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Dementia Flashcards

1
Q

What are the 2 subgroups of MCI

A

Amnestic MCI and non-amnestic MCI

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2
Q

Amnestic MCI (single domain)

A
  • subjective memory complaint preferable and supported by an informant. Objective deficits in verbal and visual episodic memory
  • app. 10-15% of individuals with MCI develop dementia per year and 80% within 6 yrs
  • neuroimaging shows significant hippocampal atrophy
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3
Q

Non-amnestic MCI (single domain) 3 possible presentations

A
  • Dysexecutive: in some cases, deficits in executive function occur in isolation before the onset of dementia
  • Visuospatial: refers to a sub-group of MCI with selective impairment of visuospatial functions with intact memory skills
  • Language: not much is known specifically about this subgroup of MCI with language deficits
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4
Q

MCI multiple cognitive domains

A
  • Includes individuals who have deficits in multiple cognitive domains
  • Prevalence of MCI-MCDT is higher than aMCI
  • Neuroimaging evidence: volume loss in right inferior frontal gyrus, right middle temporal gyrus, and bilateral superior temporal gyrus
  • Individuals with MCI-MCDT or non-amnestic MCI have higher mortality rates compared to aMCI group
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5
Q

Linguistic modifications to improve lang comp in MCI Form

A
  • Use a slower than normal rate of speech
  • Limit the number of conversational partners
  • Use a pleasant and accepting vocal tone
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6
Q

Linguistic modifications to improve lang comp in MCI Content

A
  • Reduce the number of propositional in sentences
  • Talk about the here and now
  • Simplify vocabulary
  • Revise pronouns with proper nouns
  • Revise and restate the unclear information
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7
Q

Linguistic modifications to improve lang comp in MCI Use

A
  • Ask multiple-choice or yes/no questions
  • Use direct rather than indirect speech acts
  • Avoid teaching and sarcasm
  • Avoid talking to the person with dementia like a child
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8
Q

Linguistic modifications to improve lang production in MCI

A
  • Provide something tangible, personal, and/or visible to stimulate conversation
  • Memory wallets and books
  • Provide food to increase sociability and talking among patients
  • To facilitate letter writing
  • Avoid placing patients in a free-recall situation
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9
Q

What are the different types of Dementia

A
  • Alzheimers disease dementia
  • Vascular dementia
  • Parkinson Disease dementia
  • Dementia w/Lewy Bodies/Lewy body dementia
  • Frontotemporal dementia
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10
Q

Brain changes associated with Alzheimer’s disease

A
  • Hippocampal atrophy
  • presence of neurotic plaques and neurofibrillary tangles
  • granulovacular degeneration:fluid filled spaces with granular debris
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11
Q

Management recommendations for Alheimer’s disease

A
  • patient/caregiver given education and support
  • physicians draw up treatment/care options
  • realistic expectations discussed with patient/caregiver
  • follow up with MMSE to monitor progression
  • cognitive stimulation treatment
  • behavior management
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12
Q

Assessment of Vascular dementia (VaD)

A
  • Neuropsychological Assessment and rating scales are used
  • Hachinski Ischemic Scale (HIS) is the most widely used assessment instrument
  • Scores of 4 or less on HIS: Indicative of Alzheimer’s disease
  • Scores of 7 or higher on HIS: Indicative of VaD
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13
Q

Vascular dementia deficits

A

Clients with VaD: relatively preserved long-term memory, more impairments in frontal-executive functions, and greater motor dysfunctions when compared to clients with AD

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14
Q

Treatment of Vascular dementia

A
  • prevention depends on prevention of future stroke: modify risk factors
  • no pharmacological treatments
  • social interaction therapies, intellectual stimulation, treatment of aphasia, emotional regulation, acupuncture
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15
Q

Parkinson’s disease dementia (PDD) symptoms affect?

A
  • cognitive/neuropsychological features
  • behavioral/neuropsychiatric features
  • motor/extrapyramidal features
  • sleep disorders
  • other
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16
Q

Cognitive/neuropsychological features of PDD

A
  • Relatively intact anterograde memory
  • Benefit from cueing for memory-related performance
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17
Q

Behavioral/neuropsychiatric features of PDD

A
  • Recurrent and fully formed hallucinations
  • Delusions
  • Apathy
  • Anxiety
  • Depression
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18
Q

Motor/extrapyramidal features of PDD

A
  • Asymmetric rest tremor (“pill-rolling quality”)
  • Bradykiniesia
  • Rigidity
  • Postural instability (often manifested in later stages)
  • Responsiveness to levodopa
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19
Q

Sleep disorders in PDD

A

Hypersomnolence (excessive daytime somnolence) due to possible lateral hypothalamic changes

20
Q

Other features associated in PDD: autonomic features, sensory features

A
  • Similar autonomic features in DLB but with greater orthostatic hypertension
  • Anosmia (loss of smell)
21
Q

Criteria for PDD

A
  • diagnosis of PD and diagnosis precedes diagnosis of dementia
  • MMSE score of 26 or less
  • cognitive dysfunction that interferes with ADLs
  • impairments in at least two of: 3-word recall, lexical fluency, clock drawing,= from MMSE
22
Q

Primary cognitive deficits in PDD

A
  • Memory deficits
  • Reduced cognitive flexibility
  • Slow information processing
  • Executive dysfunction
  • Findings from a longitudinal study: progressive deterioration in visuospatial memory, verbal memory and working memory
23
Q

Parkinsons disease MCI (PDMCI) inclusion criteria

A
  • Diagnosis of PD
  • Gradual decline in cognition (self or family reports)
  • Cognitive deficits on neuropsychological tests
  • Cognitive deficits are subtle but do not interfere with ADL performance
24
Q

Parkinsons disease MCI (PDMCI) exclusion criteria

A
  • Diagnosis of PD dementia
  • Other primary explanation for presence of dementia
25
Q

Lewy Body dementia diagnostic criteria

A
  • Rapid eye movement
  • Sleep disorders
  • Severe Neuroleptic (antipsychotic) Sensitivity
  • Reduced striatal dopamine transporter activity on functional neuroimaging
  • Diagnostic features for DLB and PDD
26
Q

Risk factors of Lewy Body dementia

A
  • Age
  • Apoliprotein E (ApoE) genes
  • Attention deficits (related to cholinergic denervation in frontal regions)
27
Q

Primary deficits in Lewy body dementia

A
  • Executive dysfunction
  • Deficits in visuperceptual and visuospatial functions: related to possible deficits in occipital duscunction due to reduced glucose metabolism
  • Memory and attention deficits
28
Q

Early clinical cognitive/neuropsychological features in DLB and PDD

A

Sometimes mild cognitive impairment (MCI) may transition to DLB or essentially normal cognition in PD may transition to MCI in PD to PDD

29
Q

Early clinical Behavioral/neuropsychiatric features in DLB and PDD

A

Early features of DLB include visual hallucinations, delusions, depression, anxiety, or apathy in absence of other neurological features

30
Q

Early clinical Motor/extrapyramidal features in DLB and PDD

A

Early feature may include subtle features of parkinsons

31
Q

Early clinical features in DLB and PDD: sleep disorders

A
  • Idiopathic RBD is a key feature of DLB where RBD occurs alone without any coexisting neurologic symptoms
  • Hypersomnia is also an increased risk factor for PD, PDD, and DLB
32
Q

Other features associated in DLB and PDD: autonomic and sensory

A
  • Erectile dysfunction, orthostatic hypotension, urinary incontinence, and constipation are common autonomic symptoms in DLB and PDD
  • Dysnosmia/anosmia and impaired color vision are associated with Lewy body pathology and seen in early stages of PD and DLB
33
Q

Dementia with Lewy bodies: diagnostic criteria: includes presence of dementia and 1 or more of the following features

A
  • Recurrent fully formed visual hallucinations
  • Spontaneous parkinsonism
  • Fluctuations in cognition or arousal
  • Rapid eye movement (REM) sleep behavior disorders (RBD)
34
Q

Huntington’s disease neuropathy changes

A
  • Atrophy of caudate nucleus and putamen
  • Atrophy may also occur in other brain areas
  • Imbalance of dopamine occurs leading to excess dopamine in caudate nucleus compared to ACh and GABA leading to choreiform movements and HD develops
35
Q

Affect and motor symptoms of Huntington’s disease

A
  • Changes in affect include sadness, irritability, depression and occasional verbal or physical abuse
  • Motor symptoms include abnormal eye movements, facial grimaces, and excessive finger movements
36
Q

Speech deficits and dysphagia associated with Huntington’s

A
  • Hyperkinetic dysarthria including deficits in respiration, phonation, articulation, and voice quality
  • Dysphagia may be a concern including impulsivity while eating, difficulty chewing food, inability to swallow, and chorea or oral or pharyngeal muscles
37
Q

Cognition changes in Huntington’s disease

A
  • Early stages: subtle changes in memory, attention, and executive function
  • Deficits in visual and verbal memory
  • Deficits in motor and motor learning
  • Deficits in executive functioning
38
Q

Common communication deficits in Huntington’s

A
  • Deficits in topic initiation
  • Word finding deficits
  • Deficits in organization and understanding what is said
  • Perseveration
  • Reduced length of utterances
39
Q

Early stages of FTD

A
  • deficits in social conduct, personal regulation, emotional blunting, personality changes towards coldness, repetitive motor behaviors, impaired judgment
  • disinhibition, apathy, eating disorders
40
Q

2 types of FTD

A

progressive and non-progressive

41
Q

Assessing FTD

A

can be more effective by including a careful medical history and information from family members, combined with clinical investigations, neuropsychological testing, and examination of social cognition performance

42
Q

Treatment of FTD

A
  • No disease-specific treatment exist for FTD
  • Treatment largely consists of measures aimed to reduce the effects of the distressing symptoms
  • Selective serotonin reuptake inhibitors have been used to treat disinhibition and challenging behaviors but their efficacy remains contradictory
  • Anticholinesterase inhibitors typically used for AD treatment are not effective in FTD treatment
43
Q

Nonfluent agrammatic PPA variant (PPA-G)

A
  • Characterized by nonfluency, agrammatism, intact comprehension for simple level sentences, impaired repetition, dyslexia, and dysgraphia
  • Affected areas include posterior frontoinsular region, the inferior frontal gyrus, insular, premotor and supplementary motor areas
43
Q

Types of Primary Progressive Aphasia (PPA)

A
  • Nonfluent agrammatic PPA Variant
  • Semantic dementia
  • Logopenic progressive aphasia
44
Q

Semantic Dementia (SD)

A
  • Predomincactly is asymmetric in nature with damage to either the left or right temporal lobe
  • Category specific naming is impaired in SD such that individuals first begin to substitute specific words for superordinate categories followed by loss of word and the associate concept
45
Q

Logopenic Progressive aphasia (PPA-L)

A
  • Characterized by slow speech, impaired comprehension of complex syntax, impaired repetition and anomia
  • Logopenic refers to hailing anomic quality of spontaneous speech marked by hesitation and pauses and with simple syntactic sentences
  • Affected areas include left perisylvian atrophy and neuronal degeneration in cortical layers

comps (33 decks)

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