Dementia 1 Flashcards
Which two types of intelligence (lecture) are there and which type changes with age (normal cognitive aging)
Crystallized (skills, abilities, knowledge- vocabulary), stays stable or improves with age
Fluid (problem-solving and reasoning, processing speed and executive functions), decline with age
Processing speed, attention, memory, language, visuospatial and executive function are all cognitive domains, for each type, name which type of intelligence it is
Processing speed: Fluid
Attention: Fluid
Memory: Fluid
Language: Crystalized > fluid
Visuospatial: Mixed
Executive function: Fluid
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
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
There are different facets of memory, which DECLINE with normal age?
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)
There are different facets of memory, which remain STABLE with normal age?
Recognition memory (cued retrieval)
Temporal order memory (time/sequence of memory)
Procedural memory (how to do things)
There are several functional and structural changes the brain goes through with normal aging, which are these?
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)
What are some “protective factors” for cognitive decline
Active and healthy lifestyle, cognitive and social stimulation and limiting cardiovascular risk
There are two factors that go into a “cognitive reserve”. What are these factors and what is a cognitive reserve?
Lifestyle and education make up this cognitive reserve, which means they will have a later onset of cognitive decline
Even though cognitive reserves can differ from person to person, explain why it doesn’t really matter if the person gets dementia?
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
What is cognitive retraining?
teaching strategies to improve memory,
reasoning and speed of processing
What is the definition of dementia and what neurological condition does not fall under dementia?
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
DSM V dementia definition?
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
Alzheimer is the most common form of dementia in people >65, what are the 5 most common ones for people <65?
Alzheimer, Vascular dementia, frontotemporal dementia, alcohol related dementia, dementia with lewy bodies and huntington disease
What does mild cognitive impairment (mci) usually represent?
a transitional phase between normal aging and dementia
Three diagnostic criteria of mci?
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
What treatment is there for mci
none really, nothing has been proven to be useful in decreasing symptoms or delaying/preventing the progression towards dementia
What are two differences between mci and alzheimer (ad)?
alzheimer’s most distinctive symptom is memory impairment and it interferes with daily life
What are two factors of cortical atrophy in dementia?
- Amyloid-beta plague buildup (outside)
- tau tangles (inside)
What does cortical atrophy look like in dementia?
Extreme shrinkage of the cerebral cortex, severely enlarged ventricles and extreme shrinkage of the hippocampus
What are criticisms against the amyloid cascade hypothesis?
- 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
7 risk factors for alzheimer?
Female, age (65>), cardiovascular disease, brain injury, inactivity, genetics and lower levels of education
What two vascular problems coincide with alzheimer a lot?
Alzheimer with cerebrovascular damage (mixed pathology) and brain hypoperfusion (inadequate blood flow to the brain)
Criticism of vascular hypothesis?
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
Which parts of the clinical diagnosis of ad fit into which part of the diagnostic cycle?
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
What meds can be given to inhibit cognitive symptoms for ad?
- Cholinesterase inhibitors (for patients with mild to moderate AD)
- N-Methyl D-aspartate (NMDA) antagonist (for patients with moderate to severe AD)
Posterior Cortical Atrophy impacts what?
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
What is anosognosia and in what neurological disorder is this common?
Reduced insight into deficits, dementia/alzheimer
Which type of memory problems are seen in ad in the early and late stages?
early: anterograde long-term memoy impairment
late: anterograde impairment and semantic memory problems (general knowledge)
What are some other problems in ad (not memory)
executive, attention, problem solving and also things like visuospatial perception, language or apraxia
What are more other symptoms in later stages of ad?
olfactory dysfunction, seizures and motor signs
What are two factors that affect the progression of ad?
Age onset (later onset = slower rate of decline), higher level of education (later onset, yet faster decline)
