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Unit 19 > Dementia > Flashcards

Dementia Flashcards

1
Q

name indicators of normal aging in the brain

_______ cortex shrinks

A

prefrontal cortex shrinks

neurons and NT change affecting communication

Blood flow reduced

increase in free radicals and inflammation

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2
Q

Name indicators in normal aging in behavior

A

decreased ability to learn new things, retrieve information, attention for complex tasks of attention, learning in memory

IF GIVEN ENOUGH TIME TO DO THE TASK THEY SCORE THE SAME! give less information, more time to process and practice it and they’ll be great

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3
Q

name some things that impact cognitive reserve

A

genetics

education

occupation

lifestyle

leisure activities

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4
Q

which kind of cognitive decline is “you notice changes but it is not detectable on tests”

A

preclinical

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5
Q

what stage of cognitive decline are ADL’s intact

A

MCI

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6
Q

MMSE is out of how many points?

How often do we use this?

A

out of 30

the other screening tools (mini cog, MOCA, clock in box) have taken over

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7
Q

what is defined as “cognitive decline greater than expected for their age and education level”

A

MCI

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8
Q

what predominates in MCI

A

memory loss

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9
Q

noticeable memory, thinking, and behavioral sx that impair a persons ability to function in daily life is what?

A

dementia

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10
Q

difference btwn dementia and MCI

A

MCI does not interfere with everyday activities

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11
Q

what is agnosia

A

inability to recognize or identify objects - possible to cause aggression

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12
Q

what is apraxia

A

inability to execute motor activities

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13
Q

missing a monthly payment sign of dementia?

A

no: inability to manage a budget would be

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14
Q

early vascular dementia what is cc?

A

planning and judgement issues

memory is fine

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15
Q

what is the predominant early sx of alzehimers?

vascular dementia

A

memory loss

impaired judgment, inability to make decisions, plan or organize

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16
Q

looking at a graph of decline in AD vs. vascular dementia what would you see?

A

AD: steady decline

Vascular dementia: step down

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17
Q

three screens for dementia

A

mini cog

clock in box

MOCA

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18
Q

explain the minicog test

scoring?

A

remember 3 unrelated words

draw a clock at 10 past 11

repeat the 3 previous words

add the 3 item recall and clock drawing scores together. Total score of 3,4,5 indicates lower likelihood of dementia

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19
Q

What does MOCA help assess?

Max score?

Normal score?

A

lots of different cognitive domains (attention, concentration, executive function, memory etc ; this is the one that has all the different sections with animals and words etc)

30 points maximum
>26 is normal

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20
Q

what population is MOCA sensitive for?

A

MCI and AD

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21
Q

four stages of memory

A

encoding, storing, consolidation, retrieval

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22
Q

memory is a _____

A

capacity!

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23
Q

Explain LTP and LTD long term potentiation and depression

why is it relevant for this unit?

A

if a synapse is used often it requires less NT to produce the same response whether that response is excitation or depression.

super important for memory!!

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24
Q

neurons that fire together wire together” is what concept we talked about

A

LTP - long term potentiation

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25
Q

where is STM stored?

A

frontal lobe

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26
Q

same stimulus leads to a decrease in post synaptic response in CNS is an example of what

A

habituation, a non associative implicit memory system which the reflex pathways are implicated in

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27
Q

driving w/o thinking about it is….

declarative or non-declarative

what category

what part of the brain is implicated?

A

nondeclarative

procedural

striatum

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28
Q

declarative
nondeclarative

implicit
explicit

A

explicit: declarative
implicit: nondeclarative

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29
Q

what part of the brain is implicated in explicit long term memories?

A

medial temporal lobe

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30
Q

formation and recall of declarative memory is formed in what part of the brain?

A

hippocampus

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31
Q

learning memory and emotion is what part of the brain

A

hippocampus

32
Q

what are the structures associated with the hippocampus (3 more)

A

Dentate gyrus
Subiculum
Entorhinal cortex

33
Q

what structure is needed for consolidation, retrieval and storage of memory?

A

hippocampus

34
Q

Explain the memory chart starting with the unimodal and polymodal association areas

A

unimodal and polymodal association areas –>

parahippocampal & perirhinal cortex –>

Entorhinal cortex –>

Hippocampus –> SUBICULUM –> all the way back through to the association areas where memory is stored!

35
Q

what part of the brain is the main interface btwn the neocortex and the hippocampus?

A

entorhinal cortex

36
Q

what two major piece of memory happens in the hippocampus?

A

consolidation and retrieval!

37
Q

for memories to be stored after they are consolicated in the hippocampus, what structure do they need to travel through?

A

subiculum! and then back through the circuit.

38
Q

to retrieve a memory what structure do we use?

A

hippocampus

39
Q

where are long term memories stored?

A

median temporal lobe

40
Q

What part of the brain are each of these stored?

STM

LTM

Object recognition, spatial representation

Emotion

Episodic memory

Semantic memory

A

STM: frontal lobe

LTM: median temporal lobe

Object recognition, spatial representation: hippocampus

Emotion: amygdala

Episodic memory: prefrontal cortex

Semantic memory: t/o cortex

41
Q

HM had his hippocampus cut out, what was he unable to do?

relied on what

A

form new memories bc he couldn’t consolidate, retrieve or store

relied on procedural tasks (striatum)

42
Q

what gross anatomy of the brain changes with AD?

A

cortex thinning

larger ventricals

larger sulci

smaller gyri

smaller hippocampus

43
Q

research done in racial disparity in AD showed what?

A

it has to do with health conditions/socioeconomic conditions rather than genetic predisposition

44
Q

APOE, amyloid precursor protein (APP), Presenilin 1 and 2 (PS1 and PS2) are all associated with what

A

genetic predisposition of AD

45
Q

what kind of neuron dealth is associated with AD?

A

cholinergic neurons projecting to neocortex and hippocampus

46
Q

Degeneration in what areas of the brain other than the hippocampus are seen in AD?

A

neocortex: where some memories are stored

entorhinal area: from neocortex to hippocampus

47
Q

what area would be implicated in someone creating new memories or retrieving old memories

A

entorhinal area: btwn the neocortex/polymodal association areas and hippocampus

48
Q

A-beta amyloid
Tau

extracellularly
intracellularly

A

Abeta: extracellularly - between neurons

Tau: intracellularly - within neruons

big picture neurons die and brain areas shrink!

49
Q

neurofibullary tangles are assoicated with what compound?

A

Tau

50
Q

plaques are associated with what substance?

A

a-beta amyloid

51
Q

lack of ACH is thought to be associated with what

in terms of attention
memory
REM

A

lack of attention

lack of retrieval and creation of memories

NON-REM sleep (never dream/beta waves)

normally ACH causes REM sleep

52
Q

abeta extracellulary and neurofibrillary tangles intracelluarly both lead to what

A

neuronal dysfunction/death and the inability to communicate btwn neurons

53
Q

overall brain atrophy for dementia begins where?

A

hippocampus

54
Q

There is an association bwn the lack of neurons in the hippocampus and what?

A

scores on the MMSE

mild: 27
Moderate: 15

perfect score is 30

55
Q

name a couple other things other than abeta amyloid and tau that can lead to AD

A

proteolysis failure

altered cell signaling

calcium dysregulation

inlammation

oxidative stress

56
Q

true or false: changes can be present in the brain before sx show up in AD

A

true!

57
Q

true of false: there are genetic and neogenetic etiologies of AD?

A

true! plus aging

58
Q

when looking at a picture of a brain, what discriminates MCI from AD?

A

AD has atrophy of the hippocampus AND the whole cortex!

59
Q

Lower hippocampal volume = lower or higher MOCA?

A

lower MOCA sore: the ability to retrieve and recall information is impacted

60
Q

there are functional cortical networks we talked about

DMN: default mode network

SAL: salience network

Dorsal attention network
L&R frontopareital netwok

talk about the first two

and the main point!!

A

DMN: internally directed attention - reflexion or remembering

SAL: externally directed or goal oriented - requirement for behavioral change this is on

NOT ALL PARTS OF THE BRAIN ARE NEGAGED WITH EVERY PRART OF THE ACTIVITY. if you’re thinking and wondering about something that is a very different part of your brain than when you’re actually dealing with the external environment.

61
Q

progression of AD: there are 5

A

attention

episodic

semantic

planning, working memory

language, motor

62
Q 
stages of AD
0
1
2
3
SNAP
A

0: no abnormalities
1: asymptomatic amyloids
2: amyloids + neuronal dysfunction
3: amyloids +neuronal dysfunction + suble cognitive decline

SNAP: suspected non alzeimers pathology: no evidence of amyloids but still have sx of the disease

63
Q

what stage is MCI turning into dementia?

A

III

64
Q

Four phamacology options for AD

A

acetylcholinesterase inhibitors

NMDA antagonist: trying to optimize transport accross synthesis

Combination

Natraceuticals

65
Q

whats the deal with pharma for AD

A

none have a dramatic input on even slowing the disease

none cure

huge side effects

66
Q

true or false: there is a normal slight decline in cognition with age?

A

true!

67
Q

behavioral and psychological sx, frequently affecting people with brain disease are coined as what?

A

neuropsychiatric sx (NPS)

68
Q

agitation vs. aggression

A

agitation is less severe

69
Q

AD + NPS (neuropsychiatric sx) = what for prognosis

A

more rapid progression

70
Q

big picture approach for treating dementia

A

PERSON CENTERED APPROACH

Max activity: tap into things they liked to do before

Max communication: give them time to respond, simple steps, touch to reassure

Enhance environment: remove clutter, eliminate noise

71
Q

you want to improve ADL and performance based measures: are you going compensatory or restoration?

You want to improve executive functions: are you going compensatory or restoration? How?

A

Compensatory

Restoration with errorless learning!

72
Q

delirium vs. dementia

A

RAPID ONSET, fluctuating course

73
Q

what is a good assessment method for delerium?

A

CAM - confusion assessment method

great +LR

74
Q

what are the two must have elements of CAM

what are the two either or elements of CAM

A

rapid onset, inattention

disorganized thinking OR
altered level of conciseness

75
Q

predisposing vs. precipitating factors for delirium in older adults

A

precipitating: things that trigger it

if someone is highly predisposed they would need a lower precipitating factor/trigger to make it happen

76
Q

polypharmacy, coma, physical restraints, major surgery are all predisposing or precipitating factors for delerium?

A

precipitating!

77
Q

CHANGES IN PATHOLOGY PRECEDE APPARENT COGNITIVE DECLINE OR FUNCTIONAL LOSS IN DEMENTIA

A

ENTER THEIR REALITY

SHORT AUTOMATIC CUES

Unit 19 (4 decks)

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