Dementia 1

Question 1

Which two types of intelligence (lecture) are there and which type changes with age (normal cognitive aging)

Answer 1

Crystallized (skills, abilities, knowledge- vocabulary), stays stable or improves with age

Fluid (problem-solving and reasoning, processing speed and executive functions), decline with age

Question 2

Processing speed, attention, memory, language, visuospatial and executive function are all cognitive domains, for each type, name which type of intelligence it is

Answer 2

Processing speed: Fluid
Attention: Fluid
Memory: Fluid
Language: Crystalized > fluid
Visuospatial: Mixed
Executive function: Fluid

Question 3

Processing speed, attention, memory, language, visuospatial and executive function are all cognitive domains, for each type, name whether it declines with normal aging or not

Answer 3

Processing speed: Yes
Attention: Simple no, complex yes
Memory: mixed
Language: no, with the exception for visual confrontation naming and verbal fluency
Visuospatial: Mixed
Executive function: Fluid

Question 4

There are different facets of memory, which DECLINE with normal age?

Answer 4

Delayed free call (spontaneous retrieval)

Source memory (knowing the source of learned info)

Prospective memory (remembering intended future actions, like needing to take meds in two hours)

Question 5

There are different facets of memory, which remain STABLE with normal age?

Answer 5

Recognition memory (cued retrieval)

Temporal order memory (time/sequence of memory)

Procedural memory (how to do things)

Question 6

There are several functional and structural changes the brain goes through with normal aging, which are these?

Answer 6

Cortical thinning and gray matter volumetric shrinking

Decreased white matter density (especially frontal and occipital)

Loss of dopamine receptors (attentional dysregulation, executive dysfunction, difficulty with contextual processing)

Question 7

What are some “protective factors” for cognitive decline

Answer 7

Active and healthy lifestyle, cognitive and social stimulation and limiting cardiovascular risk

Question 8

There are two factors that go into a “cognitive reserve”. What are these factors and what is a cognitive reserve?

Answer 8

Lifestyle and education make up this cognitive reserve, which means they will have a later onset of cognitive decline

Question 9

Even though cognitive reserves can differ from person to person, explain why it doesn’t really matter if the person gets dementia?

Answer 9

Because even though there will probably be a later onset, there will also be a faster cognitive decline, meaning at some point they will reach the same point of decline regardless

Question 10

What is cognitive retraining?

Answer 10

teaching strategies to improve memory,
reasoning and speed of processing

Question 11

What is the definition of dementia and what neurological condition does not fall under dementia?

Answer 11

Dementia is the umbrella term
for a number of neurological
conditions, of which the major
symptom is the decline in
cognitive function due to
physical changes in the brain.

Minor cognitive impairment

Question 12

DSM V dementia definition?

Answer 12

Evidence of substantial cognitive decline in one or more cognitive domains and a decline in neurocognitive performance. Has to interfere with independence + not due to other factors

Question 13

Alzheimer is the most common form of dementia in people >65, what are the 5 most common ones for people <65?

Answer 13

Alzheimer, Vascular dementia, frontotemporal dementia, alcohol related dementia, dementia with lewy bodies and huntington disease

Question 14

What does mild cognitive impairment (mci) usually represent?

Answer 14

a transitional phase between normal aging and dementia

Question 15

Three diagnostic criteria of mci?

Answer 15

a) Concern regarding cognitive change by the patient or
informant
b) Impairment in one ore more cognitive domains based on
neuropsychological exam
c) Impairment does NOT interfere with activities of daily
living

Question 16

What treatment is there for mci

Answer 16

none really, nothing has been proven to be useful in decreasing symptoms or delaying/preventing the progression towards dementia

Question 17

What are two differences between mci and alzheimer (ad)?

Answer 17

alzheimer’s most distinctive symptom is memory impairment and it interferes with daily life

Question 18

What are two factors of cortical atrophy in dementia?

Answer 18

1. Amyloid-beta plague buildup (outside)
2. tau tangles (inside)

Question 19

What does cortical atrophy look like in dementia?

Answer 19

Extreme shrinkage of the cerebral cortex, severely enlarged ventricles and extreme shrinkage of the hippocampus

Question 20

What are criticisms against the amyloid cascade hypothesis?

Answer 20

• Lack of coherent evidence
• It is not yet clear whether plaques and tangles
  are a cause of Alzheimer’s disease or just a
  consequence.
• Failure to provide an effective treatment

Question 21

7 risk factors for alzheimer?

Answer 21

Female, age (65>), cardiovascular disease, brain injury, inactivity, genetics and lower levels of education

Question 22

What two vascular problems coincide with alzheimer a lot?

Answer 22

Alzheimer with cerebrovascular damage (mixed pathology) and brain hypoperfusion (inadequate blood flow to the brain)

Question 23

Criticism of vascular hypothesis?

Answer 23

Unclear whether the vascular component of AD constitutes the cause or rather the effect of the disease
* Unclear whether typical AD pathology and
vascular pathology are two simultaneously yet unrelated processes or two processes that affect and amplify each other

Question 24

Which parts of the clinical diagnosis of ad fit into which part of the diagnostic cycle?

Answer 24

Complaints analysis = clinical interview (patient and relatives)

Problem analysis = neuropsychological assessment, neuropsychiatric symptoms, other symptoms

diagnosis = diagnosis, progression, prognosis

indication for treatment = no cure but meds to inhibit cognitive symptoms, cognitive training, management of behavioural symptoms

Question 25

What meds can be given to inhibit cognitive symptoms for ad?

Answer 25

• Cholinesterase inhibitors (for patients with mild to moderate AD)
• N-Methyl D-aspartate (NMDA) antagonist (for patients with moderate to severe AD)

Question 26

Posterior Cortical Atrophy impacts what?

Answer 26

perceptual-motor functions (atrophy of the visual cortex and sometimes cerebellum)

Visual field, inability to recognize objects/faces, letter recognition/reading, optic ataxia. visual/spatial orientation

Question 27

What is anosognosia and in what neurological disorder is this common?

Answer 27

Reduced insight into deficits, dementia/alzheimer

Question 28

Which type of memory problems are seen in ad in the early and late stages?

Answer 28

early: anterograde long-term memoy impairment
late: anterograde impairment and semantic memory problems (general knowledge)

Question 29

What are some other problems in ad (not memory)

Answer 29

executive, attention, problem solving and also things like visuospatial perception, language or apraxia

Question 30

What are more other symptoms in later stages of ad?

Answer 30

olfactory dysfunction, seizures and motor signs

Question 31

What are two factors that affect the progression of ad?

Answer 31

Age onset (later onset = slower rate of decline), higher level of education (later onset, yet faster decline)