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Fall P2 > IDT - Alzheimers/Dementia Lee > Flashcards

IDT - Alzheimers/Dementia Lee Flashcards

1
Q

What is defined as a deficiency in cognitive function relating to memory, reasoning, planning, attention, language and executive function, and visuospatial perception?

A

Cognitive Impairment

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2
Q

What is it called when there is a drop from prior levels of cognitive function, and when is it most commonly see?

A

Mild Cognitive Impairment, common with age progression

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3
Q

Mild Cognitive impairment plus a loss in the ability to care for one’s self is called?

A

Dementia

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4
Q

What are some daily living activities often impaired in Dementia?

A 
Eating
Bathing
Grooming
Toileting
Transferring
Cooking
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5
Q

What is the difference between MCI and Dementia?

A

Detailed history of levels of function prior to impairment

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6
Q

Number of people affected with Alzheimers Disease?
Mortality?
Annual US cost?

A

5 million Americans
1 in 3 seniors dies w/ Alzheimers or Dementia
6th leading cause of death
Costs 236 billion annually

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7
Q

What Genetic Markers are commonly seen in Alzheimers/Dementia?

A

APOE-e4 (increases risk)
APP
PSEN-1&2
Family history of CVD

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8
Q

What activities help increase and maintain cognitive reserve?

A

Education

Social Engagement

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9
Q

What is the most common form of Dementia?

A

Alzheimers (60-80%)

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10
Q

What is the effect of normal aging on # of neurons?

A

Preserved

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11
Q

What is the effect of normal aging on brain mass?

A

Preserved

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12
Q

What is the effect of normal aging on number/speed of Synaptic connections?

A

Lost

Lose both speed and linkage

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13
Q

What is the effect of normal aging on the storage of memories?

A

Slowed, not impaired

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14
Q

What is the effect of normal aging on the retrieval of memories?

A

Preserved, yet slower recall

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15
Q

What is the effect of normal aging on thinking/reasoning?

A

Slowed, but not impaired

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16
Q

What region of the brain is earliest affected due to dementia? What processes are affected?

A

Hippocampus (affects memory creation/recall and language

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17
Q

What is the effect of dementia on the size of ventricles and sulci?

A

Enlargement

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18
Q

What is the timeline for cholinergic neuron loss due to dementia?

A 
(Early)
Memory
Language
Reasoning/Understanding
Disinhibition of behavior (Later)
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19
Q

The formation of what cellular body may be responsible for increase in dementia?

A

Amyloid Beta Plaques (accumulate on outside of cells)

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20
Q

How are Amyloid Beta plaques formed?

A

APP is cleaved by B-secretase, then gamma-secretase, forming the B-amyloid42 plaques due to insolubility

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21
Q

What normal function should occur to create less amyloid beta plaques?

A

A-secretase cleavage of APP to B-amyloid40, much more soluble

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22
Q

What is the function of Hyperphosphorylated Tau protein?

A

Responsible for stabilization of microtubules, which transport molecules and nutrients within the cell, axon, dendrites

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23
Q

What is the Cholinergic Hypothesis?

A

Hypothesis for Alzheimers which states Loss of cholinergic neurons is responsible for AD, now considered a downstream event.

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24
Q

What is the impaired glucose transport Hypothesis?

A

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.

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25
Q

What is the “bottom line” about the cause of AD?

A

Multifactorial disease with no single cause and no single cure.

26
Q

What is the relationship between appearance of plaques and AD Dementia

A

Positive, approximately a 10 year delay between pathology and symptoms.

27
Q

What is the prevalence/start time of Early onset AD?

A

5% of all AD patients
Symptoms start <65yo
Can start in 30s
(Genetics is stronger)

28
Q

What is MMSE score of 30-26?

A

Preclinical

No symptoms, only possible biomarker changes

29
Q

What is MMSE score of 22-26?

A

A drop in cognitive function, can be due to normal aging, no functional changes yet

30
Q

What is MMSE score <22?

A

Dementia due to AD based on clinical symptoms, functional impairments have occurred

31
Q

Mild AD primarily is expressed as?

A

Problems with Memory

  • finding right word/name
  • forgetting material just read
  • losing/misplacing things
  • problems organizing/planning
32
Q

Moderate AD primarily expressed as?

A

More problematic

  • forgetfulness of personal history (address, phone #)
  • trouble with bladder
  • personality/behavioral changes
33
Q

Severed AD primarily expressed as?

A

Late Stage
Require full time care
Loss of awareness
Changes in physical abilities

34
Q

approximately 10-20% of all dementias, caused by cerebrovascular infarcts or narrowing of the arteries that is progressive.

A

Vascular Dementia,

35
Q

Symptoms of Vascular Dementia

A

Depend on where infarcts are, may include urinary incontinence and frequent falls. Symptom progression is stepwise.

36
Q

Vascular Dementia vs Alzheimer’s Slope

A

Alzheimers - Steady decline
Vascular - Step decline
(Possible combination)

37
Q

Lewbody Dementia Symptoms

A 
Inattention
Executive Dysfunction
Visuaspatial impairment
Visual Hallucinations (common)
Memory Loss (less common)
38
Q

What is Picks Disease?

A

Frontotemporal dementia, makes up 2% of dementias
Social behavior and personality changes
(grumpy old people)
Do well on cognitive testing, memory and executive function

39
Q

Treatment options for AD and Dementia

A

Cholinesterase Inhibitors

NMDA antagonist

40
Q

Types of Cholinesterase Inhibitors

A

Donepezil
Galantamine
Rivastigmine
Tacrine (not marketed)

41
Q

NMDA antagonist for AD

A

Memantine

42
Q

ChE inhibitors Mechanism

A

Increase ACh in synaptic cleft, to help with loss of cholinergic neurons

43
Q

What is the length of efficacy of cholinesterase inhibitors

A

About 6 months of delayed symptoms

44
Q

Adverse effects of ChE inhibitors

A 
Cholinergic Side Effects
GI: Nausea, Vomiting Diarrhea
Anorexia, weight loss
Bradycardia
Muscle Tremor/Weakness
Insomnia
45
Q

Memantine for treatment of AD

A

Not useful as Monotherapy

effective in combination with ChE inhibitor

46
Q

What are the four current targets for Drug Research in AD?

A

Tau Protein
Insulin
Inflammation
B-A Cascade

47
Q

What is the difference between Delirium and Dementia?

A

Delirium is an acute disease that fluctuates throughout the day but does not progress further and may also have some precipitating factors.

48
Q

What percentage of hospitalized older adults experience delirium?

A

30%

49
Q

What percentage of older adults are hospitalized for a hip fracture or injurious fall?

A

50%

50
Q

What percentage of delirium in older hospitalized patients is missed?

A

70%

51
Q

What percentage of older adults w/ delirium in hospitals have symptoms over 6 months?

A

30%

52
Q

What is the average length of hospital stay for adults with delirium and what is the estimated cost of delirium to the US?

A

8 days, approximately $150 million

53
Q

D.E.L.I.R.I.U.M

A 
Dementia
Electrolytes levels
Lungs (liver, heart, kidney)
Infection
Rx
Injury, pain, stress
Unfamiliar scenery
Metabolic
54
Q

What are common precipitating factors for postoperative delirium?

A 
Confusion
New Environment
Pain or Discomfort
Depression
Sleep disruption
55
Q

What are some strategies to prevent delirium?

A 
Cogntitive Stimulation
Quiet Time
Sleep Hygiene
Orientation Protocols
Prevent Hypoxemia
Mobilization
Avoid Restraints
Hydration
Glasses/Hearing Aids
Manage Pain
56
Q

What Tests can be used to screen for Delirium?

A

CAM
DSM-4
(recommended frequently, up to daily, it is based on recent history)

57
Q

What percentage of psychiatric consults with older adults are diagnosed with delirium?

A

40%

58
Q

Hypoactive vs Hyperactive Delirium

A

Hypoactive - say yes, sedated, peaceful, “model patient”

Hyperactive - Agitation, aggression, pull out IV lines

59
Q

When do you treat for delirium?

A

Only when they might cause harm to self or others

NEVER “just in case”

60
Q

Psychiatric symptoms of dementia?

A 
Agitation
Aggression
Delusions
Hallucinations
Wandering
Depression
Sleep Disturbances

Fall P2 (13 decks)

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