Dementia Flashcards
What is dementia? (4)
o Dementia is the term used to describe the symptoms of a large group of illnesses which cause a progressive decline in a person’s functioning.
o It is a broad term used to describe a loss of memory, intellect, rationality, social skills and physical functioning.
o There are many types of dementia including Alzheimer’s disease, vascular dementia, frontotemporal dementia and Lewy body disease.
o Dementia can happen to anybody, but it is more common after the age of 65.
How do we diagnose dementia?
Of dementia –clinically
Of disease process –on autopsy
What are the DSM5 criteria for diagnosing dementia? (9)
A diagnosis of Major NeurocognitiveDisorder (formerly Dementia) requires:
1. A significant cognitive decline from a previous level of performance in one or more of the following cognitive domains:
a. Complex attention (which includes sustained attention, divided attention, selective attention and information processing speed)
b. Executive functioning (which includes planning, decision making, working memory, response to feedback, inhibition and mental flexibility)
c. Learning and memory (which includes free recall, cued recall, recognition memory, semantic and autobiographical long term memory, and implicit learning)
d. Language (which includes object naming, word finding, fluency, grammar and syntax, and receptive language)
e. Perceptual motor function (which includes visual perception, visuoconstructional reasoning and perceptual-motor coordination)
f. Social cognition (which includes recognition of emotions, theory of mind, and insight)
- The cognitive deficits must be sufficient to interfere with independence in activities of daily living
◦If the cognitive impairments do not have a functional impact the person is said to have Mild NeurocognitiveDisorder or a Mild Cognitive Impairment - The cognitive deficits must not be attributable to another medical disorder
What is the incidence and prevalence of dementia? (8)
WORLDWIDE:
o Over 55 million people are living with dementia (in 2020)
o This number will almost double every 20 years
o These numbers are projected to reach 82 million by the year 2030 and 152 million by 2050
o The annual number of new cases of dementia is 9.9 million, approximately 30% higher than in 2010
o Every three seconds someone in the world develops dementia
AUSTRALIA:
o Dementia is thesecond leading cause of deathof Australians.
o In 2016 dementia became the leading cause of death of Australian women, surpassing heart disease
o In 2022, there is an estimated 487,500 Australians living with dementia
What are 5 cortical dementias?
ALZHEIMER’S DISEASE (AD)
FRONTOTEMPORAL DEMENTIA (FTD)
Bv-FTD
Primary progressive aphasia
Semantic dementia
What is AD (+ incidence)? (6)
Most common neurodegenerative disease
The majority of cases develop after 65 (although you can get an early onset Alzheimer’s Dementia which has a more rapid progression)
◦Affects 2% of people over 70
◦25% of people over 80
◦50% of people over 90
Slow and insidious progression (often lasting 10+ years)
What are the diagnostic criteria for AD? (9)
Meets clinical criteria for dementia and also has:
◦Insidious onset
◦Clear-cut history of worsening of cognition
◦The initial and most common cognitive deficits are evident on history and during testing in one of the following categories:
◦Amnesic category (most common): deficits in learning and recall of recently learned information with evidence of decline in at least one other cognitive domain
◦Language presentation (word finding difficulties most prominent)
◦Visuospatial presentation (spatial cognition deficit most prominent)
◦Executive dysfunction (impaired reasoning, judgment, problem solving most prominent)
◦No evidence of substantial cerebrovascular disease, or another dementia syndrome, non-neurological medical comorbidity or medication that could substantially affect cognition
What is AD’s pathology? (10)
“Hallmark” lesions
◦Amyloid plaques
◦Neurofibrillary tangles
Begin in medial temporal lobes
◦Hippocampi
◦Entorrhinalcortex
Progress to parietal and frontal lobes
Neurochemistry:
o Loss of acetylcholine and nicotinic receptors
o Up to 70% loss of choline acetyltransferase (precursor to acetylcholine) in temporal and parietal lobes in AD
o Correlates with number of amyloid plaques and severity of cognitive dysfunction
What are AD symptoms? (5)
Early symptoms vary from person to person
◦Typically memory problems
◦Word finding, spatial issues, impaired reasoning
Often noticed by family and friends not the individual (AD is associated with poor insight)
Usually cope relatively well in established environments early on (but may have difficulty coping with complexity, new situations, changed environments)
What is AD’s presentation? (5)
o Repetitive in conversation
o Forget recent conversations
o Insidious onset of symptoms
o Deny or minimize deficits
o Difficulty with activities of daily living
What is AD’s progression?
Mild AD
Wandering and getting lost
Trouble handling money and paying bills
Repeating questions
Taking longer to complete normal daily tasks
Losing things or misplacing them in odd places
Personality and behavioural changes
Moderate AD
Increased memory loss and confusion
Difficulties recognising family and friends
Inability to learn new things
Self-care/dressing problems
Hallucinations, delusions, paranoia
Impulsive behaviour
Severe AD
Inability to communicate
Weight loss
Seizures
Skin Infection
Difficulty swallowing
Groaning/grunting
Increased sleeping
Incontinence
What are 7 risk factors for AD?
Ø Age
Ø Family history
Ø Vascular disorder
Ø ApoEe4 allele
Ø Female
Ø History of head injury
Ø Negative relationship with education level
What is APOE? (6)
Ø Presence of the ApoEe4 allele of the apolipoprotein gene in 15 % of the population
Ø 60% of AD patients are e4 carriers
Ø E4 increases AD risk 20 fold
Ø Young, non-demented carriers of e4 show lower temporal, parietal and frontal metabolism
Ø Age of onset about 10 years younger
Ø Associated with more severe cholinergic deficit, increased amyloid beta burden, more neurofibrillary tangles
What is AD’s cognitive profile? (4)
- Memory
Anterograde episodic memory is impaired
Characterised by poor encoding and rapid forgetting - Language
Semantic loss
Word finding difficulties
Anomia - Visuospatial Impairment
Apraxia
Getting lost/driving issues/sewing/puzzles
Visual agnosia (inability to recognise objects) - Executive Dysfunction
Problem-solving
Flexible thinking
Abstraction Planning
What is the neuropsychology of AD? (5)
- Behavioural/Affective Changes
Apathy Social withdrawal
Agitation Anxiety and Depression - Anosagnosia/insight
Lack of awareness of difficulties
What is frontotemporal dementia (FTD)? (+ onset and course) (5)
Umbrella term for neurodegenerative disorders that affect anterior parts of the brain
Clinically and pathologically distinct from AD
Onset typically between 50 –60 years
◦Earlier onset than AD
Insidious onset and rapid progression
◦5-7 year course from diagnosis
What are FTD’s subtypes? (5)
Two broad categories of FTD and several subtypes
Behavioural Variant (bvFTD)
◦Previously known as Pick’s Disease
Primary Progressive Aphasia (i.e., Temporal Variant)
◦Progressive Non-fluent Aphasia
◦Semantic Dementia
◦Logopenic Progressive Aphasia
What is bvFTD’s neuropathology? (2)
Focal atrophy of the orbito-mesial frontal and anterior temporal lobes, extending over time to the hippocampus, DLPFC and basal ganglia
Tau or ubiquitin (TDP43) positive
What is PPA’s neuropathology?
Progressive non-fluent Aphasia
◦Greater degeneration in the left posterior frontal cortex
Semantic Dementia
◦Polar and inferior temporal cortex atrophy
Logopenic PPA
◦Posterior aspect of the left superior and middle temporal gyriand parietal lobe involvement
What are bvFTD’s symptoms? (6 bvral +5 cog)
Behavioural
◦Change in social conduct and personality
◦Lack of empathy, Reduced emotional warmth
◦Apathy; neglect of self-care
◦Disinhibition
◦Perseverative behaviours
◦Excessive eating, change in food preferences
Cognitive
◦Executive dysfunction
◦Reasoning, decision making, judgment impaired
◦Memory impairment variable (poor encoding rather than forgetting)
◦No visuospatial disorientation
◦Lack of insight
