IDT - Alzheimers/Dementia Lee Flashcards
What is defined as a deficiency in cognitive function relating to memory, reasoning, planning, attention, language and executive function, and visuospatial perception?
Cognitive Impairment
What is it called when there is a drop from prior levels of cognitive function, and when is it most commonly see?
Mild Cognitive Impairment, common with age progression
Mild Cognitive impairment plus a loss in the ability to care for one’s self is called?
Dementia
What are some daily living activities often impaired in Dementia?
Eating Bathing Grooming Toileting Transferring Cooking
What is the difference between MCI and Dementia?
Detailed history of levels of function prior to impairment
Number of people affected with Alzheimers Disease?
Mortality?
Annual US cost?
5 million Americans
1 in 3 seniors dies w/ Alzheimers or Dementia
6th leading cause of death
Costs 236 billion annually
What Genetic Markers are commonly seen in Alzheimers/Dementia?
APOE-e4 (increases risk)
APP
PSEN-1&2
Family history of CVD
What activities help increase and maintain cognitive reserve?
Education
Social Engagement
What is the most common form of Dementia?
Alzheimers (60-80%)
What is the effect of normal aging on # of neurons?
Preserved
What is the effect of normal aging on brain mass?
Preserved
What is the effect of normal aging on number/speed of Synaptic connections?
Lost
Lose both speed and linkage
What is the effect of normal aging on the storage of memories?
Slowed, not impaired
What is the effect of normal aging on the retrieval of memories?
Preserved, yet slower recall
What is the effect of normal aging on thinking/reasoning?
Slowed, but not impaired
What region of the brain is earliest affected due to dementia? What processes are affected?
Hippocampus (affects memory creation/recall and language
What is the effect of dementia on the size of ventricles and sulci?
Enlargement
What is the timeline for cholinergic neuron loss due to dementia?
(Early) Memory Language Reasoning/Understanding Disinhibition of behavior (Later)
The formation of what cellular body may be responsible for increase in dementia?
Amyloid Beta Plaques (accumulate on outside of cells)
How are Amyloid Beta plaques formed?
APP is cleaved by B-secretase, then gamma-secretase, forming the B-amyloid42 plaques due to insolubility
What normal function should occur to create less amyloid beta plaques?
A-secretase cleavage of APP to B-amyloid40, much more soluble
What is the function of Hyperphosphorylated Tau protein?
Responsible for stabilization of microtubules, which transport molecules and nutrients within the cell, axon, dendrites
What is the Cholinergic Hypothesis?
Hypothesis for Alzheimers which states Loss of cholinergic neurons is responsible for AD, now considered a downstream event.
What is the impaired glucose transport Hypothesis?
Novel hypothesis for AD, that a disruption of energy formation in brain leads to oxidative stress, free radical formation, inflammation, and neuronal death, decreasing cognitive function.
What is the “bottom line” about the cause of AD?
Multifactorial disease with no single cause and no single cure.
What is the relationship between appearance of plaques and AD Dementia
Positive, approximately a 10 year delay between pathology and symptoms.
What is the prevalence/start time of Early onset AD?
5% of all AD patients
Symptoms start <65yo
Can start in 30s
(Genetics is stronger)
What is MMSE score of 30-26?
Preclinical
No symptoms, only possible biomarker changes
What is MMSE score of 22-26?
A drop in cognitive function, can be due to normal aging, no functional changes yet
What is MMSE score <22?
Dementia due to AD based on clinical symptoms, functional impairments have occurred
Mild AD primarily is expressed as?
Problems with Memory
- finding right word/name
- forgetting material just read
- losing/misplacing things
- problems organizing/planning
Moderate AD primarily expressed as?
More problematic
- forgetfulness of personal history (address, phone #)
- trouble with bladder
- personality/behavioral changes
Severed AD primarily expressed as?
Late Stage
Require full time care
Loss of awareness
Changes in physical abilities
approximately 10-20% of all dementias, caused by cerebrovascular infarcts or narrowing of the arteries that is progressive.
Vascular Dementia,
Symptoms of Vascular Dementia
Depend on where infarcts are, may include urinary incontinence and frequent falls. Symptom progression is stepwise.
Vascular Dementia vs Alzheimer’s Slope
Alzheimers - Steady decline
Vascular - Step decline
(Possible combination)
Lewbody Dementia Symptoms
Inattention Executive Dysfunction Visuaspatial impairment Visual Hallucinations (common) Memory Loss (less common)
What is Picks Disease?
Frontotemporal dementia, makes up 2% of dementias
Social behavior and personality changes
(grumpy old people)
Do well on cognitive testing, memory and executive function
Treatment options for AD and Dementia
Cholinesterase Inhibitors
NMDA antagonist
Types of Cholinesterase Inhibitors
Donepezil
Galantamine
Rivastigmine
Tacrine (not marketed)
NMDA antagonist for AD
Memantine
ChE inhibitors Mechanism
Increase ACh in synaptic cleft, to help with loss of cholinergic neurons
What is the length of efficacy of cholinesterase inhibitors
About 6 months of delayed symptoms
Adverse effects of ChE inhibitors
Cholinergic Side Effects GI: Nausea, Vomiting Diarrhea Anorexia, weight loss Bradycardia Muscle Tremor/Weakness Insomnia
Memantine for treatment of AD
Not useful as Monotherapy
effective in combination with ChE inhibitor
What are the four current targets for Drug Research in AD?
Tau Protein
Insulin
Inflammation
B-A Cascade
What is the difference between Delirium and Dementia?
Delirium is an acute disease that fluctuates throughout the day but does not progress further and may also have some precipitating factors.
What percentage of hospitalized older adults experience delirium?
30%
What percentage of older adults are hospitalized for a hip fracture or injurious fall?
50%
What percentage of delirium in older hospitalized patients is missed?
70%
What percentage of older adults w/ delirium in hospitals have symptoms over 6 months?
30%
What is the average length of hospital stay for adults with delirium and what is the estimated cost of delirium to the US?
8 days, approximately $150 million
D.E.L.I.R.I.U.M
Dementia Electrolytes levels Lungs (liver, heart, kidney) Infection Rx Injury, pain, stress Unfamiliar scenery Metabolic
What are common precipitating factors for postoperative delirium?
Confusion New Environment Pain or Discomfort Depression Sleep disruption
What are some strategies to prevent delirium?
Cogntitive Stimulation Quiet Time Sleep Hygiene Orientation Protocols Prevent Hypoxemia Mobilization Avoid Restraints Hydration Glasses/Hearing Aids Manage Pain
What Tests can be used to screen for Delirium?
CAM
DSM-4
(recommended frequently, up to daily, it is based on recent history)
What percentage of psychiatric consults with older adults are diagnosed with delirium?
40%
Hypoactive vs Hyperactive Delirium
Hypoactive - say yes, sedated, peaceful, “model patient”
Hyperactive - Agitation, aggression, pull out IV lines
When do you treat for delirium?
Only when they might cause harm to self or others
NEVER “just in case”
Psychiatric symptoms of dementia?
Agitation Aggression Delusions Hallucinations Wandering Depression Sleep Disturbances
