Dementia Overview Flashcards
what is the foundation of memory?
attention
focalized (focused) attention
ability to respond specifically to one stimulus
sustained attention
usage for tasks that take a long time
divided attention
multitasking
alternating attention
most important for cognitive flexibility
memory
- short term
- long term
- working memory
types of memory
- declarative memory
- nondeclarative memory
types of declarative memory
- episodic
- semantic
episodic declarative memory
our family’s vacation at the Grand Canyon
semantic declarative memory
what is the capitol of Maine?
types of nondeclarative memory
- procedural skill
- associative
- nonassociative
- priming
procedural skill nondeclarative memory
how to swing a golf club
associative nondeclarative memory
classical conditioning, fear memory
nonassociative nondeclarative memory
habituation and sensitization
priming nondeclarative memory
the power of suggestion
dementia
- 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
dementia: nature and course depend on etiology
- most are progressive
- some are static
- 10%-20% may have “reversible” causes
- therefore, need careful dx
dementia: other conditions
- arteriosclerosis
- hearing disorders
- epilepsy
- syphilis
- alcohol abuse
dementia: signs and symptoms
- 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
dementia: cognitive changes
forgetfulness and disorientation
dementia: psychiatric symptoms
withdrawal and apathy
dementia: problem behaviors
agitation, wandering
changes in activities due to dementia
- basic communication skills
- transportation
- meal preparation
- shopping
- housework
- managing medications
- managing personal finances
dementia: basic communication skills
participating on conversation, such as using a regular phone, mobile phone, remote control email, or the internet
dementia: transportation
either by driving oneself, arranging rides, or the ability to use public transportation
dementia: meal preparation
meal planning, cooking, clean up, storage, and the ability to safely use kitchen equipment and utensils
dementia: shopping
the ability to make appropriate food and clothing purchase decisions using a debit card, cash, and apps to pay
dementia: housework
doing laundry, washing dishes, dusting, vacuuming, and maintaining a clean place of residence
dementia: managing medications
- taking the correct amount of medication at the correct time
- managing re-fills and avoiding conflicts
dementia: managing personal finances
operating within a budget, writing checks, paying bills, and avoiding scams
areas that may/will be impacted
- intellectual function
- judgment
- thinking
- visuospatial skills
- language
- memory
- emotion and behavior
how to help
- routines
- organizing, but make it fun
diagnosis
- at least 3 of the functions are impacted
- American Psychiatric Association: requires memory be impaired
mild cognitive impairment
- 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
definition of dementia
the loss of intellectual functions (such as thinking, remembering, and reasoning) of sufficient severity to interfere with a person’s daily functioning
diagnostic criteria: DSM-V
- 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)
diagnostic: DSM-IV
had individual criteria for Alzheimer’s, vascular dementia and substance-induced dementia
DSM-V
- 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
Huntington’s Prion disease
- affects nervous system, dementia, ataxia, Creutzfeld-Jakob
- can be genetic or sporadic
dementia is an acquired deterioration of at least 2 of the following
- 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
social cognition
- 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
dementia: prevalence
- 1%-6% over age 65 is severe
- 2%-15% over age 65 is mild/mod
dementia: incidence
1/100 = severe
10/100 = mild/mod
dementia overview
- 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
dementia and down syndrome
- if they live to middle age, have plaques and tangles
- may have a chemical relationship between the 2 through cerebrovascular amyloid protein
TBI
- 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
repeated head injuries
- increased risk of dementia
- boxers
- football players
- cognitive impairment
- evidence of tau tangles
tau
an important protein found in neurons
chronic traumatic encephalopathy (CTE)
- “a brain disease not a brain injury”
- Boston CTE Center is the largest research center
Huntington’s disease
- progressive neurological disorder with dementia
- autosomal dominant, chromosome 4
ethnocultural factors
- 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
causes of dementia
- 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
reversible causes
- 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
reversible causes: metabolic/electrolytic imbalances
- calcium, sodium, potassium
- chronic renal failure, long-standing lung or cardiac disease/anemia
reversible causes: toxicity
occupational, environmental, household exposures that are harmful, drug-induced
cortical dementia
- degeneration in cortical association areas
- subcortical structures usually intact
- most common is Alzheimer’s disease
cortical dementia: most common is Alzheimer’s disease
- 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
subcortical dementia
- affect deep brain structures
- basal ganglia
- thalamus
- brainstem
- cortical structures are spared
- cognitive slowness
- motor abnormalities
- low F of aphasia and apraxia
- extrapyramidal syndromes
extrapyramidal syndromes
- Parkinson’s disease
- Huntington’s disease
- progressive supranuclear palsy
- Wilson disease
- spinocerebellar degenerations
- idiopathic basal ganglia calcification
Alzheimer’s disease: early onset
up to age 60 or 65 (6%)
Alzheimer’s disease: late onset
usually occurs during the 70s and 80s
Alzheimer’s disease: symptoms
- memory impairment
- difficulty with orientation
- learning and retraining new information
- impairment in communication
- difficulty with visual spatial skills
- cognition
- calculation
- motor systems
- personality deterioration
Alzheimer’s disease: behavioral difficulties
- delusions
- agitation
- dinural disturbances
- motor restlessness
- emotional liability
- suspiciousness
- depression
- paranoia
Alzheimer’s disease: there is a destruction and death
of nerve cells
Alzheimer’s disease: this destruction causes
- memory failure
- personality changes
- problems in carrying out daily activities
there are 3 main stages of dementia
- early stage
- middle stage
- late stage
gross brain inspection
- atrophy
- cellular/neuronal loss
Alzheimer’s disease: microscopic inspection
- neurofibrillary tangles
- senile plaques (amyloid)
- granulovacuolar degeneration
- reduction cholingeric and noradrenergic systems
Alzheimer’s disease: neuronal loss
- nerve cells are destroyed
- brain is shrunken
- most obvious in cerebral hemispheres
- especially temporal and parietal lobes
Alzheimer’s disease: neurochemical changes
- depletion of neurotransmitters
- acetylcholine, somatostatin, vasopressin, and corticotropin
Alzheimer’s disease results in progressive degeneration over time akin to
an acceleration of the mental aging process
in patients with early disease
only minor memory problems out of proportion to their age (mild cognitive impairment) might be apparent
with mild-to-moderate disease
patients may become lost, take longer handling daily tasks, and repeat questions
with increased progression
patients also exhibit changes with mood and personality, language, reasoning, and sensory processions
in severe Alzheimer’s disease
patients have great difficulty interacting with daily life and require increasing amounts of supportive care
