Final Exam: Week 5 Dementia Flashcards
Cognitive aging
A lifelong developmental process occurring from birth to death
Cognitive aging framework
Gains, declines and stability
Cognitive aging is impacted by…
Diet, exercise, health habits, and education
Other factors affecting cognition
Neurobiological influences and affective influences
Neurobiological influences
Related to biology, disease process, sensory systems, auditory/visual systems and will have direct affect on cognition, medication
Affective influences
Things that happen in our lives that may affect our cognition but not directly related to the pathophysiology: anxiety, fatigue, pain, depression
Sensory processes
Transmits stimuli from environmental to neural structures, auditory and visual processing declines with old age
Perception
Assign meaning to stimuli, older adults utilize situational context and experience to maintain perceptual abilities necessary to function
Sustained attention
Direct to a single task, no change comparing younger to older adults
Selective attention
Direct to a task while simultaneously using resources to ignore distracting information. Probably no change with age
Alternating attention
Switching between two or more tasks, older adults have more difficulty
Divided attention
Allocate attentional resources to two or more tasks at the same time, declines with age
T/F: Memory does not decline with age
False, memory has the MOST decline with age
Sensory memory
Stores incoming info for a very short time
Short-term memory
15-20 seconds stored without rehearsal
Working memory
Stores, maintains actively manipulates information
Long-term memory
Declarative: verbal based memory
Semantic: general world knowledge not linked to a specific learning episode
Procedural memory
Well preserved in later life, stores information for motor based skills and behaviors
Prospective memory
Remember future oriented or scheduled tasks without the use of external memory aids
Executive functioning
- Reasoning, decision making, problem solving, judgement, abstract thought, and logic
- Significant differences from younger to older
- Differences seem to be greater as task complexity increases and as additional cognitive resources are needed
Problem solving
Older adults tend to use less efficient strategies, persist longer in using erroneous solution and produce more errors
Everyday cognition
Utilize cognitive processes in real world contexts, fewer age related differences
Language production and speech comprehension
Older adults OUTPERFORM younger in message production and discourse (storytelling)
Wisdom
Do not know if this changes or remains the same with age
Expertise
High level of skill/knowledge in one area- problem solving, reasoning, memory
- Maintains in later life and compensates for other deficits
Implicit processing
Unintentional, occurs without awareness, requires minimal cognitive resources, minimal change young to old
Explicit processing
Intentional, occurs with awareness, effortful- requires moderate to substantial cognitive resources, some age related decline
Intellectual abilities
Fluid intelligence- ability to use abstract reasoning, decline begins around age 70
Crystalized intelligence- accumulation of knowledge, experience, increase throughout life and maintains in old age
Optimizing cognition in later life
Physical activity, mentally stimulating activities, social engagement
Mild cognitive impairment (MCI)
The changes in memory and other areas of cognitive function that may be seen in healthy older adults
Impact of MCI on daily activities
Not a strong impact, still can complete ADLs and IADLs
Impact of MCI on leisure activities
Does not impact- however engagement in leisure has been found to have positive impact on cognition
Most common form of dementia
Alzheimer’s dementia
5.2 million living with AD
What is dementia?
- Can’t meet everyday demands of life
- Affects cognition, behavior, and occupational performance
- Irreversible condition
- Memory loss not always first sign
- An acquired, persistent impairment in multiple areas of functioning not due to delirium
Impact dementia has on behavior and occupational performance
- Deterioration in day to day functioning
- Ability to engage in meaningful occupation
- Safety concerns
Impact dementia has on family
- Increased stress on informal caregivers
- Financial situations
Delirium
Alteration of mental status characterized by an inability to appreciate and respond normally to the environment
Difference between delirium and dementia
Delirium is often reversible, viewed as a medical problem that can be diagnosed and treated
Causes of delirium
- Thyroid disorders
- Urinary Tract Infection (UTIs)
- Electrolyte imbalances
- Hormonal imbalances
- Normal Pressure Hydrocephalus (NPH)
- Tumors
- Stroke
- Intoxication
- Withdrawal from substances
- Depression
- Systemic Illness (kidney, cardiac)
- Other infections
- End stage liver disease
____% of dementias are due to delirium, other ____% are other types
13%, 87%
Other types of dementia
- Alzheimer’s disease
- Vascular Dementia
- Frontal-temporal Dementia
- Lewy-body Dementia
- Korsakoff’s syndrome
- Huntington’s disease
- AIDS related
- Parkinson’s with Dementia
- Multiple Sclerosis
Other types of dementia
- Alzheimer’s disease
- Vascular Dementia
- Frontal-temporal Dementia
- Lewy-body Dementia
- Korsakoff’s syndrome
- Huntington’s disease
- AIDS related
- Parkinson’s with Dementia
- Multiple Sclerosis
Cause of vascular dementia (VaD)
- Result of cerebral vascular damage
- Single brain infarct or multiple lesions
- Changes to white matter
Subcortical ischemic vascular dementia (SIVD)
Numerous discrete subcortical lesions
Vascular cognitive impairment (VCI)
- Changes that occur due to vascular lesions (cognitive)
- Can be treated, doesn’t always turn into VaD
- Recognition of VCI may allow for early diagnosis/intervention
Hallmark of VCI and VaD
Dysexecutive syndrome- problems with attention, working memory, planning, sequencing, abstraction
Who is at risk for VCI or VaD?
Advanced age, male, history of stroke, hypertension
Cause of dementia with Lewy bodies
- Presence of lewy bodies→ damaged nerve cells, amyloid and plaque formation similar to AD
- Hallmark → round neurofilament inclusion bodies that contain damaged nerve cell deposits
Core features of DLB
- Hallucinations
- Parkinsonian symptoms
- Cognitive fluctuations
COG BEFORE MOTOR
Age onset of frontotemporal dementia
57 years, insidious onset with slow progression
Symptoms of FTD
- Changes in personality→ casual but prominent
- Behavioral disturbances and changes in social interaction
- Failure to demonstrate basic emotions
- Difficulty regulating behaviors
Parkinson’s disease with dementia
Typically develops slowly… cog skills diminish first
Other than TIME SEQUENCE of symptoms there are no distinguishing factors between PDD and DLB
Alzheimer’s disease
- Most common form
- Intellectual impairment/behavior and personality
- Irreversible and progressive
- Advancing age is risk factor
- Diagnosed when individuals demonstrate onset of hallmark feature impaired memory as well as deficits in one other cognitive domain
Pathology of Alzheimer’s disease
- Brain shrinks over time
Diagnosis of Alzheimer’s disease
Must demonstrate a decline in three or more of the following:
- Memory
- Language
- Perception (especially visuospatial)
- Praxis
- Calculations
- Conceptual or Semantic Knowledge
- Executive Functions
- Personality or social behavior
- Emotional awareness or expression
T/F Most of the AD population is female
True
Dementia risk factors
- Increasing age
- Female
- Black
- Having family history of dementia
- Serious head injury with loss of consciousness
- Genetic factors
