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neuro 210 finallll > Dementia and Alzheimer's Disease > Flashcards

Dementia and Alzheimer's Disease Flashcards

1
Q

What is Dementia?

A

dementia is global deterioration of intellectual function in the face of unimpaired consciousness

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2
Q

What are 7 steps in evaluating someone with dementia?

A
  1. general medical history
  2. general neurological history
  3. neurobehavioral history (i.e. personality issues)
  4. psychiatric history
  5. toxic, nutritional and drug history
  6. family history
  7. objective examination … (physical, neurological and neuropsychological)
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3
Q

What are bedside tests? what do they include?

A

type of comprehensive assessment of mental state… includes mini-mental status examination (MMSE) and Montreal Objective Cognitive Assessment (MOCA) .. these rate patients on a scale

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4
Q

what are 6 domains of cognition that are tested in the bedside tests?

A
  1. level of consciousness: i.e. alert, drowsy …etc..
  2. orientation: time, place, person
  3. memory, remote, recent, immediate (3 object recall… such as repeating, recalling 3 objects)
  4. attention and concentration (serial 7’s –> subtraction by 7, and digit span)
  5. Knowledge and insight
  6. language: fluency, comprehension, repetition, objecting naming, tests for apraxia, and reading & writing
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5
Q

What is one condition that involves the parietal cortex that patients with dementia frequently exhibit?

A

visual-spatial difficulties involving the parietal cortex…

construction of apraxia –> they can draw (have motor capability) but they cannot construct something… lesions in parietal lobe reflect this

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6
Q

What are some abnormal reflexes shown in people with dementia in neurological exams?

A

they are reflexes related to frontal lobe dysfunction

  1. pout reflex –> tap lips with tendon hammer -> a pout response is observed
  2. glabellar reflex –> patient cannot inhibit blinking in response to stimulation of tapping between eyes
  3. grasp reflex –> stroking palm of hand induces ‘grasp’
  4. palmo-mental reflex –> quick scratch on palm of hand induces sudden contraction of mentalist muscle in the face
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7
Q

what two ways can we think of causes and types of dementias?

A
  1. the part of the brain that is mostly affect.. ie. frontal (anterior) vs. parietal (posterior) lobes/cortex [anatomically]
  2. the rapidity of progression of the dementia

location and rate of progression

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8
Q

what changes are noticed when theres dysfunction in the anterior area of the brain?

A

includes the frontal and pre-motor cortex

behavioural changes/loss of inhibition, antisocial behaviour, facile and irresponsible

includes: frontotemporal dementia (pick’s disease)
and huntington’s disease

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9
Q

what changes are noticed when theres dysfunction in the posterior area of the brain?

A

includes the parietal and temporal lobes

disturbance of cognitive function (memory and language) without marked changes in behaviour

includes: alzheimer’s disease

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10
Q

What is an example of a chronic disorder based on its temporal progression and intellectual function?

A

Alzheimer’s disease –> its slow, and the symptoms don’t come right away… usually takes years

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11
Q

What is an example of a Subacute based on its temporal progression and intellectual function?

A

includes normal pressure hydrocephalus –> CSF cavities in the brain not clear CSF properly and the ICP of the brain starts to rise.. this is slow but not slow enough to be chronic .. it takes about months to notice

also Creutzfeldt-Jakob syndrome is also a subacute disorder however, its quicker in development than hydrocephalus …

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12
Q

What is an example of a acute disorder based on its temporal progression and intellectual function?

A

These are quick showing disorders that show up within weeks and have a lot of damage to the brain… these include encephalitis (brain infections) and rapid decline in intellectual function

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13
Q

what are 7 causes of dementia?

A
  1. degenerative
  2. cerebrovascular
  3. Structural
  4. infections
  5. toxic/metabolic
  6. immune disorders and cancer
  7. depession
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14
Q

What are some ways that neurodegernativity can cause dementia?

A
  • caused by 80% of dementias
  • includes alzheimer’s disease
  • lewy body dementia
  • taupathies like pick’s disease and progressive supra nuclear palsy
  • huntington’s disease
  • parkinson’s disease
  • wilson’s disease
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15
Q

what are some ways that dementia can be cerebrovascular in cause

A
  • vascular dementia (multi-infarct dementia) and CNS vasculitis
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16
Q

What are some ways that dementia can be structural disorder and in cause?

A
  • normal pressure hydrocephalus
  • brain tumour
  • head injury
  • subdural hematoma (collections of blood in the brain)
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17
Q

What are some ways dementia can be caused by infections?

A
  • creutzfeld-jacob disease …
  • neurosesyphilis, others
  • HIV
  • sequelae of viral encephalitis (Herpes)

these are more rapidly progressing dementias

18
Q

what are some ways dementia can be caused by toxic/metabolic problems?

A
  • drug induced
  • alcoholism
  • toxins, heavy metals and carbon monoxide
  • vitamin defiendes, like b12, thiamine and folate
  • hypothyroidism
  • uremia and dialysis-related
  • hepatic encephalopathy

these are the most treatable and has some sort of cure to it

19
Q

what are some ways dementia can be caused by immune disorders and cancer?

A

lupus

paraneioplastic disease

20
Q

What are 4 common themes that run in neurodegenerative dementias?

A
  1. usually an age dependent progression and worsening of dementia reflecting loss of neurons and their connections in the CNS
  2. some parts of the brain and neurons within these regions are more vulnerable to the insult (whatever it is) –> i.e. for alzheimer’s it affects the basal forebrain area, parkinson’s affects the substantia nigra and huntingon’s affects the caudate nucleus area
  3. proteins that are misfiled and abnormally deposited in the specific brain areas, seem to play a key role in these diseases
  4. for the most part, precise causes unknown and hence no definitive treatment available to stop progression of disease
21
Q

What is alzheimer’s disease?

A

alzheimer’s disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills… affects mainly hippocampal and basal ganglia area

in most people with AD, symptoms first appear after age 60 AD is not a normal part of aging

it is caused by a fatal disease that affects the brain

22
Q

How many number of neurons does the brain have?

A

100 billion

23
Q

how many number of synapses does the brain have?

A

100 trillion

24
Q

What three essential jobs of the neurons does AD disrupt?

A
  1. communication between neurons
  2. metabolic functions of neurons
  3. repair functions of neurons
25
Q

What are some alzheimer’s facts?

A
  1. 70-80% cause of dementia (most common cause)

2. a lot in canada

26
Q

What are some clinical features of signs and symptoms of alzheimer’s disease?

A

symptoms:
- impairment of memory and attention
- language and communication

  • abstract thinking
  • judgement
  • personality changes
  • depression
  • visuospatial disorientation (difficulty orienting in space)

signs:

  • motor and gait disturbance (balance)
  • poverty of movement and slowness
  • falls
  • problems with bladder and bowel control
  • seizures
27
Q

What are the three time course events in alzhiemers?

A
  1. early diagnosis –> shows increasing number of cognitive symptoms
  2. mild-moderate –> loss of functional independence, behavioural problems
  3. severe –> nursing home placements and death
28
Q

What is the aetiology and occurrence of alzheimers?

A

occurrence: most cases occur usually late 60’s or later

etiology:
1. familial forms: less than 10% of cases
2. sporadic (unknown case) –> over 90% of cases
3. early onset like 40s and 50s is usually familial and associated with susceptibility genes that include mutations of amyloid precursor protein (APP), presenilin 1 and 2 mutations
3. late onset (60s and later) –> mostly sporadic (unknown cause)

  • E4 gene is the main susceptibility gene, some other genes include SORL1, Clustering CLU, complement receptor 1 CR1 and TREM2
29
Q

What are the 5 neuropathology’s associated with alzheimer’s disease?

A
  1. cortical atrophy (brain shrinkage)
  2. synaptic and neuronal loss
  3. neurofibrillary tangles (NFTs) with paired helical filaments, abnormally hyperphosphorylated forms of microtubule associated TAU protein
  4. neuritic plaques with amyloid core
  5. amyloid angiopathy
30
Q

What are some signs of cortical atrophy in the brain?

A

its not specific to AD

but it shows widening of sulk and thinning of cortex

31
Q

What are plaques and tangles?

A

the brains of people with AD have an abidance of two abnormal structures

  1. beta-amyloid plaques: these are dense deposits of proteins and cellular material that accumulate outside and around nerve cells
  2. neurofibrillary tangles –> which are twisted fibres that build up inside the nerve cell
32
Q

What is Amyloid precursor protein (APP) and how does it form beta-amyloid plaques?

A

APP is a membrane protein that sits in the membrane end and extends outwards

it is thought to be important for neuronal growth, survival and repair

enzymes cut the APP into fragments, the most important of which for AD is called the beta-amyloid enzyme

Beta-amyloid is “sticky” so the fragments that are cut cling together along with other materials in the cell forming the plaques seen the AD brain

33
Q

how can alzheimer’s disease be described in terms of neurotransmitter abnormalities?

A
  • low chemical messengers in the brain especially acetylcholine from the cortex and hippocampus areas
34
Q

what is the cholinergic basal forebrain and its connections?

A

aCH lives in the basal forebrain and spreads through the cortex

  • when the basal forebrain areas die, it produces less ACH
35
Q

what are some symptomatic cholinergic agents/drugs for alzheimer’s disease?

A
  • choleninergic drugs act to block reuptake sites for aCH and increase release of it, and keep it longer in the synapse

also has selective m1 agonists

drugs include: cholinesterase inhibitors: donepezil (accept), rivastigmine (exelon), galatamine (reminyl) … these stop the enzyme cholinesterase from eating the aCH

36
Q

what are some non cholinergic agents of alzheimer’s disease?

A

memantine, which is a glutamate receptor modulator

37
Q

What are some other approaches for treating AD?

A
  • amyloid vaccine
  • secretase inhibitors
  • anti amyloid agents
  • drugs that lower cholesterol
38
Q

what are some unproven treatments for AD?

A
  • estrogens
  • NSAID’s
  • vasodilators
  • propentofylline
39
Q

what are some non drug approaches to treating DA?

A
  • higher education
  • intellectual stimulation
  • excersize and diet

these are not backed up by science though

40
Q

What is dementia with lewy bodies?

A
  • involves fluctuating cognition with pronounced variation in attention and alertness (one day they have good cognition and the other day they don’t)
  • recurrent visual hallucinations
  • parkingsonian features like rigidity, stiffness in muscles, slowness, and poverty of movement and tremors
  • treatment with cholinesterase inhibitors, antipsychotic drugs to control behavioural problems and agitation and hallucinations

it is represented in the brain by loss of pigmented (dopamine containing) neurons in the substantia nigra in parking sons and dementia with lewy bodies which look similar

also its the presence of lewy bodies which contain alpha synuclein protein

41
Q

What is frontotemporal dementia (pick’s disease)?

A
  • female preponderance and at a younger age than AD
  • focal frontal and temporal lobe atrophy
  • disinhibition, apathy, perseveration, mental rigidity and affective symptoms
  • tau pathology is most frequently observed
  • gene on chromosome 17 is apparently mutated
  • ALS or lou gherig disease are either forms associated with neurodegenerative condition

the pick bodies that are present are called tau
theres no cure

42
Q

What is vascular dementia?

A
  • accounts for 1-015% of dementias
  • dementia occurs stroke by stroke with progressive focal loss of function
  • risk factors that cause stroke are present in patients such as hypertension, diabetes, high cholesterol, smoking
  • may occur concurrently with neurodegenerative dementia
  • CT scan may show multiple areas of cerebral infarction (obstruction of blood supply)
  • treatment of hypertension and other vascular risk factors

MRI scan shows multiple small strokes

neuro 210 finallll (12 decks)

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