Dementia (Hanif) Flashcards
What is the ability to restore and retrieve information?
- Three systems?
Memory
- Sensory memory
- Short-term memory
- Long term memory
A. Receives information from the sensory memory; information can stay here for 15-20 seconds
B. Receives information through the 5 senses (certain people have different strengths) and passes that information on to short term memory
C. Recalls information gathered over time - can stay here for a few days to a life time; used to process information
A. Short-term memory
B. Sensory memory
C. Long term memory
Dementia symptoms in the Mildly Cognitive Impaired:
- Impaired ________ to time/place (forgetting conversations, misplacing items, forgetting names, loss of conversational skills)
- Impaired ______
- Loss of _____ or inability to perform hobbies or chores, eg. telephone, cooking, bills, finances
- Alterations in ____/_____ (subtle change in interpersonal relations
- New onset ___/___/___
- orientation
- judgement
- interest
- mood/behavior
- anxiety/depression/paranoia
Alzheimer’s disease:
- 3 causative genes have been associated with **AD, familial: ?
- ** 1 genetic risk factor? (this increases a person’s risk of developing the disease, but people who develop AD may not have this allele)
Early onset familial AD caused by any one of a number of different single gene mutations on: ?
- APP, PSEN1, PSEN2
- APOEe4 allele
Chromosomes 21, 14, 1
What do mutations on chromosome 21 cause?
- chromosome 14?
- chromosome 1?
The formation of abnormal amyloid percursor protein (APP)
14: abnormal presenilin 1
1: abnormal persenilin 2
Some causes of dementia:
- _____: alzheimers, frontotemporal, DLB, Parkinsons, PSP, HD, WD, CJD
- _____: multi-infarct, Binswanger’s CADASIL
- _____: MS, vasculitis
- _____: syphilis, lyme, HIV, other viral/fungal
- _____: primary, metastatic, paraneoplastic
- _____; hydrocephalus (NPH), trauma, concussions, chronic traumatic leukoencephalopathy
- Primary neurodegenerative disorders
- Vascular
- Inflammatory
- Infectious
- Cancers
- Other/physical
Diagnosis?
- Affects as many as 4 million Americans
- Nearly 50% of all people age 85+ may have symptoms
- Likely to affect more than 14.3 million americans by 2050; 1/10 people over 65 is affected
- Degenerative brain disorder leading to progressive loss of memory and other cognitive functions
- Most common form of dementia - changes in personality, behavior, judgement; loss of activities of daily living skills
- RF: advanced age, FH,
Alzheimer’s Disease
Alzheimer’s disease:
- In the mild stage - have _____ memory loss and forgetfulness; difficulty finding specific words; ______ deficits; MMSE of ?
- In the moderate stage - short term memory is severely _____, less complex language, impaired ____, decreased _______, MMSE of ?
- In the severe stage - _____ severely impaired, ____, recall becomes impossible, language may become restricted leading to ____, MMSE of ?
- Mild - short term, executive functioning, 20-24
- Moderate - restricted, insight, visuospatial ability and orientation, 11-19
- Severe - attention, apraxia, mutism, less than or equal to 10
Diagnostic criteria for what?
- Development of multiple cognitive deficits manifested by:
- memory impairment
- 1+ of the following: aphasia, apraxia, agnosia, disturbance in executive functioning
- Significant impairment in social or occupational functioning representing a significant decline from a previous level of functioning
- Gradual onset and progressive cognitive decline
Alzheimer’s disease
What besides history, physical, lab tests, can be performed to aid in the diagnosis of Alzheimer’s disease?
- Mental status examination
- MMSE or MOCA (evaluates - registration, recall, visuospatial skills, calculation, abstract reasoning)
- Brain Scans
________ is an important neurotransmitter in areas of the brain involved in memory formation - what are these areas?
- this decreases early in AD in the basal forebrain and correlates with the impairment of memory
- Increases in this may benefit cognitive symptoms
- reduced activity of what enzyme?
- reduced number of ____ neurons
- selective loss of certain nicotinic receptor subtypes
Acetylcholine - hippocampus, cerebral cortex, amygdala
- choline acetyltransferase
- cholinergic neurons
AD:
- Presynaptic ____ receptors modulate the release of multiple neurotransmitters (memory, mood) - what are they?
- Blocking these IMPAIRS COGNITION
- Stimulating these IMPROVES MEMORY
- Nicotinic
- ACh, glutamate, serotonin, norepinephrine
What are the anatomic abnormalities seen of the brain with Alzheimer’s disease?
What abnormalities are seen under the microscope?
- Pronounced atrophy, cerebral atrophy - ventricular dilation resulting from loss of cortex [hydrocephalus ex vacuo]
- in neuropil see fragmentation of neurites = senile plaques (may contain astrocytes, microglia)
- neurofibrillary tangle - commonly found in pyramidal cells of the hippocampus and cerebral cortex
AD:
Using fMRI to see where the brain fires when it is performing an activation task - subjects try to memorize a series of faces shown to them - what did this show?
*** THE EARLIEST DEFICIT - a PHYSIOLOGIC LESION
Decreased activation in the hippocampus for the AD patients - depicts a functional deficit
What are some treatment options for AD?
- ____ - for treatment of mild to moderate AD
- ____ - for behavioral symptoms
- ____ - ?
- ____ - 5 to 20mg/day, antagonizes NMDA receptors
- ____ - antioxidant, 1000 U bid
- Potential prevention: NSAIDs, HMG-CoA reductase inhibitors, red wine, smoking cessation, aerobic exercise
- Cholinesterase inhibitors
- Antipsychotics, antidepressants
- Estrogen replacement therapy
- Namenda (memantine)
- Vitamin E
