Dementia (week 10) Flashcards
Dementia (definition)
progressive failure of many cerebral functions that is not caused by an impaired level of consciousness
characteristics of dementia
- reduced cognitive function
- impaired mental abilities
- decreased ability to orient
- decreased STM, followed by LTM
- decreased language ability
- impaired judgement
- alterations of behavior
what occurs with dementia
memory impairments disorientation hallucinations illusions delusions confusion
what is the commonality of dementias
degeneration of neurons
atrophy of cerebral cortex and basal ganglia
classifications of dementia
cortical
subcortical
combination
types of cortical dementias
Alzheimer’s
Pick’s
types of subcortical dementias
Parkinson's Huntington's Hydrocephalus Endocrinopathies Drug Intoxication Heavy Metal Poisoning Depression-Dementia Syndrome
Combination Dementias
Multiinfarct dementia
AIDS
Creutzfeldt-Jacob
factors that play a role in development of dementia
genetic predisposition
environment
behavior
testing for dementia
lab testing (to r/o other causes) neuropsychological exam
How is dementia treated
no cure, tx aims to slow the progression & maximize fxn
most common disease that interferes with cognitive ability in people over age 65
Alzheimer’s
Alzheimer’s accounts for __-__% of cases of late life dementia
50-60
what accounts for the other 40-50% of cases of late life dementia
anoxic and infarct
primary risk factor for Alzheimer’s
age; increases with each decade of age
What other diseases are associated with Alzheimer’s
Parkinson’s
Down’s Syndrome
What is found in post mortem Alzheimer’s brains
- aggregation and precipitation of amyloid
- neurofibrillary tangles
what makes up the neurofibrillary tangles
microtubules in nerve cells
what are amyloid plaques composed of
A-beta peptides
Amyloid cascade hypothesis for Alzheimer’s
there is an imbalance in production and removal of A-beta peptides in the brain that leads to accumulation and aggregation
what is Amyloid
a lipoprotein
where are neurofibrillary tangles primarily found in Alzheimer’s
hippocampus & cerebral cortex
what are neurofibrillary tangles composed of
hyperphosphorlyated Tau protein that are unable to bind to microtubules allowing them to collapse
how is the inflammatory response triggered in Alzheimer’s
accumulation of A-beta peptides is attacked by microglia, which sets up inflammatory process
what is released during inflammatory response that is neurotoxic
cytokines
nitric acid
free radicals
what drug class may serve protective function against Alzheimer’s
NSAIDs
cholinergic hypothesis
significant loss of cholinergic neurons and nicotinic receptors in hippocampus and cortex thought to be secondary to the primary process of Alzheimer’s
have attempts to increase ACh levels in the brain been successful?
no; ACh may not have been getting to the right part of the brain to help
Other neurotransmitters that may contribute to Alzheimer’s
- excitatory amino acids
- increased activity of MAO-B
- loss of serotonergic neurons
how is LDL related to Alzheimer’s Disease
- some LDLs are associated with increased deposition of A-beta peptides
- AD is positively correlated with hypertension, increased LDL, and diabetes
What vitamins may reduce risk of AD
E & C
is vitamin E fat or water soluble?
fat (can be toxic)
is vitamin C fat or water soluble
water (can cause kidney stones)
How is estrogen associated to AD
estrogen may protect from AD
what particular behavior changes are likely to be seen in AD
irritability
agitation
restlessness
what types of imaging are used to diagnose AD
CAT
MRI
to check for shrinkage of sulci in cortex
What serologic tests are performed to r/o other causes of AD
blood cell counts electrolytes hepatic function thyroid function B12 levels
what pharmaceuticals can induce symptoms of AD?
sedatives and hypnotics anticholinergics opiates antipsychotics anticonvulsants histamine receptor blockers
what medications are used to treat AD
- cholinesterase inhibitors for mild-moderate (improve cholinergic transmission)
- glutamate receptor antagonist (Namenda) for moderate-severe
what has been shown to decrease the likelihood of AD
exercise lifestyle
quality of brain (education, brain teasers, etc)
what AD treatment is currently under investigation
immunotherapy to increase removal of A-beta peptides
