Dementia and Aging Flashcards
What are general similarities in centurions?
New England Centenarian (100+) Study:
- Compression of Disability: 88% independent at age 92
- 50% have first-degree relatives reaching very old age - 80% women
- Few centenarians are obese.
- Smoking rare.
- Better able to handle stress
- Women more likely to have children after age 40
- Low age related diseases
What are major contributors to premature death?
What were the major takeways from the 40 years study of Harvard students into elder age?
[Study of Adult Development at Harvard University: Vaillant]
•Assessed Every 2 years
Before Age 50:
- Absence of Smoking or Smoking Less than 30 Packs per Year
- Absence of Alcohol Abuse
- Humor and Ability to Anticipate
- Warm Marriage
- Absence of Depression
- Good Physical Health
Explain selective optimization with compensation.
•SELECTION: Restriction to fewer
life domains of functioning
•OPTIMIZATION: augmentation
of reserves, maximize functioning
•COMPENSATION: Use psychological
and technological aids
What extrinsic influences are important in aging?
- Social engagement and support
- Physical activity
- Mental activity
- Creativity
- Spirituality
- Adapting to loss and managing stress
- Humor
What are the criteria for major neurocognitive disorder (dementia)?
- 1 or more significant cognitive impairment
- Interfering with daily functioning
What are the criteria for minor neurocognitive disorder (mild cognitive impairment)?
- 1 or more modest cognitive impairment
- Does not interfere with daily functioning
Name 5 major neurocognitive disorder types.
1) Alzheimer’s disease
2) Vascular disease
3) Frontotemporal lobar degeneration
4) Lewy body disease
5) Parkinson’s disease
Name the cognitive domains.
Attention
Executive function
Memory
Language
Perceptual motor ability
Social cognition
What range of MOCA scores are considered abnormal?
<26 is abnormal
What are the major symptoms of Major Neurogocnitive Disorder due to Alzheimer’s?
- Memory impairment is the earliest affected cognitive function
- Progresses to involve other brain functions which affect their daily functions and self care
- Neuropsychiatric symptoms are common- Depression, anxiety, psychosis and behavioral disturbances
What are the major uncontrollable risk factors for Major Neurocognitive Disorder due to Alzheimer’s?
Age: primary risk factor
- Risk doubles every five years after age 65
- Risk is nearly 50 % after age 85
Head trauma
Low education
Female gender
What are the major medical risk factors of Major Neurocognitive Disorder due to Alzheimer’s?
- Medical: Cardiovascular risk factors
- CVA, HDL, HTN, DM, atherosclerosis, obesity, A. fibrillation
Genetics:
- APOE genotyping E4 on chromosome 19
- late onset-worst prognosis and higher risk
- Amyloid Precursor Protein gene is located on chromosome 21 (Down Syndrome)
- Presenelin-1 on chromosome 14
- Presenelin-2 on chromosome 1
- Presenelin 1 & 2 are early onset
How are patients evaluated for Alzheimer’s?
History: Patient and collateral
- Functional status: iADLs -> basic ADLs
- In dementia iADLs are lost first, ADLs lost last
Cognitive assessment
- MoCA or neuropsych testing
Labs: - Mainly to exclude other potential or reversible causes
Imaging
Genetic testing: - CSF amyloid and tau levels
What are the symptoms of Major Neurocognitive disorder due to vascular disease?
- Stepwise decline
- Mixed, often with Alzheimer’s disease pathology
- Focal neurological deficits or imaging findings
- Executive function and attention affected early on, more functional impairment
- Memory mildly affected
