Emily Wilkins - Mild cognitive Impairment Flashcards
Define Mild Cognitive impairment (MCI)
MCI is defined as cognitive decline beyond that expected for age and education, without significantly interfering with normal daily function
What is amnestic MCI
When the impairment in MCI manifests as memory loss
What is dementia
- Dementia is the chronic and progressive insidious deterioration of behaviour and higher intellectual function due to organic brain disease.
- It is an umbrella term for memory loss impairment.
What are the differences between MCI and dementia
- MCI is associated with ageing and dementia is not always
- MCI describes a set of symptoms and not a disease and does not always have a causative underlying pathophysiology however dementia has a multitude of pathophysiologies that it could arise from.
- MCI does not interfere with normal daily function meanwhile dementia does
- There is no approved drug treatment for MCI but there is for dementia
What factors can reduce the risk of developing dementia?
- Physical activity
- Mediterranean diet
- Not smoking
- Not excessively drinking
- Being socially active
- Engaging in cognitive stimulation
- Prompt treatment of depression
What 6 questions does the cognitive impairment test ask?
- What year is it?
- What month is it?
- Give the patient and address phrase to remember with 5 components
- About what time is it?
- Count backwards from 20-1
- Say the months of the year in reverse
What are the score breakdowns for the 6 item cognitive impairment test?
0-7 - Normal
8-9 - MCI (Might refer)
10-28 - Severe cognitive impairment (Refer)
Define capacity
The ability to use and understand information to make a decision and communicate any decision made
What are the 3 main points that the Mental capacity act states?
- Understand the information relevant to the decision
- Retain the information and recall it d
- Use or weigh up the info to make a decision
What is the 2 stage test of capacity the MCA sets out?
- Does the person have an impairment of their mind or brain
- Does the impairment mean the person is unable to make a specific decision when they need to.
How many doctors are needed to agree if capacity should be withdrawn
2
How can patients convey their wishes in case they lose their capacity?
- Write an advance statement - not legally binding but acts as a guide for those who need to make future decisions about their care
- Make an advance decision - A legally binding decision that allows someone to refuse specified medical treatment in the case that they lack capacity to consent to the treatment
- Appoint a legal power of attorney
What is Alzheimer’s disease?
AD is a chronic neurodegenerative disease with slow cognitive decline and an insidious onset and is the most common type of dementia.
What are the symptoms of AD
- Amnesia
- Anomia (inability to name objects)
- Apraxia (loss of dexterity)
- Agnosia (inability to recognise things and/or their functions)
- Aphasia (inability to talk)
- Loss of judgement
How can Extracellular amyloid plagues cause AD
- The transmembrane protein Amyloid precursor protein (APP) is cleaved by alpha secretases and is used for neuronal growth and repair.
- In AD there is abnormal cleavage of APP by beta and gamma secratases which results in a surplus’s of amyloid beta.
- This aggregates into oligomers and fibrils which exit the cell and form insoluble senile plaques.
- The accumulation of these plaques interferes with neuronal communication and increases inflammation.
How do intracellular neurofibrillary tangles cause AD
- Tau proteins, which are important for neuronal growth and development, are hyper phosphorylated and undergo oligomerisation causing them to aggregate into filamentous neurofibrillary tangles (NFTs)
- NFTs disrupt the micro-tubular system resulting in impaired neuronal growth, transport and communication.
- Thy deposit in the hippocampus, temporal lobes and frontal cortices which is the distinct pathogenesis of AD
How do Amyloid beta plaques cause AD
The plaques trigger phosphorylation of tau and therefore causes the accumulation of NFTs.
This leads to a reduction in neuronal function and apoptosis. There is also degeneration of choline rigid nuclei and reduction in Ach.
Why are acetylcholinesterase inhibitors used to treat AD
Neuronal atrophy is associated with AD and results in Ach deficiency as the neurons affected are predominantly rich in Ach. Therefore Achase prevents Ach from being hydrolysed and increases their conc in the synaptic cleft.
What is vascular dementia?
Vascular dementia occurs when there is reduced blood supply to the brain due to diseased vessels and multiple infarcts in the minor blood vessels.
Symptoms follow a stepwise progression with deterioration over several years.
Sudden changes in deterioration are attributed to strokes.
What disease is linked with vascular dementia
Cardiovascular disease
What are the symptoms of vascular dementia
- Slower thinking
- Personality changes
- Movement problems
- Bladder problems
What is Lewy body dementia
LBD is associated with aberrant deposits of alpha synuclein protein (Lewy bodies) within the primary motor cortex.
It has a progressive and insidious onset over time.
What are the symptoms of Lewy body dementia
- Hallucinations
- Sleep problems which consequently affects cognitive function
- Memory loss
- Parkinsonian like features - movement impairments and tremor
What are the treatments for Lewy body dementia
Acetylcholinesterase inhibitors
What is frontotemporal dementia?
FTD is associated with neuronal atrophy of the frontal and temporal lobes due to the presence of abnormal proteins (predominantly phosphorylated Tau and TDP-43)
- There is an autosomal dominant inheritance pattern of mutations in protein tau genes among other genes
- It is a chronic and progressive disease and has a very rapid onset
What are the symptoms of FTD?
- Speech problems
- Behavioural changes
- Emotional problems
- Disinhibition
- Progressive non fluent aphasia (due to effects in temporal lobe)
- Development of unusual beliefs
- Changes in diet
- Lack of interest in looking after themselves
What is the posterior cingulate cortex concerned with?
Orientation (time, place and identity)
What is the hippocampus associated with?
Short term memory
What is the anterior thalamus concerned with?
Attention
