dementia Flashcards
dementia and age?q
it is a disease of aging. 50% chance of having dementia by 85
dementia continuum
normal aging decline > mild cognitive impairment > dementia
what are some normal age associated changes
difficulty retrieving words. slower processing speed. difficulty sustaining attention with distractions. learning something new takes more effort. there should be no functional impairment.
mild cognitive impairment
memory complaint corroborated. objective memory impairment for age and education. preserved general cognition. normal activities of daily living. not demented, although some do progress to dementia
amnestic MCI
memory loss, but not enough to meet dementia criteria. progresses to AD in 10-15%. maybe the earliest phase of AD>
what are the criteria for dementia
memory decline and impairment. at least one of the following: aphasia, apraxia. decline in memory, cognition, complex attention, executive function, learning/memory, language, perceptual/motor or social cognition.
this is an impairment.
early onset AD
between 30-60. rare. familial in most.
what genes/chromosomes associated with early onset AD.
1 - presinilin 2
14 - presinilin 1
21 - amyloid precursor.
late onset AD
most common form. develops after age 60. chromosome 19 seems to be involved. this is E4 gene.
alzheimers
most common cause of dementia. deficits in recent memory that progresses to global impairment of cognition. usually sporadic and late onset. neuronal and synaptic loss effects the cortical and subcortical areas.
gross affects of AD
cerebral atrophy, especially affecting the temporal, parietal, and frontal areas. this is found with ventricular enlargement. flattening of gyri enlarging sulci. the hippocampus is greatly atrophied.
microscopic affects of AD
amyloid plaques, neurofibrillary tangles, granulovacular degeneration. hirano bodies.
where are the A-beta plaques?
they are extracellular and often associated with dystrophic neurites.
where are the neurofibrilary tangles and what are they?
they are intracellular, in the cytoplasm. they are composed of hyperphosphorylated Tau. for AD they are in the shape of the neuron.
what is characteristic about the plaques?
they have apple-green birefringence this confirms the presence of amyloid. perivascualr causes bleeding.
what is Pick’s disease?
this is a tauopathy. it is frontal-temporal lobe dementia. the occipital and parietal lobes are spared. typical knife-edge gyri
what are the risk factors for AD?
increasing age, females, family history, fewer years of education, lowr income, depression or emotional illnesses, head injury, low seri, folate/b12, elevated homocysteine, postop delirium, alcohol abuse.
what are three spheres of dementia
impairments in cognition, function, and behavior.
Pick’s FTLD
insidious onset, gradual progression, early decline in social interpersonal conduct, loss of regulation of interpersonal conduct with loss of insight. early emotional blunting. behavioral abnormalities. memory loss may occur later but is not as pronounce as AD
treatments for FTLD
NO ACH -DOESNT WORK. use divalproex for behavior. SSRI for irritability.
AD psychopharm
ACH inhbitors, NMDA antagonists.
why does acetylchoine work?
nucleus basal is of maynert degeneration in AD causes widespread loss of ACH. replenishing that seems to resolve some symptoms.