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Neuropsychology > Dementias > Flashcards

Dementias Flashcards

1
Q

Why do we have more age related diseases than ever before?

A

Increased medical care awareness and disease research has created an ageing population, which results in people living longer and being at greater risk for dementia

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2
Q

What is dementia?

A

A group of disorders associated with global declines in cognitive and behavioural functioning

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3
Q

What is the greatest risk factor for dementia?

A

Age, the risk of getting dementia increases linearly from age 65

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4
Q

Why would it be good to find a cure or prevention for dementia?

A

It has a large economic impact, because it allows people to work for longer. It also relieves a massive social burden.

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5
Q

What is successful ageing?

A

Living as long as you can, as healthily as you can.

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6
Q

How does variability in cognitive functioning work, age wise?

A

It’s like a two mouthed vuvuzela, there is a lot of variation with children, it levels out more or less with adults and then variation increases again in the older generation

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7
Q

Two causes of cognitive decline

A

Brain diseases associated with ageing or normal age related declines

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8
Q

Relationship between normal ageing and dementia

A

It’s not a continuum, there are qualitative differences

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9
Q

What is crystallised intelligence?

A

It’s semantic knowledge gained from books that increases with a diverse range of experiences

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10
Q

How is crystallised intelligence affected by age?

A

It changes only slightly

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11
Q

How does crystallised intelligence play a role in preventing dementia?

A

Crystallised intelligence forms a functional cognitive reserve, which creates a barrier through which the dementia has to break before it can set in.

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12
Q

Examples of functional cognitive reserve

A

Nun study: women who wrote with more complex vocab in their twenties were less likely to have developed dementia in their older years
Scottish study: adolescent IQ tests done nation wide and found that kids who scored higher in these were less likely to develop dementia

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13
Q

What is fluid intelligence?

A

Abilities like novel reasoning, adaptability and response to abstract ideas.

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14
Q

How is fluid intelligence found and its relation to age

A

It’s unrelated to formal education, strongly related to biological factors. It shows definite changed as people age.

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15
Q

What are the three most reliable declines in cognition?

A
  1. Processing speed
  2. Abstract and complex new problem solving
  3. Memory and new learning
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16
Q

Aspects of memory affected by ageing

A
  • Decline in free recall, partly due to poor encoding
  • Decline in working memory
  • Decline in less contextualised and effortful tasks
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17
Q

Four aspects of memory that remain intact with age

A
  1. Storage processes
  2. Performance on recognition tasks
  3. Procedural memory tasks
  4. Short term memory
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18
Q

Age related structural changes in the brain

A
  • Loss of weight and volume
  • Flattening of cortical surfaces
  • Widening of ventricles
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19
Q

Neuronal age related changes (6)

A
  1. Shrinking and death of ageing cells
  2. Loss of dendritic processes
  3. Neurofibrillary tangles
  4. Neuritic plaque
  5. White matter abnormalities
  6. Grey matter loss
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20
Q

Regions vulnerable to age related brain changes

A
  • Hippocampus
  • Frontal lobes, mostly PFC
  • Temporal and parietal association areas
21
Q

Regions preserved in age related brain changes

A
  • Occipital cortex

- Somatosensory cortex

22
Q

Grey matter atrophy patterns

A

Cortical atrophy varies, grey matter atrophy, plaque and tangles are not invariably associated with dementia, particularly in ages 84-90.

23
Q

Genetic and environmental factors in dementia

A

The apoE4 gene, the one linked to Alzheimer’s.
Stress, affects the telomeres and cortisol and hippocampal vulnerability
Exercise

24
Q

What is the differential preservation hypothesis?

A

There are individual differences in how well a person is going to age, and these stem from how active a person is both physically and mentally, the activity can be started later in life.
This suggests that staying active will allow you to maintain your cognitive functions.

25
Q

What is the preserved differentiation hypothesis?

A

Individual differences stem from cognitive reserve, which suggests that those who performed physically and cognitively when they were younger are better off with successful ageing.

26
Q

What neuronal changes are always associated with dementia?

A
  • Grey matter atrophy
  • Plaque
  • Tangles
27
Q

What is mild cognitive impairment?

A

A stage of cognitive impairment that indicates that a person is not cognitively intact but does not meet the criteria for dementia

28
Q

Three criteria for mild cognitive impairment

A
  1. Objective cognitive problems: 1.5 std dev below the mean
  2. Subjective cognitive problems: complaints of cognitive function loss
  3. Intact ADLs: daily living functions are fine
29
Q

Mild cognitive impairment and dementia

A

MCI doesn’t always lead to dementia. But there is an increased risk of developing it and it will occur at a faster rate.

30
Q

Three different types of MCI

A
  1. Amnestic - only memory impaired
  2. Vascular - only executive functioning is impaired
  3. Multiple domain - more than one cognitive domain is impaired
31
Q

Nature of amnestic MCI

A

There are deficits in encoding and retrieval, like Alzheimer’s. Other cognitive areas and activities of daily living are intact. Damage is in the hippocampal atrophy

32
Q

Definition of dementia:

A

A behavioral syndrome, not one disease. It includes multiple conditions, with a variety of aetiologies.

33
Q

How are dementia subcategories defined? (3)

A
  • Site of damage
  • Cause
  • Suspected disease
34
Q

Classifications of dementia

A
  1. Cortical vs subcortical
  2. Static vs progressive
  3. Reversible vs irreversible
35
Q

Cortical vs subcortical dementia

A

Cortical: primary effects in the cerebral cortex and grey matter structures. Alzheimer’s.
Subcortical: primary effects in the white matter and subcortical grey matter

36
Q

Problems with the cortical vs subcortical dichotomy

A

Dementia does not conform to boundaries and at the very end stages, most dementia looks the same

37
Q

Static vs progressive dementia

A

Static: steady state cognitive disorder, it won’t decline once arrested. Caused by infection or neurotoxic substance
Progressive: it only gets worse, caused by the disease process. Alzheimer’s

38
Q

Reversible vs irreversible dementia

A

Reversible: decline in functioning gets reversed and goes back to baseline functioning
Irreversible: usually seen with progressive dementia, Alzheimer’s

39
Q

Two different sets of diagnostic criteria for dementia

A

DSM-IV-TR and NINCDS-ADRDA

40
Q

Agreed upon criteria for dementia (from DSM-IV-TR and NINCDS-ADRDA)

A
  • Loss of cognitive or intellectual functioning
  • Multiple areas of cognitive impairment
  • No confusion or disorientation (it’s not delirium)
41
Q

Classification of Alzheimer’s

A

Cortical, progressive and irreversible

42
Q

Epidemiology of Alzheimer’s

A

It’s found globally, and is the most prevalent of the dementias. The incidence of it increases with age.

43
Q

Risk factors for Alzheimer’s

A
  • Age
  • Sex
  • Education
  • Genetics (ApoE4)
44
Q

Diagnostic criteria for Alzheimer’s

A
  • Behavioural presence of dementia (see a change of personality, irritable and aggressive)
  • Identification of neuropathological markers
  • Definitive diagnosis can only be made on an autopsy
45
Q

Diagnostic problem with Alzheimer’s

A

It’s overdiagnosed because people don’t distinguish between AD and other dementias

46
Q

If I looked at an MRI of a person with Alzheimer’s, what would I see?

A
  • Large ventricles
  • Neuron loss
  • Dark spots on hippocampi
47
Q

Presentation of early stage Alzheimer’s, functions impaired:

A
  • Recent memory
  • Delayed recall
  • Visuospatial abilities
  • Naming
48
Q

Presentation of early stage Alzheimer’s, functions intact

A
  • Receptive language
  • Expressive language
  • Strength
  • Motor and processing speed
  • Executive function

Neuropsychology (17 decks)

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