Dementia

Question 1

What ar1e the normal changes with aging?`

Answer 1

1. timing
2. attention on tasks
3. more fluctuation in task performance

Question 2

What is the most common cause of dementia?

Answer 2

Alzheimer’s disease

Question 3

What is dementia?

Answer 3

loss of brain function that affects:
thinking
memory
language
judgement
behavior

Question 4

What are some preventable causes of dementia?

Answer 4

Stroke

Trauma

Question 5

How many people in the US are affected by Alzheimer’s?

In the world?

Answer 5

5 million

35 million

Question 6

How many adults age 65-84 have Alzheimer’s?

How many people over 85?

Answer 6

1/9

1/3

Question 7

Excess of what substance is thought to cause Alzheimer’s disease?

Answer 7

amyloid (specifically B42) deposition in the brain and reduced clearance of the substance

Question 8

What is the MAJOR risk factor for Alzheimer’s?

What are other risks?

Answer 8

MAjor: Age
Other risks:
1. Family history
2.Females
3. Education level
4. physical activity
5. diabetes
6. vascular disease

Question 9

What percent of all Alzheimer’s cases is caused by genetic autosomal dominant form?

Answer 9

less than one percent

Question 10

What are the three genes that can be mutated in the genetic form of alzheimers?
How do these lead to the disease?

Answer 10

Amyloid Precursor Protein (APP)
Presenilin 1 or 2

All three cause an overproduction of amyloid so excess is deposited in the brain

Question 11

What is the cause of excess amyloid deposition in the non-genetic (late onset/sporadic) form of AD?
What causes the production of amyloid?

Answer 11

Decreased clearance leads to excess amyloid.

Amyloid is produced as a compensatory reaction to vascular insult or oxidative stress

Question 12

In addition to the autosomal dominant Alzheimers, there is one allele that is more often associated with late onset AD. What is this allele?

Answer 12

APOE4

Question 13

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?

Answer 13

APOE2-4

2 is good, 3 is most common, 4 is bad

Question 14

What two things will you see in brain tissue for mild cognitive impairment?

Answer 14

1. amyloid plaques

2. neurofibrillary tangles

Question 15

What is the first stage of progression into AD? What would happen to this person? Do people really notice?

Answer 15

Mild Cognitive Impairment is the first step. It starts by the person forgetting familiar words and having short memory lapses. Not at this stage

Question 16

What can frequently precede Mild Cognitive Impairment and should cause the person to be screened?

Answer 16

New onset mood changes (anger, irritability, depression)

Question 17

What is sundowning?

Answer 17

becoming psychotic, confused and agitated at night

Question 18

What is the most common complaint as people age?

Answer 18

memory complaints

Question 19

Should attention decrease with aging?

Answer 19

No

Question 20

Should encoding and retreiving from recent memory decline with normal aging?
When is it specifically difficult to do?

Answer 20

yes- especially if the information cant be placed in context or is nonsensical

Question 21

Are the following associated with normal aging or a sign of dementia?

1. loss of vocabulary
2. inability to recall historical events
3. loss of general fund of knowledge
4. inability to ascertain the gist of stories

Answer 21

All are associated with dementia.

Vocab, general info, gist, historical info should all be retained as people age

Question 22

What increases with age?

Answer 22

Wisdom- the ability to apply knowledge to appropriate situations

Question 23

How do young and old people perform differently on problem-solving tasks?

Answer 23

Older people use less efficient strategies, are less successful at finding solutions, make more errors, use simpler strategies

Question 24

If you do an MRI of a patient with Alzheimer’s what structure would be atrophied?>

Answer 24

hippocampus

Question 25

What are the three overarching stages of Alzheimers development?

Answer 25

1. preclinical
2. mild cognitive impairment
3. Dementia

Question 26

What events occur in the preclinical stage of progression to dementia?

Answer 26

1. amyloid builds up

2. tau neuronal insult

Question 27

What happens to the brain during mild cognitive impairment?

Answer 27

Brain structure problems are noted and there are noticable memory problems

Question 28

Is dementia a clinical diagnosis? why or why not?

Answer 28

No because it is a presentation, but you need to look to find the cause

Question 29

Which is more likely to cause dementia, a cortical stroke or subcortical stroke?

Answer 29

cortical

Question 30

What treatment is used for AD?

Answer 30

1. Ach-esterase inhibitor leaves Ach in the synapse for longer
2. NMDA channel blocker to decrease excitotoxicity

Question 31

Aside from AD, what other diseases must be considered when your patient presents with dementia?

Answer 31

1. Vascular dementia
2. frontotemporal lobar degenerative disease
3. lewy body dementia

Question 32

What is frontotemporal lobar degenerative disease?

Answer 32

behavior variant, affects men>women
tau inclusions
Non-fluent aphasia (Brocas)
Associated with younger presentation then AD

Question 33

What is deposited in the brain in Lewy Body Dementia?

Answer 33

alpha-synclein

Question 34

If patients have Lewy Body inclusions, what other symptoms many they have?

Answer 34

parkinsonism, dementia, psychosis

Question 35

How can dementia be prevented?

Answer 35

control weight, cholesterol, diabetes, hypertension/

Avoid- traumatic brain injury and concussions

Question 36

What do the Braak stages describe?

Answer 36

the progression of neurofibrillary tangles in the brain.

Phase 1 is the hippocampus.