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Neuro 4 (sam > Dementia > Flashcards

Dementia Flashcards

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1
Q

How much will the # of centenarians grow by?

A

500% in 2030

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2
Q

What is the max. number of years a human can live?

A

~120

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3
Q

What is the overall life expectancy?

A
  1. 8 overall
  2. 4 males
  3. 2 females
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4
Q

What is the average life expectancy for black males/females?

A

males 72.1

females 78.2

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5
Q

Hispanic female life expectancy?

A

live longer than white males

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6
Q

How has the survival curve changed since the 1900s?

A

Curve has moved to the right-life expectancy has increased over time but max life span has not

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7
Q

What is the cellular theory of aging?

A

Max. lifespan is predetermined and depends on number of mitotic divisions your fibroblasts undergo in a lifetime

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8
Q

What is the DNA mutation theory?

A

Aging occurs as a result of changes in DNA and RNA

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9
Q

What are some factors that can cause changes in DNA and RNA?

A

External factors
accumulation of errors that have occurred over time with transcription
Telomere destruction

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10
Q

What affect does inheritance have on aging?

A

Many inherited factors contribute to aging

They may affect one system primarily but usually affect multiple systems

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11
Q

What is the oxidative stress theory in regards to aging?

A

During aerobic metabolism, free radicals are produced as byproducts of using O2. These free radicals affect membranes and mitochondrial function which further accelerates aging

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12
Q

What diseases are associated with Oxidative stress?

A

Parkinsons (normal breakdown of dopamne leads to free radical formation)
Familial type of ALS

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13
Q

What is the 7th leading cause of death?

A

Alzheimer’s

5th leading cause in people >65

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14
Q

What is considered “ideal” aging?

A

1-2% of brain loss/decade for 40-80 year olds

total 6-10% brain loss by old age (>80)

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15
Q

What part of the brain looses volume at a faster rate than the rest?

A

Hippocampus ~5% a decade, so ~25% by 80 yo

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16
Q

What happens to the cortex and the ventricles?

A

Decrease in cortical thickness and ventricular enlargement

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17
Q

Where do you see the most profound loss of neurotransmitters and receptors?

A

See throughout the whole brain but especially in the basal ganglia and prefrontal cortex

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18
Q

Effects of aging on cell bodys?

A

Cell bodies shrink

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19
Q

What happens to the dendritic tree with aging?

A

Decreased branching, decreased spines ~(46% decrease in number of spines and density in people >50)

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20
Q

What happens to axon collaterals with aging?

A

Decreased number of axon collaterals

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21
Q

What are inclusions?

A

Neurofibrillary tangles

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22
Q

What abnormal structures are found in normally aging brains?

A

Senile plaques and inclusions albeit at a much reduced number than

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23
Q

What are glial cells active during?

A

Active in myelinization and transport of nutrients and maintaining homeostasis

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24
Q

Declines in what systems are related to postural control and aging?

A

Decline in sesory/motor systems
Decline in central processing
Decline in dual task abilities

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25
Q

Two aging hypothesis?

A

Aging machinery and Negative plasticity

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26
Q

Ways to combat negative plasticity

A 
exercise
Control BP
healthy diet
reduce caloric intake
reduce stress
stable marriage
rest (8 hour sleep)
Life-long learning
27
Q

Why do some people age “better” than others?

A

better genes
better lifestyle
higher education level/SES–>less dementia

28
Q

What is the “cognitive reserve” theory?

A

the more education and cognitive processing you have, the more you need to loose to feel the effects of dementia and mental decline

29
Q

Number of baby boomers expected to be diagnosed with dimentia?

A

1 out of every 8 baby boomers will be expected to develop dimentia

30
Q

What is the direct cost of dementia? Indirect cost?

A

20 billion/yr direct

50 billion/yr indirect (lost wages of family member caregivers etc)

31
Q

What is the breakdown of different types of dementia?

A

60% alsheimers
30-40% vascular (dual pathology often exists)
15% other

32
Q

What are some causes of the other 15% of dementia cases?

A 
Huntingtons/parkinsons
lewy body dementia
alcoholism
endocrine disorders
depression
AIDS and AIDS related CNS conditions
Fronto-temporal dimentia
33
Q

What areas of the brain are affected with Alzheimers?

A

Neuronal degeneration of all areas of brain espesially forebrain and cortex

34
Q

Which areas of the brain are reported to be affected first with Alzheimer’s?

A

hippocampus and left parietal cortex

35
Q

What are the microscopic changes associated with Alzheimer’s?

A 
Neurofibrillary tangles (NT, tau proteins)
Amyloid plaques in extracellular spaces (AP)
36
Q

What are used to diagnose Alzheimers?

A

Neurofibrillary tangles and amyloid plaques

37
Q

What type of process has recently been implicated in Alzheimer’s?

A

Inflammatory process

38
Q

How do you make a definite diagnosis of Alzheimer’s?

A

Can only make a definite diagnosis postmortem

39
Q

What are some neurotransmitter changes in Alzheimer’s? What is treatment aimed at?

A

Decreased acetylcholine in basal forebrain. treatment aimed at raising Ach levels

40
Q

What is the clinical presentation of Alzheimer’s at the initial onset?

A

Characterized by short term memory deficits

41
Q

What are later signs if ALzheimers?

A

Apraxia is a later sign as wel

42
Q

What are some risk factors for ALzheimer’s?

A

Advanced age
Women
Previous TBI with unconsciousness

43
Q

Stage 1 on Functional Assessment Stage for Alzheimer’s

A

No impairments

44
Q

Stage 2 on Functional Assessment Stage for Alzheimer’s

A

Very mild cognitive decline (may be normal age related changes or earliest signs of AD)

45
Q

Stage 3 on Functional Assessment Stage for Alzheimer’s

A

Mild cognitive decline

46
Q

Stage 4 on Functional Assessment Stage for Alzheimer’s

A

Moderate cognitive decline
greater difficulty performing complex tasks
Becoming moody or withdrawn

47
Q

Stage 5 on Functional Assessment Stage for Alzheimer’s

A

Moderately severe cognitive decline

48
Q

Stage 6 on Functional Assessment Stage for Alzheimer’s

A

Severe cognitive decline lose awareness of recent experiences as well as surroundings

49
Q

What is the APP gene?

A

Amyloid precursor protein

located on chromosome 21 (probably why increased risk of AD in those with down syndrome (trisomy 21)

50
Q

IN what stage of alzheimers is apraxia a sign?

A

Later stage sign

51
Q

What is a medical treatment for dementia?

A

ACE inhibitors act by inhibiting the enzyme that breaks down ACh, thus raising level of ACh in brain

52
Q

What are the effects of AcH inhibitors in Dementia?

A

Modest benefit early in disease but effect peaks afteral several weeks or months

53
Q

What % of dementias do vascular cerebral infarcts acount for?

A

30-40% by recent studies

54
Q

What is important to manage with dementia?

A

Blood pressure and lipid management

55
Q

What is binswanger’s disease?

A

Affects subcortical white matter

disease of microcirculation (amyloid plaques in vessels)

56
Q

What is Binswanger’s disease associated with?

A

Hypertension and other vascular diseases (Stroke, TIA)

57
Q

What do you see on imaging with Binswanger’s disease

A

White matter lesions, shrunken gyri, enlarged ventricles

58
Q

What are the symptoms of lewy body dementia?

A

Pronounced fluctuations in awareness
visual hallucinations
Parkinsonian-like motor signs (rigidity, tremor, bradykinesia)

59
Q

What causes Lewy Body dementia?

A

Build up of Lewy bodies(alpha synuclein protein) in neuronal cell bodies

60
Q

What is the course of Lewy Body Dementia?

A

Progressive, with an average life expectancy after diagnosis 8 years with increasing disability

61
Q

What are lewy body dementia treatments aimed at?

A

Controlling the cognitive, psychiatric and motor symptoms of the disorder

62
Q

What medications are used for Lewy Body Dementia? Which ones should you avoid?

A

Use-ACh inhibitors, may have benefit from L-dopa for motor symptoms
Avoid- antipsychotics

63
Q

What disease has a high incedence of dimentia associated?

A

AIDS has a high incidence with exact cause unknown

64
Q

What other neurological complications is AIDS related dementia associated with?

A

CNS infection
CNS lymphoma
Toxic enxephalopathy

Neuro 4 (sam (7 decks)

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