Dementia, Delirium, Depression Flashcards
what is the normal aging process?
- Cerebral atrophy - neurons decrease; loss of neurons and connections between them
- Thickened leptomeninges : glia cells increase in both size and #
- DNA damage
- malfunctioning DNA damage response (DDR)
what are nml signs of the aging neurologic system?
These changes are implications of what?
- Decreased # of neurons and increase in size and # of neuroglial cells = Increased risk for neurological problems: cerebrovascular accident
- decline in nerves and nerve fibers
- parkinsonism
- slower conduction of fibers - atrophy of brain and increase in cranial dead space
- decline in short-term mem
- changes in gait - thickened leptomeninges in spinal cord = increased risk of hemorrhage before sx show
how do glia cells support neurons?
insulation
remove pathogens
supply nutrients
name the 4 glia cells
- Ependymal – controls production and flow of CSF, brain metabolism and waste clearance
- Astrocytes – metabolic, structural, homeostatic and neuroprotective tasks- stabilizing and regulating BBB
- Microglial - macrophages that remove damaged neurons and infections
- Oligodendrocyte - myelinating cells of theCNS
Cerebral atrophy can either be _____ (brain shrinks) OR _____ (affecting only a limited area of the brain)
generalized or focal
associated dz of cerebral atrophy
- Stroke and TBI
- Alzheimer’s, Pick’s dz, and fronto-temporal dementia
- Cerebral palsy: lesions may impair motor coordination
- Huntington’s: genetic mutations
- Leukodystrophies: such as Krabbe disease; destroys the myelin sheath that protects axons
- Mitochondrial encephalomyopathies: Kearns-Sayre syndrome; interferes w/ basic neuron functions
- MS: inflammation, myelin damage, and lesions in cerebral tissue
- Infectious dz: encephalitis, neurosyphilis, and AIDS; infectious agents or inflammatory rxn
sx of cerebral atrophy
- Dementia:
- Progressive impairment of memory and intellectual function that is severe enough to interfere with social and work skills
- Memory, orientation, abstraction, ability to learn, visual-spatial perception, and higher executive functions such as planning, organizing, and sequencing may also be impaired
- Seizures:
- Aphasias:
- disturbances in speaking and understanding language
- Receptive aphasia: impaired comprehension
- Expressive aphasia: odd choices of words, the use of partial phrases, disjointed clauses, and incomplete sentences
in thickened leptomeninges, what are the two layers involved?
arachnoid
pia
nml aging findings of cognitive function
- Difficulty recalling names or locations of placed objects, often to remember at a later time
- Subtle deficits in memory function - not severe enough to disturb/delay life
- No functional impairment
- Learning remains intact: 3-word recall
Cognitive function in older adults is considered a ?
spectrum
nml changes with aging –> Mild cognitive impairment (MCI): pathology develops –> dementia
key hx info for cognitive impairment
- Duration and nature of progression
- Memory (recent and remote) and learning
- Language - word-finding problems, difficulty expressing self
- Visuospatial skills - hx of getting lost in familiar places
- Executive functioning - ex: balancing checkbook, overdraw account
- Apraxia - not able to do previously learned motor tasks, eg, slicing a loaf of bread
- Behavior or personality changes - easily missed dx as depression
- Psychotic sx
- Functional assessment: ADL’s, IADL’s
- Social support assessment
- PMHx, comorbidities, hx of head trauma
- Thorough medication review - easily reversible
- FHx
- ROS - screen for depression and alcohol/substance abuse
PE to assess for cognitive impairment
- Neuro: look for focal findings, extrapyramidal signs, gait and balance assessment
- CV examination
- Signs of abuse or neglect
- Screen hearing and vision
- Can’t recall info secondary to decreased visual or auditory acuity
Has to be alert - Can not rely on results if pt has altered LOC / delirium
diagnostics for cognitive impairment
- labs - VitB12, TSH
- additional: LFT, LP - imaging - noncontrast CT/MRI of brain
- r/o stroke, small vessel dz, tumor, SDH, normal pressure hydrocephalus
ddx for cognitive impairment
- Alzheimers Dementia
- Vascular dementia
- Dementia with Lewy body
- Frontotemporal dementia
- Depression (in mild cognitive changes)
- Chronic traumatic encephalopathy
- Drug induced
- Alcohol or drug abuse
- Vit B12 def - peripheral nerve changes/cognitive dysfunction
- Normal pressure hydrocephalus
- Toxic metabolic - DKA, hepatic encephalopathy
- CNS neoplasms
- Tertiary syphilis
- HIV-Associated Dementia
an intermediate state between normal cognition and dementia often seen in older adults
mild cognitive impairment (MCI)
Pt has
Difficulty remembering names and appointments
Difficulty solving complex problems.
Testing shows abnormal memory but no functional impairment
what is your dx?
mild cognitive impairment
cause/pathology of MCI
age-related neurodegenerative dz
management for MCI
- Look for reversible causes
- Med SE, Sleep disturbances, Depression, vit B12 def, Hypothyroidism - Identify and modify vascular RF
- Nonpharm strategies
- No studies point to improvement
- Regular exercise
- Cognitive training: jigsaw puzzle, playing cards, read and look up unfamiliar words, encourage activities that use senses, learn a new skill, teach a new skill, listen to or play music
A general term used to describe various conditions in which there are deficits in multiple areas of cognitive function resulting inimpairment in daily functioning (at any lvl)
dementia
types of dementia
- Alzheimer disease - MC
- Vascular dementia
- Dementia with Lewy bodies
- Frontotemporal dementia
A neurodegenerative disorder of uncertain etiology and pathogenesis, resulting in cognitive and behavioral impairment
Alzheimer Disease
cause/etiology of alzheimers
- damage starts in hippocampus and entorhinal cortex (essential in forming memories)
- As more neurons die, more of the brain are affected and begin to shrink
- By final stages, damage is widespread and brain tissue has shrunk significantly
alzheimers is associated with 2 types of cerebral cortex lesions:
- Amyloid plaques
- Neurofibrillary tangles
unknown if lesions are what cause AD or if they occur as a result of AD
reason/pathogenesis not fully understood
describe the normal neuron anatomy
- axon has microtubule that transport nutrients, organelles, and other messages from the cell body to the tip of the axon
- Tau proteins: glue that hold microtubules in place
- impulse comes down from cell body, follows along track and ends at point
pathophys of nerofibrillary tangles
- tau proteins breakdown and adhere to each other instead of adhering to microtubules
- Resulting in inadequate transport from the cell body to the end of axon, preventing nml neuron communication
a protein found on membrane of various cells throughout the body and concentrated in the synapse of the neuron
enzymes come in and cut these proteins
Amyloid precursor protein (APP)
aka senile plaques
a sticky fragment of the APP that is released when various enzymes are present
sticky and adhere to each other
Beta amyloid protein
a lesion consisting of beta amyloid proteins that occurs between neurons and thought to affect neuronal communication
prevents dendrites from communicating with each other
Beta amyloid plaque
RF for AD
- Increasing age
- Female sex
- Apo ε4 gene on chromosome 19 - help w/ cholesterol transport
- Hx of head trauma
- Lower educational level - “don’t use it you lose it”
- Vascular disease
- DM
- Down syndrome - (Trisomy 21) extra APP gene on chromosome 21 - make more proteins, develop same patho, but happens earlier
- FHx
classic triad of AD
- Difficulty learning and recalling info - memory impairment
- Visuospatial problems - gets lost in unfamiliar surroundings → familiar surroundings
- Language impairment - word retrieval issues → fluent aphasia → nonverbal
disorientation and behavioral changes are also common
Sx interfere with social, occupational, or daily functioning
early behavioral changes vs later changes associated with AD
early: depression, apathy, irritability
late: agitation and psychotic symptoms (delusions, hallucinations, paranoia)
- longer time to perform daily tasks
- recognizing familiar places
- paying bills, handling money
- recalling new names
- word recall
- losing or misplasing items
- pallning or organizing
- remember new reading material
This presents what type of AD?
mild AD
- recalling demographics
- easily lost
- disorientated to place/time
- short attention span
- disorganized thought processes
- choosing appropriate clothing
- difficulty recognizing family/friends
- repetitive statements
- loss of new learning
- behavioral changes
- psychotic sx
- trouble reading, writing
these are associated with which AD?
moderate AD
- absent recognition of family/friend
- wt loss
- increased sleep
- loss of bowel/bladder control
- Death often occurs due to a complicating illness (aspiration pneumonia)
- increased infections
- trouble swallowing
- unable to communicate effectively
these are associated with what type of AD?
severe AD
