blood supply to brain causing a shortage of oxygen and glucose (ischaemic) visible damage on MRI scans a single large stroke can affect cognitive processes

SVD related to white matter damage

found progressive white matter damage in patients with SVD so increase in white matter lesions (WHM)

What is test to distinguish between dementias?

Cognitive performance can distinguish between AD and VaD with 89% accuracy Cognitive deficits in: -episodic memory = AD -VaD = executive function

what are things to consider about AD

although early AD sings are in temporal grey matter, later changes occur throughout the brain, affecting both grey and white matter

what are some things to consider about VAD and AD

although early primary cognitive deficits usually distinguish VAD and AD, some studies have shown no difference on executive function task performance by the time dementia occurs and progresses, cognitive difficulties are widespread in late stage-dementia, there are fewer cognitive differences between different types of dementia

Does normal ageing brain also have plaques and tangles

normal ageing brain also has some plaques and tangles

Why has the purity of dementia been questioned

AD and VAD often co-occur