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Cognitive and Neurogenic Communication Disorders > Dementia Overview > Flashcards

Dementia Overview Flashcards

1
Q

what is the foundation of memory?

A

attention

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2
Q

focalized (focused) attention

A

ability to respond specifically to one stimulus

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3
Q

sustained attention

A

usage for tasks that take a long time

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4
Q

divided attention

A

multitasking

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5
Q

alternating attention

A

most important for cognitive flexibility

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6
Q

memory

A
  • short term
  • long term
  • working memory
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7
Q

types of memory

A
  • declarative memory
  • nondeclarative memory
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8
Q

types of declarative memory

A
  • episodic
  • semantic
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9
Q

episodic declarative memory

A

our family’s vacation at the Grand Canyon

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10
Q

semantic declarative memory

A

what is the capitol of Maine?

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11
Q

types of nondeclarative memory

A
  • procedural skill
  • associative
  • nonassociative
  • priming
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12
Q

procedural skill nondeclarative memory

A

how to swing a golf club

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13
Q

associative nondeclarative memory

A

classical conditioning, fear memory

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14
Q

nonassociative nondeclarative memory

A

habituation and sensitization

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15
Q

priming nondeclarative memory

A

the power of suggestion

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16
Q

dementia

A
  • acquired neurological syndrome characterized by persistent intellectual decline which is due to neurogenic causes
  • progressive deterioration
  • must rule out other conditions (they can be treated medically)
  • depression
  • delirium
  • medicine side effects
  • thyroid problems
  • infections
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17
Q

dementia: nature and course depend on etiology

A
  • most are progressive
  • some are static
  • 10%-20% may have “reversible” causes
  • therefore, need careful dx
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18
Q

dementia: other conditions

A
  • arteriosclerosis
  • hearing disorders
  • epilepsy
  • syphilis
  • alcohol abuse
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19
Q

dementia: signs and symptoms

A
  • cognitive changes
  • psychiatric symptoms
  • personality changes
  • problem behaviors
  • changes in day-to-day functioning
  • trouble driving, getting lost
  • impacts independence in performing activities of daily living
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20
Q

dementia: cognitive changes

A

forgetfulness and disorientation

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21
Q

dementia: psychiatric symptoms

A

withdrawal and apathy

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22
Q

dementia: problem behaviors

A

agitation, wandering

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23
Q

changes in activities due to dementia

A
  • basic communication skills
  • transportation
  • meal preparation
  • shopping
  • housework
  • managing medications
  • managing personal finances
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24
Q

dementia: basic communication skills

A

participating on conversation, such as using a regular phone, mobile phone, remote control email, or the internet

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25
Q

dementia: transportation

A

either by driving oneself, arranging rides, or the ability to use public transportation

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26
Q

dementia: meal preparation

A

meal planning, cooking, clean up, storage, and the ability to safely use kitchen equipment and utensils

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27
Q

dementia: shopping

A

the ability to make appropriate food and clothing purchase decisions using a debit card, cash, and apps to pay

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28
Q

dementia: housework

A

doing laundry, washing dishes, dusting, vacuuming, and maintaining a clean place of residence

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29
Q

dementia: managing medications

A
  • taking the correct amount of medication at the correct time
  • managing re-fills and avoiding conflicts
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30
Q

dementia: managing personal finances

A

operating within a budget, writing checks, paying bills, and avoiding scams

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31
Q

areas that may/will be impacted

A
  • intellectual function
  • judgment
  • thinking
  • visuospatial skills
  • language
  • memory
  • emotion and behavior
32
Q

how to help

A
  • routines
  • organizing, but make it fun
33
Q

diagnosis

A
  • at least 3 of the functions are impacted
  • American Psychiatric Association: requires memory be impaired
34
Q

mild cognitive impairment

A
  • dx used when the problem is mild and limited to a single domain (e.g., memory)
  • if you have MCI, you are more likely to develop Alzheimer’s and other dementias
  • 10%-15% of people with MCI develop dementia
  • especially likely if the MCI involves memory loss
35
Q

definition of dementia

A

the loss of intellectual functions (such as thinking, remembering, and reasoning) of sufficient severity to interfere with a person’s daily functioning

36
Q

diagnostic criteria: DSM-V

A
  • neurocognitive disorders (NCD)
  • dementia and amnesia disorders are now included under NCD
  • can have major NCD or mild NCD is new
  • can still use the term dementia
  • memory is not essential (added social cognitive disorder due to early signs of frontotemporal dementia)
37
Q

diagnostic: DSM-IV

A

had individual criteria for Alzheimer’s, vascular dementia and substance-induced dementia

38
Q

DSM-V

A
  • major or mild vascular NCD
  • major or mild NCD due to Alzheimer’s
  • new separate criteria for frontotemporal NCD
  • lewy bodies
  • TBI
  • Parkinson’s
  • HIV
  • Huntington’s Prion disease
  • other medical condition
  • multiple etiologies
  • substance-medication induced
  • unspecified NCD
39
Q

Huntington’s Prion disease

A
  • affects nervous system, dementia, ataxia, Creutzfeld-Jakob
  • can be genetic or sporadic
40
Q

dementia is an acquired deterioration of at least 2 of the following

A
  • memory (st, lt, semantic, episodic, procedural)
  • language (recep. inner. exp.)
  • orientation
  • perception
  • attention
  • ability to carry out purposeful tasks
  • visuospatial skills
  • cognition (judgment, abstraction, calculation)
  • social cognition
41
Q

social cognition

A
  • concept is also introduced as one of the core functional domains that can be affected by a neurocognitive disorder
  • this concept may be particularly significant in the evaluation of patients with non-Alzheimer’s dementias, such as frontotemporal dementia
42
Q

dementia: prevalence

A
  • 1%-6% over age 65 is severe
  • 2%-15% over age 65 is mild/mod
43
Q

dementia: incidence

A

1/100 = severe
10/100 = mild/mod

44
Q

dementia overview

A
  • after age 65, prevalence doubles every 5 years
  • age 85+ prevalence is 30%
  • family history
  • people with a parent or sibling with dementia have a higher risk
  • may be autosomal dominant trait
45
Q

dementia and down syndrome

A
  • if they live to middle age, have plaques and tangles
  • may have a chemical relationship between the 2 through cerebrovascular amyloid protein
46
Q

TBI

A
  • increased risk of Alzheimer’s disease and other dementias
  • moderate head injuries = twice the risk of a person with no head injury (loss of consciousness lasting more than 30 minutes)
  • more than 24 hours, then severe
  • mild TBI does not increase risk for dementia
47
Q

repeated head injuries

A
  • increased risk of dementia
  • boxers
  • football players
  • cognitive impairment
  • evidence of tau tangles
48
Q

tau

A

an important protein found in neurons

49
Q

chronic traumatic encephalopathy (CTE)

A
  • “a brain disease not a brain injury”
  • Boston CTE Center is the largest research center
50
Q

Huntington’s disease

A
  • progressive neurological disorder with dementia
  • autosomal dominant, chromosome 4
51
Q

ethnocultural factors

A
  • data is limited
  • Shoenberg, Anderson, and Haerer 1985: Whites and African Americans (men and women) had roughly same prevalence rate
  • Ritchie and Lovestone 2002: dementia (esp. Alzheimer’s) may be more common in whites than African Americans, Asian Americans, or Hispanic Americans
  • vascular dementia may be more prevalent in African Americans and in Japan
  • Europe/U.S.: Alzheimer’s more prevalent than vascular dementia
  • also, more non-white elderly may receive care at home and not use health services, therefore may lead to an underestimation of dementia
52
Q

causes of dementia

A
  • Alzheimer’s disease: 50%-60% of all patients
  • vascular origin: 20%
  • dual dx/Alzheimer’s + vascular: 15%
  • others include Pick’s disease, Parkinson’s, progressive supranuclear palsy, primary progressive aphasia, Creutzfeldt-Jakob disease
53
Q

reversible causes

A
  • sleeping pills/sedatives
  • anti-Parkinson’s drugs
  • anti-hypertensive/cardiovascular drugs
  • infections such as colds, flu, and pneumonia
  • disorders of endocrine function
  • nutritional disorders such as B12 deficiency, folate/protein deficiencies
  • chronic renal failure
  • lung and heart failure
  • drug toxicity
  • strokes, partially reversible
  • anemia
  • metabolic/electrolytic imbalances
  • trauma
  • toxicity
54
Q

reversible causes: metabolic/electrolytic imbalances

A
  • calcium, sodium, potassium
  • chronic renal failure, long-standing lung or cardiac disease/anemia
55
Q

reversible causes: toxicity

A

occupational, environmental, household exposures that are harmful, drug-induced

56
Q

cortical dementia

A
  • degeneration in cortical association areas
  • subcortical structures usually intact
  • most common is Alzheimer’s disease
57
Q

cortical dementia: most common is Alzheimer’s disease

A
  • confirmed only upon autopsy
  • occurs 2-3x more in women
  • characterized by pathological changes in the brain, primarily the association areas of the parietal, temporal, frontal lobes, and hippocampus
58
Q

subcortical dementia

A
  • affect deep brain structures
  • basal ganglia
  • thalamus
  • brainstem
  • cortical structures are spared
  • cognitive slowness
  • motor abnormalities
  • low F of aphasia and apraxia
  • extrapyramidal syndromes
59
Q

extrapyramidal syndromes

A
  • Parkinson’s disease
  • Huntington’s disease
  • progressive supranuclear palsy
  • Wilson disease
  • spinocerebellar degenerations
  • idiopathic basal ganglia calcification
60
Q

Alzheimer’s disease: early onset

A

up to age 60 or 65 (6%)

61
Q

Alzheimer’s disease: late onset

A

usually occurs during the 70s and 80s

62
Q

Alzheimer’s disease: symptoms

A
  • memory impairment
  • difficulty with orientation
  • learning and retraining new information
  • impairment in communication
  • difficulty with visual spatial skills
  • cognition
  • calculation
  • motor systems
  • personality deterioration
63
Q

Alzheimer’s disease: behavioral difficulties

A
  • delusions
  • agitation
  • dinural disturbances
  • motor restlessness
  • emotional liability
  • suspiciousness
  • depression
  • paranoia
64
Q

Alzheimer’s disease: there is a destruction and death

A

of nerve cells

65
Q

Alzheimer’s disease: this destruction causes

A
  • memory failure
  • personality changes
  • problems in carrying out daily activities
66
Q

there are 3 main stages of dementia

A
  1. early stage
  2. middle stage
  3. late stage
67
Q

gross brain inspection

A
  • atrophy
  • cellular/neuronal loss
68
Q

Alzheimer’s disease: microscopic inspection

A
  • neurofibrillary tangles
  • senile plaques (amyloid)
  • granulovacuolar degeneration
  • reduction cholingeric and noradrenergic systems
69
Q

Alzheimer’s disease: neuronal loss

A
  • nerve cells are destroyed
  • brain is shrunken
  • most obvious in cerebral hemispheres
  • especially temporal and parietal lobes
70
Q

Alzheimer’s disease: neurochemical changes

A
  • depletion of neurotransmitters
  • acetylcholine, somatostatin, vasopressin, and corticotropin
71
Q

Alzheimer’s disease results in progressive degeneration over time akin to

A

an acceleration of the mental aging process

72
Q

in patients with early disease

A

only minor memory problems out of proportion to their age (mild cognitive impairment) might be apparent

73
Q

with mild-to-moderate disease

A

patients may become lost, take longer handling daily tasks, and repeat questions

74
Q

with increased progression

A

patients also exhibit changes with mood and personality, language, reasoning, and sensory processions

75
Q

in severe Alzheimer’s disease

A

patients have great difficulty interacting with daily life and require increasing amounts of supportive care

76
Q
A

Cognitive and Neurogenic Communication Disorders (3 decks)

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