Dementia I Flashcards
2 major categories of memory
declarative (explicit) and non-declarative (implicit)
Declarative memory is
recall of facts or event
Non-declarative memory is
stands for non-verbal motor learning such as
playing a musical instrument or riding a bicycle
Declarative memory areas
Medial temporal lobe and associated structures
non-declarative memory areas
Striatum, Amygdala, Neocortex and Cerebellum
Learning vs. memory
Learning involves acquisition of new facts and knowledge, whereas memory refers to the storage and retrieval of learned information
2 memory types (temporally differentiated)
STM and LTM
Short term memory
STM/working memory
ability to hold information for seconds to minutes
Long-term memory
retention of information in a more permanent form
Memory impairment diagnosis is based on…
studies of medical history, neuropsychological testing, neurological/psychiatry examinations and brain imaging
Dementia Definition
- A clinical syndrome characterized by acquired losses of cognitive and emotional abilities severe enough to interfere with daily functioning
- Strictly a clinical diagnosis
Dementia has a fixed level of decline TRUE OR FALSE
FALSE
Rate of cognitive decline varies with
individuals and specific disease
Dementia is caused by dysfunctions in these areas
dysfunction of the cerebral hemisphere, especially cortex, hippocampus and their subcortical nuclei such as caudate nuclei and thalamus
Dementia may be associated with the following domains of consciousness
Dementia may be associated with ANY major domains of cognition
INCLUDES declarative memory, executive function, visuospatial function or language
Co-morbid symptoms in dementia
Psychiatric symptoms are common in dementia: apathy and loss of initiative are always present.
Depression, anxiety and hallucinations are also frequent
Advanced dementia shows issues in
basic daily living activities (bathing, dressing, feeding)
Is dementia fatal?
No, it decreases life expectancy BUT death in dementia is mainly due to sepsis, pneumonia, pulmonary embolism or heart disease
When do dementia patients die (at what stage)
usually die at mild-to-moderate stages
Primary Dementia has 2 categories
non-degenerative diseases and neurodegenerative diseases
Primary dementia
dementia caused by neurodegenerative and non-neurodegenerative diseases
when dementia is the main cause (not secondary to another pathology)
makes up 98% of dementias
Neurodegenerative diseases
AD, Frontotemporal dementia (FTLD), Lewy Body
dementia (LBD), Huntington disease, Prion disease
Non-neurodegenerative diseases
Vascular dementia, Normal Pressure Hydrocephalus etc.
___% of dementias are secondary and triggered by ____ and ____ (can/can’t) be resolved if treated
About <2% of dementia may be triggered by infections, metabolic disorders and drug intoxication which if treated early can be resolved completely
Most common causes of dementia
Alzheimer’s (AD–55%), vascular dementia (VaD–20.6%), frontotemporal dementia (FTLD–8.4%), Dementia with Lewy Bodies (LBD-4.5%)
Most dementia patients exhibit…
similar symptoms/pathologies including behavioural/psychological symptoms including delusions, depression, anxiety etc.
Evidence suggests that some people with
pathology similar to AD don’t develop
cognitive deficits–believed to be due to
which is believed to be due to higher cognitive reserve related to brain anatomical modification or
adaptability to overcome cognitive deficit
Most dementia occurs after age ___ and are _____, those before are caused by ____
Most cases of dementia are sporadic and occur after 65yrs of age,
whereas only a small percentage of cases which
appear before 65yrs are caused by genetic abnormalities
Hereditary AD is due to mutations of (3)
amyloid precursor protein (APP), presenilin 1 (PS1) and PS2
Hereditary VaD is due to mutations of (2)
Neurogenic locus notch homolog protein 3 (NOTCH-3)
and APP
Heritable FTLD is due to mutations (3)
mutations of microtubule-associated protein tau (MAPT), granulin (GRN) and chromosome 9 open reading frame 72 (C90RF72)
Dementia affects ___% of people over 65
5-7%
Dementia prevalence ____ with age
Increases (after 65)
Dementia affects ___% if people between the ages of 85-89 years
20-25%
Incidence of dementia (new cases per year)
1 per 100 per year at 70 years, increases
to ~2-3 new cases per 100 per year by 80 years
Cost of dementia in 2018
$1 trillion USD and increasing
Dementia rates are ____
Increasing; especially in low-middle income countries
declining in some wealthy countries (US, UK, sweden, Netherlands)
Sex difference in dementia
More women than men have dementia
Racial and ethnic differences in dementia
None
Risk factors for dementia–unmodifiable
include age and inheritance of Apolipoprotein E4 (APOE4) allele
Risk factors for dementia–modifiable
depending on stages of life include less education, hypertension, obesity, hearing loss, physical inactivity, diabetes, smoking, social isolation and depression, elevated cholesterol and poor diet
Around ___% of dementia can be attributed to modifiable risk factors
30%
determined by calculating population-attributable risks for 7 established risk factors (i.e., diabetes,
hypertension, obesity, physical inactivity,
depression, smoking and low educational)
recently added risk factors
excessive alcohol, traumatic brain injury (TBI), air pollution
Diagnosing dementia–based on
cognitive history and the mental status examination (Mini Mental State Examination, Montreal Cognitive Assessment)
There is not laboratory test for diagnosing dementia (true or false)
TRUE
At present there is no laboratory test for dementia diagnosis.
Laboratory test may help in determining the cause of dementia
Techniques to help identify dementia types
Structural imaging (compound tomography, CT or magnetic resonance imaging, MRI) is recommended to identify potentially treatable cause dementia such as tumor
10 warning signs of dementias
- memory loss
- difficulty performing daily tasks
- problems with language
- disorientation to time and places
- poor or decreased judgement
- problems keeping track of things
- misplacing things
- changes in mood and behaviour
- trouble with images and spatial relationships
- withdrawal from work or social activities
MRI in dementia–uses
for diagnosis of different subtypes of dementia.
MRI usually shows atrophy of the temporal lobes, frontal cortex and hippocampi regardless of the dementia subtype
PET in dementia
- PET shows a region-specific reduction in fluorodeoxyglucose (FDG) uptake depending on the type of dementia
- Additionally, amyloid or tau PET scan can identify amyloid and tau aggregates which occur in AD and some other type of dementia
Dementia treatments–failed clinical trials
Clinical trials of non-steroidal anti-inflammatory drugs, hypoglycemic drug (rosiglitazone), estrogen replacement therapy, statins, vitamins and ginkgo biloba have all been negative.
indapamide as a dementia therapy
There is some evidence that antihypertensive
indapamide may have some beneficial effects on dementia
T/F: there is currently disease-modifying treatments for dementia
FALSE
No disease-modifying treatment for dementia is currently available
Current drugs for dementia
Only symptomatic with modest effects on cognitive function.
These treatments which include acetylcholinesterase inhibitors, memantine, ADs and cholesterol lowering drugs
acetylcholinesterase inhibitors for dementia
counteract the low levels of acetylcholine that contribute to memory impairment or prevent the cognitive deficit by blocking glutamatergic NMDA receptor functioning.
Current therapies for AD
ONLY TREATS SYMPTOMS Acetylcholinesterase inhibitors (galantamine, donepezil and rivastigmine) and memantine (NMDA receptor antagonist)
Current therapies for VaD
ONLY TREATS SYMPTOMS
Acetylcholinesterase inhibitors, memantine and cholesterol-lowering drugs
Current therapies for LBD
ONLY Treats SYMPTOMS
Acetylcholinesterase inhibitors, memantine and antidepressants
Non-drug dementia prevention–WHY
Since genetics account for only part of the risk for dementia, influencing modifiable risk factors may able to reduce the development of dementia.
Indeed, some of the following non-pharmacological strategies have been shown to lower the risk of developing dementia in older population.
Non-drug dementia prevention strategies
Physical exercise Mental stimulation Diet/supplements Social Engagement Stress reduction
Physical exercise in dementia
Animal and human studies indicate regular physical exercise can improve memory.
Aerobic conditioning increases Brain-derived neurotrophic factor (BDNF) which lowers the risk of AD-related dementia.
Mental stimulation in dementia
Reading, learning, doing puzzles and board games have been suggested to lower the risk of developing dementia.
While physical activity increases production
of hippocampal neurons, mental stimulation increases the neuronal survival rate, functioning and plasticity of neuronal circuits.
Social engagement in dementia
High social engagements have been suggested to increase cognitive ability and decreased the risk of dementia
Stress reduction in dementia
Meditation, tai chi chih, yoga or other relaxation can improve memory abilities.
Adequate sleep also reduces stress, whereas poor sleep is associated with cognitive deficits and greater Aβ burden in the brain
Nutrition in dementia
Brain healthy diets emphasize anti-inflammatory omega-3 fats from fish and antioxidant fruits and vegetables.
Mediterranean diets are recommended for healthy aging.
Some gastrointestinal bacteria that increase fat metabolism may also help in cognitive ability
MCI (mild cognitive impairment) definition
represents the transition between the normal cognition and dementia
Abnormalities in MCI interface with daily function: True or False
FALSE
Patients with MCI have abnormalities in
a specific aspect of cognition but does
not interfere with daily functioning
Most common MCI
The amnesic form of MCI, in which declarative episodic memory is impaired
Potential alterations in the neuropathology with MCI
The neuropathology of MCI is mixed, but amyloid plaques and tangles may be detected
Common symptoms in MCI
Most MCI patients exhibit psychiatric symptoms such as depression, anxiety, apathy and irritability
Progression of MCI
Most individuals with MCI though progressed to dementia, smaller groups of individuals remain either stable or reverted back to normal
What can alter MCI progression
Evidence indicates that diabetes, metabolic syndrome, lower serum folate level increase the risk of progression
from MCI to dementia
A Mediterranean diet decreases the risk of conversion from amnestic MCI to AD compared with other diets
