Dementia Flashcards
What ar1e the normal changes with aging?`
- timing
- attention on tasks
- more fluctuation in task performance
What is the most common cause of dementia?
Alzheimer’s disease
What is dementia?
loss of brain function that affects: thinking memory language judgement behavior
What are some preventable causes of dementia?
Stroke
Trauma
How many people in the US are affected by Alzheimer’s?
In the world?
5 million
35 million
How many adults age 65-84 have Alzheimer’s?
How many people over 85?
1/9
1/3
Excess of what substance is thought to cause Alzheimer’s disease?
amyloid (specifically B42) deposition in the brain and reduced clearance of the substance
What is the MAJOR risk factor for Alzheimer’s?
What are other risks?
MAjor: Age Other risks: 1. Family history 2.Females 3. Education level 4. physical activity 5. diabetes 6. vascular disease
What percent of all Alzheimer’s cases is caused by genetic autosomal dominant form?
less than one percent
What are the three genes that can be mutated in the genetic form of alzheimers?
How do these lead to the disease?
Amyloid Precursor Protein (APP)
Presenilin 1 or 2
All three cause an overproduction of amyloid so excess is deposited in the brain
What is the cause of excess amyloid deposition in the non-genetic (late onset/sporadic) form of AD?
What causes the production of amyloid?
Decreased clearance leads to excess amyloid.
Amyloid is produced as a compensatory reaction to vascular insult or oxidative stress
In addition to the autosomal dominant Alzheimers, there is one allele that is more often associated with late onset AD. What is this allele?
APOE4
What are the three forms of APOE alleles? Which is correlated with reduced AD risk?
Which one increases AD risk?
Which do most humans have?
APOE2-4
2 is good, 3 is most common, 4 is bad
What two things will you see in brain tissue for mild cognitive impairment?
- amyloid plaques
2. neurofibrillary tangles
What is the first stage of progression into AD? What would happen to this person? Do people really notice?
Mild Cognitive Impairment is the first step. It starts by the person forgetting familiar words and having short memory lapses. Not at this stage
What can frequently precede Mild Cognitive Impairment and should cause the person to be screened?
New onset mood changes (anger, irritability, depression)
What is sundowning?
becoming psychotic, confused and agitated at night
What is the most common complaint as people age?
memory complaints
Should attention decrease with aging?
No
Should encoding and retreiving from recent memory decline with normal aging?
When is it specifically difficult to do?
yes- especially if the information cant be placed in context or is nonsensical
Are the following associated with normal aging or a sign of dementia?
- loss of vocabulary
- inability to recall historical events
- loss of general fund of knowledge
- inability to ascertain the gist of stories
All are associated with dementia.
Vocab, general info, gist, historical info should all be retained as people age
What increases with age?
Wisdom- the ability to apply knowledge to appropriate situations
How do young and old people perform differently on problem-solving tasks?
Older people use less efficient strategies, are less successful at finding solutions, make more errors, use simpler strategies
If you do an MRI of a patient with Alzheimer’s what structure would be atrophied?>
hippocampus
What are the three overarching stages of Alzheimers development?
- preclinical
- mild cognitive impairment
- Dementia
What events occur in the preclinical stage of progression to dementia?
- amyloid builds up
2. tau neuronal insult
What happens to the brain during mild cognitive impairment?
Brain structure problems are noted and there are noticable memory problems
Is dementia a clinical diagnosis? why or why not?
No because it is a presentation, but you need to look to find the cause
Which is more likely to cause dementia, a cortical stroke or subcortical stroke?
cortical
What treatment is used for AD?
- Ach-esterase inhibitor leaves Ach in the synapse for longer
- NMDA channel blocker to decrease excitotoxicity
Aside from AD, what other diseases must be considered when your patient presents with dementia?
- Vascular dementia
- frontotemporal lobar degenerative disease
- lewy body dementia
What is frontotemporal lobar degenerative disease?
behavior variant, affects men>women
tau inclusions
Non-fluent aphasia (Brocas)
Associated with younger presentation then AD
What is deposited in the brain in Lewy Body Dementia?
alpha-synclein
If patients have Lewy Body inclusions, what other symptoms many they have?
parkinsonism, dementia, psychosis
How can dementia be prevented?
control weight, cholesterol, diabetes, hypertension/
Avoid- traumatic brain injury and concussions
What do the Braak stages describe?
the progression of neurofibrillary tangles in the brain.
Phase 1 is the hippocampus.
