Dementia Flashcards by Talia Holze

name indicators of normal aging in the brain

_______ cortex shrinks

prefrontal cortex shrinks

neurons and NT change affecting communication

Blood flow reduced

increase in free radicals and inflammation

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Name indicators in normal aging in behavior

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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name some things that impact cognitive reserve

genetics

education

occupation

lifestyle

leisure activities

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

preclinical

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what stage of cognitive decline are ADL’s intact

MCI

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MMSE is out of how many points?

How often do we use this?

out of 30

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

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

MCI

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what predominates in MCI

memory loss

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

dementia

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difference btwn dementia and MCI

MCI does not interfere with everyday activities

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what is agnosia

inability to recognize or identify objects - possible to cause aggression

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what is apraxia

inability to execute motor activities

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missing a monthly payment sign of dementia?

no: inability to manage a budget would be

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early vascular dementia what is cc?

planning and judgement issues

memory is fine

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what is the predominant early sx of alzehimers?

vascular dementia

memory loss

impaired judgment, inability to make decisions, plan or organize

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

AD: steady decline

Vascular dementia: step down

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three screens for dementia

mini cog

clock in box

MOCA

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explain the minicog test

scoring?

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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What does MOCA help assess?

Max score?

Normal score?

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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what population is MOCA sensitive for?

MCI and AD

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four stages of memory

encoding, storing, consolidation, retrieval

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memory is a _____

capacity!

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Explain LTP and LTD long term potentiation and depression

why is it relevant for this unit?

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

LTP - long term potentiation

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where is STM stored?

frontal lobe

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

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

driving w/o thinking about it is.... declarative or non-declarative what category what part of the brain is implicated?

nondeclarative procedural striatum

declarative nondeclarative implicit explicit

explicit: declarative implicit: nondeclarative

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

medial temporal lobe

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

hippocampus

learning memory and emotion is what part of the brain

hippocampus

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

Dentate gyrus Subiculum Entorhinal cortex

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

hippocampus

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

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!

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

entorhinal cortex

what two major piece of memory happens in the hippocampus?

consolidation and retrieval!

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

subiculum! and then back through the circuit.

to retrieve a memory what structure do we use?

hippocampus

where are long term memories stored?

median temporal lobe

What part of the brain are each of these stored? STM LTM Object recognition, spatial representation Emotion Episodic memory Semantic memory

STM: frontal lobe LTM: median temporal lobe Object recognition, spatial representation: hippocampus Emotion: amygdala Episodic memory: prefrontal cortex Semantic memory: t/o cortex

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

form new memories bc he couldn't consolidate, retrieve or store relied on procedural tasks (striatum)

what gross anatomy of the brain changes with AD?

cortex thinning larger ventricals larger sulci smaller gyri smaller hippocampus

research done in racial disparity in AD showed what?

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

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

genetic predisposition of AD

what kind of neuron dealth is associated with AD?

cholinergic neurons projecting to neocortex and hippocampus

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

neocortex: where some memories are stored entorhinal area: from neocortex to hippocampus

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

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

A-beta amyloid Tau extracellularly intracellularly

Abeta: extracellularly - between neurons Tau: intracellularly - within neruons big picture neurons die and brain areas shrink!

neurofibullary tangles are assoicated with what compound?

Tau

plaques are associated with what substance?

a-beta amyloid

lack of ACH is thought to be associated with what in terms of attention memory REM

lack of attention lack of retrieval and creation of memories NON-REM sleep (never dream/beta waves) normally ACH causes REM sleep

abeta extracellulary and neurofibrillary tangles intracelluarly both lead to what

neuronal dysfunction/death and the inability to communicate btwn neurons

overall brain atrophy for dementia begins where?

hippocampus

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

scores on the MMSE mild: 27 Moderate: 15 perfect score is 30

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

proteolysis failure altered cell signaling calcium dysregulation inlammation oxidative stress

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

true!

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

true! plus aging

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

AD has atrophy of the hippocampus AND the whole cortex!

Lower hippocampal volume = lower or higher MOCA?

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

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!!

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.

progression of AD: there are 5

attention episodic semantic planning, working memory language, motor

``` stages of AD 0 1 2 3 SNAP ```

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

what stage is MCI turning into dementia?

III

Four phamacology options for AD

acetylcholinesterase inhibitors NMDA antagonist: trying to optimize transport accross synthesis Combination Natraceuticals

whats the deal with pharma for AD

none have a dramatic input on even slowing the disease none cure huge side effects

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

true!

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

neuropsychiatric sx (NPS)

agitation vs. aggression

agitation is less severe

AD + NPS (neuropsychiatric sx) = what for prognosis

more rapid progression

big picture approach for treating dementia

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

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?

Compensatory Restoration with errorless learning!

delirium vs. dementia

RAPID ONSET, fluctuating course

what is a good assessment method for delerium?

CAM - confusion assessment method great +LR

what are the two must have elements of CAM what are the two either or elements of CAM

rapid onset, inattention disorganized thinking OR altered level of conciseness

predisposing vs. precipitating factors for delirium in older adults

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

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

precipitating!

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

ENTER THEIR REALITY SHORT AUTOMATIC CUES