Dementia Flashcards
______ term memory is more affected than _____ term memory
short term more affected than long term
What part of the brain handles short-term memory? What are the changes w/ age?
- prefrontal cortex
- stable, but may require more effort to encode before decay
What type of memory stays the longest w/ Alzheimer’s?
Procedural memory - stuff you do subconsciously
- implicit
What type of memory is most affected by Alzheimer’s? Why?
Explicit (declarative) episodic - autobiographical of events, contextual knowledge, and associated emotions
- occurs in hippocampus which is diminished in Alzheimer’s
Delirium vs Dementia onset
Delirium - temporary and has rapid onset
Dementia - slow progression and gradually
Delirium vs Dementia duration
Delirium - duration is only as long as the cause of the issue
Dementia - chronic, progressive continuation
Delirium vs Dementia attention
both have issues with attention but cleared up after delirium ends and does not with dementia
Delirium vs Dementia consciousness
Delirium - has issues w/consciousness
Dementia - there is no issue until the end
Delirium vs Dementia speech
Delirium - gargled speech, hallucinations
Dementia - continuum depending on the stage of dementia
- early on anomia - difficulty w/ word finding
What is also common alongside of Alzheimer’s disease?
depression - hard for the patient to verbalize sadness and other feelings of depression
What is pseudodementia? What helps patient with this?
apparent intellectual decline that stems from lack of energy or effort
- responds well to depression treatment
Difference between pseudodementia from dementia
- more rapid decline in mental function
- usually not disoriented
- difficulty w/ concentrating but less difficulty w/ short term memory
- writing, speaking, and motor skills usually not affected
- more likely to comment on memory problems
T/F: Writing, speaking, and motor skills are usually not affected w/ pseudodementia
true - they are affected w/ dementia
Depression more common in _____ to ______ stages of dementia
early to moderate
Increased severity of dementia = ________ prevalence of major depression
decreased
Amnestic vs nonamnestic cognitive impairment
Amnestic - memory is impaired but other cognitive functions are spared (prestage of dementia)
Nonamnestic - memory remains intact, but 1 or more other cognitive abilities are significantly impaired
What level of cognitive impairment does the following pt have: pt feels like their memory is slipping but testing is normal
Subjective cognitive impairment (SCI)
What level of cognitive impairment does the following pt have: testing/outcome measure shows change but not severe enough for dementia
Mild cognitive impairment
What level of cognitive impairment does the following pt have: can take care of themselves for the most part - need spouse w/ them or may live in assisted living
Mild dementia
Difference between mild cognitive impairment and mild dementia
MCI pt can still take care of themselves at home and mild dementia needs some assistance/supervision w/ ADLs
What level of cognitive impairment does the following pt have: need help w/ ADLs and lots of word finding issues
moderate dementia
What level of cognitive impairment does the following pt have: wheelchair/bed bound, may be non-verbal and need full time care
severe dementia
What is vascular dementia caused by?
Caused from stroke, atherosclerosis, diabetes, HTN, smoking – anything that inhibits blood flow to the brain
Vascular dementia key features
- abrupt most often
- memory loss usually less severe than Alzheimer’s
- mood changes and apathy common
clinical symptoms of vascular dementia
- impaired attention, planning
- difficulties w/ complex activities
- disorganized thought
What type of dementia is associated w/ complex visual hallucinations? Why?
Lewy Bodies Dementia
- temporal and occipital lobes are affected
Key features to Lewy Bodies Dementia
- complex visual hallucinations
- parkinsonism
- sleep disturbances
- autonomic symptoms (HTN)
- fluctuating cognition
What type of dementia can be in conjunction w/ Parkinson’s?
Lewy Body Dementia
Key features of frontotemporal dementia
- younger groups - 50-60 y/o
- memory in tact in early stage
- significant changes in behavior and personality
- disinhibition and impulsiveness are common
________ and _________ is more affected in frontotemporal dementia compared to other types of dementia.
Behavior and executive function
What type of behavior do frontotemporal dementia patients have?
disinhibition and impulsiveness
Key features of Alzheimer’s disease
- gradual loss of memory and function leading to dependence on caregivers
- eventual inability to recognize family/friends/self
diagnostic markers for Alzheimer’s disease.
- How many have to be present?
- medial temporal atrophy
- temporoparietal hypometabolism
- abnormal neuronal CSF markers (tau and/or Abeta)
only 1 of 3 must be present
Which areas of the brain are most affected by dementia, specifically AD?
memory and language
What builds up in between neurons in Alzheimer’s patients?
amyloid plaques that block signal transmission that leads to cell death
What biomarkers are used to determine Alzheimer’s? Where are they found?
- AB42
- tau
- p-tau
all in CSF
T/F: High level of amyloids are less likely to have tumor and vice versa
true
What appears to be driving force behind AD?
Beta amyloid
Why are drug trials not showing patient improvement in AD?
by the time the patient shows symptoms, amyloid accumulation is at the peak and the drugs can only slow further progression
- by the time the drug is given there is simply too much damage done
What is APOE? What is the lowest and what is the highest?
- genetic marker for chance to develop AD
APO2 – linked with lowest risk of Alzheimer’s
APO4 – highest risk
- Everyone has 2 of some combination (2 alleles)
What type of medication would you want for someone w/ AD?
acetylcholinesterase - want something to block the break down of Ach
What are the 3 types of memory?
- Short-term memory- Registration
- Working memory- Processing
- Long-term memory- Storage and retrieval
What is the Zarit Burden scale?
survey to see caregiver burn out
What is the functional assessment staging (FAST) scale used for?
describe the stages of dementia
- stages 1 (normal adult) - 7 (severe AD)
What is Blessed and Short Blessed testing for?
memory and concentration test
What is the dementia screening indicator?
simple screening tool that can be used in primary care setting
What types of questions are on the functional activities questionnaire? Is it short or long?
- bill paying, tracking current events, transportation questions
- short test that provides greatest diagnostic utility
What is the geriatric depression scale? How long is it?
- self report yes/no questionnaire to identify depression
- long form has 30 questions and short form has 15
What is the global deterioration scale? How is it completed?
7 stages to characterize where an individual is at in the dementia disease process (done through observation)
Mini-Cog consists of what tests?
3-step assessment:
- 3-word registration
- clock drawing
- 3-word recall
What are the 5 areas of cognitive function?
- orientation
- registration
- attention and calculation
- recall
- language
What is the mini mental state exam (MMSE)?
11 question measure that tests 5 areas of cognitive function
- orientation
- registration
- attention and calculation
- recall
- language
Clinical Dementia Rating (CDR) 0
no cognitive impairment
Clinical Dementia Rating (CDR) 0.5
very mild cognitive impairment (MCI)
Clinical Dementia Rating (CDR) 1
mild dementia
Clinical Dementia Rating (CDR) 2
moderate dementia
Clinical Dementia Rating (CDR) 3
severe dementia
What does Montreal cognitive assessment (MoCA) evaluate?
- 30 question test
- orientation
- short term memory
- executive function/visuospatial ability
- language abilities
- animal naming
- abstraction
- attention
- clock-drawing
Which test has clock drawing?
MoCA and Mini-Cog
What is the Trail making test used to assess?
- executive function
- visual search
- scanning
- speed of processing
- mental flexibility
What test uses the task of sewing stitches to evaluate cognition?
Allen Cognitive Level Screen (ACLS)
- Measures global cognitive processing abilities through observation of activity performance
3 tips for selecting the appropriate test to use on someone w/ cognitive impairments
- short instructions w/ no more than 3 steps
- short test duration to avoid fatigue
- select tests based on goal (balance, activity tolerance, etc.)
The 6 min walk test has good to excellent test-retest reliability w/ what type of patients? What is 1 downside?
mild to moderate dementia and mild to severe dementia
- there is a large MDC
What does repeated chair stand test test for?
LE strength/power and fall risk
What are the 3 parts of the short physical performance battery?
- balance
- gait speed
- 5x sit to stand
Who is the miniBESTest most appropriate for?
MCI and early stages of dementia
What measures dynamic walking ability by walking over meandering curved line with emphasis on walking speed and stepping accuracy while changing directions
Groningen Meander walking test
What type of dementia has the slowest gait speed? Why?
- frontotemporal dementia
- due to frontal lobe involvement
What can be a precursor to cognitive issues due to impact on the hippocampus?
HTN - associated w/ white matter disease and atrophy
What type of exercise is beneficial for executive functions?
aerobic activities
What reduced gait variability during dual task in both healthy subjects and those with PD – Parkinson’s?
tai chi
- rhythmic auditory cueing (RAS) reduced gait variability in patients w/ PD
What are the 6 domains of balance?
- biomechanical constraints
- stability limits/verticality
- anticipatory postural adjustments
- postural responses
- sensory orientation
- stability in gait