Final Flashcards
percentage of cases for AD
50-70%
percentage of cases for VD
10-17%
Neuropathology of AD
loss of neurons
synapses in the cerebral cortex
restricted subcortical regions
marked in the medial temporal lobe
hippocampus and entorhinal cortex
parietal lobe and parts of the frontal cortex and cingulate gyrus.
Earliest appearing hallmark = beta-amyloid plaques and neurofibrillary tangles.
Neurotransmitters = acetylcholine and glutamate.
pharmacological treatment has been influenced by neurotransmitters.
MCI
Mild Cognitive Impairment: preclinical state between cognitive changes in a typical ageing brain and pathological changes with AD or another type of dementia.
MCI core clinical criteria
Concern in the change of cognition.
impairment in one or more cognitive domains.
preservation in independence in functional abilities.
NO dementia
DSM-5 Mild Neurocognitive Disorder (MCI)
evidence of a MODEST cognitive decline in one or more domains (attention, executive function, learning/memory, language, perceptual-motor, social cognition); concern of patient/informant/clinician.
DO NOT interfere with independence in everyday activities = IADLs may require greater effort, compensatory strategies/accommodation.
NOT due to delirium.
NOT due to another mental disorder.
- specify with or without behavioral disturbance ( and specify what behavioral disturbance: psychotic symptoms, mood disturbance, agitation, apathy or other behavioral symptoms.
DSM-5 Major Neurocognitive disorder
(Dementia)
evidence of a SIGNIFICANT cognitive decline in one or more domains (attention, executive function, learning/memory, language, perceptual-motor, social cognition): concern of patient/informant/clinician. INTERFERES with everyday activities; needs assistance with IADLs at least.
NOT due to delirium.
NOT due to another mental disorder.
- specify with or without behavioral disturbance.
Symptoms of language expression in AD
EARLY STAGE:
- writing is more affected than oral language.
- can answer questions & decline words.
- miss the point of a joke, don’t understand sarcasm.
MIDDLE STAGE:
word finding difficulties are more obvious, ideational repetition, missing the point of jokes, attempting to interpret nonliteral language literally, difficulty defining words and repeating phrases.
Symptoms of cognitive and communicative functions in AD
EARLY STAGE:
Mental stage: disorientated to time but not place/person.
Motor function: good & ambulatory.
memory function: episodic memory.
NO issues with ADLs.
DIFFICULTIES with IADLs.
longer hesitations and slower speech rate in spontaneous speech.
MIDDLE STAGE:
scoring 16 or below on MMSE
Mental status: more dependency on others. Disorientations worsens, and confusion of time and place.
Motor function: good but restlessness is common.
Memory: worsening episodic memory, decrease in memory span, encoding and retrieval deficits, and semantic memory.
Difficulty focusing attention.
Continence: continence of the bladder becomes problematic.
Basic ADLs are ok, instrumental ADLs need assistance, and driving becomes an issue.
LATE STAGE:
Disorientated to person, place, and time.
MMSE scores 0-9
Incontinence of bladder and later bowel.
Communication abilities: incontinent only for the bladder had more communication skills than that incontinent for the bowel and bladder.
Speech is slower with more halting, a form of language remains intact, some are mute, and reading comprehension is severely impaired.
Risk Factors of MCI
Most significant risk factor is age.
Apolipoprotein APOE carrier status: 3 variants e2, e3, e4.
Diabetes, hyperlipidemia, current smoking, depression, high blood pressure, increased cholesterol, and lack of exercise.
Risk Factors of AD
age, family history of disease, less education, head trauma, loneliness, gender, and age of mother at individual’s birth.
Protective factors
higher level of education, socially and cognitively active lifestyle, and regular physical exercise.
hallmark impairment of MCI and AD
episodic memory impairment
Ceiling effect
Test to characterize cognitive communicative functioning in late-stage dementia is usually too easy for individuals in mild stages.
Floor effect
If a test is challenging for patients with MCI, it’ll probably be too hard for someone with moderate dementia.