Dementia Flashcards
What are the 2 subgroups of MCI
Amnestic MCI and non-amnestic MCI
Amnestic MCI (single domain)
- 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
Non-amnestic MCI (single domain) 3 possible presentations
- 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
MCI multiple cognitive domains
- 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
Linguistic modifications to improve lang comp in MCI Form
- Use a slower than normal rate of speech
- Limit the number of conversational partners
- Use a pleasant and accepting vocal tone
Linguistic modifications to improve lang comp in MCI Content
- 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
Linguistic modifications to improve lang comp in MCI Use
- 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
Linguistic modifications to improve lang production in MCI
- 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
What are the different types of Dementia
- Alzheimers disease dementia
- Vascular dementia
- Parkinson Disease dementia
- Dementia w/Lewy Bodies/Lewy body dementia
- Frontotemporal dementia
Brain changes associated with Alzheimer’s disease
- Hippocampal atrophy
- presence of neurotic plaques and neurofibrillary tangles
- granulovacular degeneration:fluid filled spaces with granular debris
Management recommendations for Alheimer’s disease
- 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
Assessment of Vascular dementia (VaD)
- 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
Vascular dementia deficits
Clients with VaD: relatively preserved long-term memory, more impairments in frontal-executive functions, and greater motor dysfunctions when compared to clients with AD
Treatment of Vascular dementia
- prevention depends on prevention of future stroke: modify risk factors
- no pharmacological treatments
- social interaction therapies, intellectual stimulation, treatment of aphasia, emotional regulation, acupuncture
Parkinson’s disease dementia (PDD) symptoms affect?
- cognitive/neuropsychological features
- behavioral/neuropsychiatric features
- motor/extrapyramidal features
- sleep disorders
- other
Cognitive/neuropsychological features of PDD
- Relatively intact anterograde memory
- Benefit from cueing for memory-related performance
Behavioral/neuropsychiatric features of PDD
- Recurrent and fully formed hallucinations
- Delusions
- Apathy
- Anxiety
- Depression
Motor/extrapyramidal features of PDD
- Asymmetric rest tremor (“pill-rolling quality”)
- Bradykiniesia
- Rigidity
- Postural instability (often manifested in later stages)
- Responsiveness to levodopa
Sleep disorders in PDD
Hypersomnolence (excessive daytime somnolence) due to possible lateral hypothalamic changes
Other features associated in PDD: autonomic features, sensory features
- Similar autonomic features in DLB but with greater orthostatic hypertension
- Anosmia (loss of smell)
Criteria for PDD
- 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
Primary cognitive deficits in PDD
- 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
Parkinsons disease MCI (PDMCI) inclusion criteria
- 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
Parkinsons disease MCI (PDMCI) exclusion criteria
- Diagnosis of PD dementia
- Other primary explanation for presence of dementia
Lewy Body dementia diagnostic criteria
- Rapid eye movement
- Sleep disorders
- Severe Neuroleptic (antipsychotic) Sensitivity
- Reduced striatal dopamine transporter activity on functional neuroimaging
- Diagnostic features for DLB and PDD
Risk factors of Lewy Body dementia
- Age
- Apoliprotein E (ApoE) genes
- Attention deficits (related to cholinergic denervation in frontal regions)
Primary deficits in Lewy body dementia
- Executive dysfunction
- Deficits in visuperceptual and visuospatial functions: related to possible deficits in occipital duscunction due to reduced glucose metabolism
- Memory and attention deficits
Early clinical cognitive/neuropsychological features in DLB and PDD
Sometimes mild cognitive impairment (MCI) may transition to DLB or essentially normal cognition in PD may transition to MCI in PD to PDD
Early clinical Behavioral/neuropsychiatric features in DLB and PDD
Early features of DLB include visual hallucinations, delusions, depression, anxiety, or apathy in absence of other neurological features
Early clinical Motor/extrapyramidal features in DLB and PDD
Early feature may include subtle features of parkinsons
Early clinical features in DLB and PDD: sleep disorders
- 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
Other features associated in DLB and PDD: autonomic and sensory
- 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
Dementia with Lewy bodies: diagnostic criteria: includes presence of dementia and 1 or more of the following features
- Recurrent fully formed visual hallucinations
- Spontaneous parkinsonism
- Fluctuations in cognition or arousal
- Rapid eye movement (REM) sleep behavior disorders (RBD)
Huntington’s disease neuropathy changes
- 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
Affect and motor symptoms of Huntington’s disease
- 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
Speech deficits and dysphagia associated with Huntington’s
- 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
Cognition changes in Huntington’s disease
- 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
Common communication deficits in Huntington’s
- Deficits in topic initiation
- Word finding deficits
- Deficits in organization and understanding what is said
- Perseveration
- Reduced length of utterances
Early stages of FTD
- deficits in social conduct, personal regulation, emotional blunting, personality changes towards coldness, repetitive motor behaviors, impaired judgment
- disinhibition, apathy, eating disorders
2 types of FTD
progressive and non-progressive
Assessing FTD
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
Treatment of FTD
- 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
Nonfluent agrammatic PPA variant (PPA-G)
- 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
Types of Primary Progressive Aphasia (PPA)
- Nonfluent agrammatic PPA Variant
- Semantic dementia
- Logopenic progressive aphasia
Semantic Dementia (SD)
- 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
Logopenic Progressive aphasia (PPA-L)
- 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
