Dementia Flashcards
How much will the # of centenarians grow by?
500% in 2030
What is the max. number of years a human can live?
~120
What is the overall life expectancy?
- 8 overall
- 4 males
- 2 females
What is the average life expectancy for black males/females?
males 72.1
females 78.2
Hispanic female life expectancy?
live longer than white males
How has the survival curve changed since the 1900s?
Curve has moved to the right-life expectancy has increased over time but max life span has not
What is the cellular theory of aging?
Max. lifespan is predetermined and depends on number of mitotic divisions your fibroblasts undergo in a lifetime
What is the DNA mutation theory?
Aging occurs as a result of changes in DNA and RNA
What are some factors that can cause changes in DNA and RNA?
External factors
accumulation of errors that have occurred over time with transcription
Telomere destruction
What affect does inheritance have on aging?
Many inherited factors contribute to aging
They may affect one system primarily but usually affect multiple systems
What is the oxidative stress theory in regards to aging?
During aerobic metabolism, free radicals are produced as byproducts of using O2. These free radicals affect membranes and mitochondrial function which further accelerates aging
What diseases are associated with Oxidative stress?
Parkinsons (normal breakdown of dopamne leads to free radical formation)
Familial type of ALS
What is the 7th leading cause of death?
Alzheimer’s
5th leading cause in people >65
What is considered “ideal” aging?
1-2% of brain loss/decade for 40-80 year olds
total 6-10% brain loss by old age (>80)
What part of the brain looses volume at a faster rate than the rest?
Hippocampus ~5% a decade, so ~25% by 80 yo
What happens to the cortex and the ventricles?
Decrease in cortical thickness and ventricular enlargement
Where do you see the most profound loss of neurotransmitters and receptors?
See throughout the whole brain but especially in the basal ganglia and prefrontal cortex
Effects of aging on cell bodys?
Cell bodies shrink
What happens to the dendritic tree with aging?
Decreased branching, decreased spines ~(46% decrease in number of spines and density in people >50)
What happens to axon collaterals with aging?
Decreased number of axon collaterals
What are inclusions?
Neurofibrillary tangles
What abnormal structures are found in normally aging brains?
Senile plaques and inclusions albeit at a much reduced number than
What are glial cells active during?
Active in myelinization and transport of nutrients and maintaining homeostasis
Declines in what systems are related to postural control and aging?
Decline in sesory/motor systems
Decline in central processing
Decline in dual task abilities
Two aging hypothesis?
Aging machinery and Negative plasticity
Ways to combat negative plasticity
exercise Control BP healthy diet reduce caloric intake reduce stress stable marriage rest (8 hour sleep) Life-long learning
Why do some people age “better” than others?
better genes
better lifestyle
higher education level/SES–>less dementia
What is the “cognitive reserve” theory?
the more education and cognitive processing you have, the more you need to loose to feel the effects of dementia and mental decline
Number of baby boomers expected to be diagnosed with dimentia?
1 out of every 8 baby boomers will be expected to develop dimentia
What is the direct cost of dementia? Indirect cost?
20 billion/yr direct
50 billion/yr indirect (lost wages of family member caregivers etc)
What is the breakdown of different types of dementia?
60% alsheimers
30-40% vascular (dual pathology often exists)
15% other
What are some causes of the other 15% of dementia cases?
Huntingtons/parkinsons lewy body dementia alcoholism endocrine disorders depression AIDS and AIDS related CNS conditions Fronto-temporal dimentia
What areas of the brain are affected with Alzheimers?
Neuronal degeneration of all areas of brain espesially forebrain and cortex
Which areas of the brain are reported to be affected first with Alzheimer’s?
hippocampus and left parietal cortex
What are the microscopic changes associated with Alzheimer’s?
Neurofibrillary tangles (NT, tau proteins) Amyloid plaques in extracellular spaces (AP)
What are used to diagnose Alzheimers?
Neurofibrillary tangles and amyloid plaques
What type of process has recently been implicated in Alzheimer’s?
Inflammatory process
How do you make a definite diagnosis of Alzheimer’s?
Can only make a definite diagnosis postmortem
What are some neurotransmitter changes in Alzheimer’s? What is treatment aimed at?
Decreased acetylcholine in basal forebrain. treatment aimed at raising Ach levels
What is the clinical presentation of Alzheimer’s at the initial onset?
Characterized by short term memory deficits
What are later signs if ALzheimers?
Apraxia is a later sign as wel
What are some risk factors for ALzheimer’s?
Advanced age
Women
Previous TBI with unconsciousness
Stage 1 on Functional Assessment Stage for Alzheimer’s
No impairments
Stage 2 on Functional Assessment Stage for Alzheimer’s
Very mild cognitive decline (may be normal age related changes or earliest signs of AD)
Stage 3 on Functional Assessment Stage for Alzheimer’s
Mild cognitive decline
Stage 4 on Functional Assessment Stage for Alzheimer’s
Moderate cognitive decline
greater difficulty performing complex tasks
Becoming moody or withdrawn
Stage 5 on Functional Assessment Stage for Alzheimer’s
Moderately severe cognitive decline
Stage 6 on Functional Assessment Stage for Alzheimer’s
Severe cognitive decline lose awareness of recent experiences as well as surroundings
What is the APP gene?
Amyloid precursor protein
located on chromosome 21 (probably why increased risk of AD in those with down syndrome (trisomy 21)
IN what stage of alzheimers is apraxia a sign?
Later stage sign
What is a medical treatment for dementia?
ACE inhibitors act by inhibiting the enzyme that breaks down ACh, thus raising level of ACh in brain
What are the effects of AcH inhibitors in Dementia?
Modest benefit early in disease but effect peaks afteral several weeks or months
What % of dementias do vascular cerebral infarcts acount for?
30-40% by recent studies
What is important to manage with dementia?
Blood pressure and lipid management
What is binswanger’s disease?
Affects subcortical white matter
disease of microcirculation (amyloid plaques in vessels)
What is Binswanger’s disease associated with?
Hypertension and other vascular diseases (Stroke, TIA)
What do you see on imaging with Binswanger’s disease
White matter lesions, shrunken gyri, enlarged ventricles
What are the symptoms of lewy body dementia?
Pronounced fluctuations in awareness
visual hallucinations
Parkinsonian-like motor signs (rigidity, tremor, bradykinesia)
What causes Lewy Body dementia?
Build up of Lewy bodies(alpha synuclein protein) in neuronal cell bodies
What is the course of Lewy Body Dementia?
Progressive, with an average life expectancy after diagnosis 8 years with increasing disability
What are lewy body dementia treatments aimed at?
Controlling the cognitive, psychiatric and motor symptoms of the disorder
What medications are used for Lewy Body Dementia? Which ones should you avoid?
Use-ACh inhibitors, may have benefit from L-dopa for motor symptoms
Avoid- antipsychotics
What disease has a high incedence of dimentia associated?
AIDS has a high incidence with exact cause unknown
What other neurological complications is AIDS related dementia associated with?
CNS infection
CNS lymphoma
Toxic enxephalopathy
