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3032 > late life disorders > Flashcards

late life disorders Flashcards

1
Q

the ‘old’ population is that aged over

A

65

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2
Q

the different classes of old are

A

65-74 - young old
75 - 84 old-old
85+ OLDEST old

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3
Q

the old population is;

a) increasing
b) decreasing
c) stable
d) none

A

A - is the fastest growing population

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4
Q

older adulthood is labelled based on social obligation rather than biological age
(T/F)

A

True

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5
Q

forgetfulness is a _____ part of ageing

A

NORMAL

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6
Q

CORRECT is;

a) global cognitive decline is normal
b) depression rates decrease, sleep decreases
c) mental illnesses are not MORE common in ageing
d) older people are lonely

A

A - global recline is NOT normal, may have specific decline
B - depression INCREASES, sleep decline is NOT NORMAL
C - not more normal, prevalence only 10-20%
D - are not lonely, but more SELECTIVE in their friendships

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7
Q

The MOST prominent + FIRST cognitive function to suffer from ageing is

A

Information processing

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8
Q

3 DSM neurocognitive disorders

A

Mild cognitive disorder
Major cognitive disorder
delirium

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9
Q

MAJOR cognitive disorder defined as;

A

1) SIGNIFICANT cog decline in 1+ domains
b) interfere with function (as reported by self-report AND assessment >1.5 SD away from norm)
c) are not attributable to delirium

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10
Q

MILD cognitive disorder defined as ;

A

a) mild cognitive decline from prior functioning (determined by self report + assmt)
b) problems do NOT interfere with daily activities
= is a MCI

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11
Q

MCI is________ and is considered a __________ stage

A

Mild Cognitive impairment (WITHIN 1.5 SD away from pop norm);
prodromal for later Ncog imparments.
Do NOT have dementia

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12
Q

The 2 types of MCI are________ and are classified based on

A

Amnestic / non Amnestic; whether or not memory impairments are present

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13
Q

of those with MCI, ____% are likely to get dementia, more people with ___MCI type are likely to get dementia

A

20-40%; aMCI 8.5x more likely.

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14
Q

Diagnosis of MCI = onset of neurocognitive disorder (T/F)

A

False - 20% remission, may be exacerbated by MDD = treat that and MCI may disappear

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15
Q

The current TMT for MCI is

A

there is none, BUT may advise;

exercise, cognitive stimulation, good diet (healthy FATS); meds (cholinergic meds)

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16
Q

Which is NOT a risk factor for MCI;

a) APOE allele
b) cardiovascular disease + hypertension
c) diabetes
d) smoking
e) marriage status

A

diabetes.

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17
Q

Dementia is _____in prevalence and we_______ treat it

A

INCREASING; cannot

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18
Q

The major types of dementia are

A

Alzheimers
frontotemporal
vascular
lewy body

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19
Q

Dementia is a new disorder and thus has a growing prevalence (T/F)

A

False - more awareness, more people seeking help, growing older population

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20
Q

Dementia and MCI have the same prognosis (T/F)

A

False - dementia will be fatal.
MCI is a type of MILD neurocog disorder
Dementia is a type of MAJOR neurocog impairment = cant have both

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21
Q

Alzheimers Disease affects ______ cognitive domains

A

Memory; language; visuospatial skills, executive function;

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22
Q

AD has a _____onset

A

insidious / gradual

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23
Q

A major issue with treating AD is that ________

A

by the time client SELF-REPORTS issues with cognition, it is already too late

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24
Q

Typical changes accompanying AD are

A

Different sleep + appetite
fatigue
depression
social withdrawal

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25
Q

the earliest physiological markers of AD are

A

amyloid B plaques
tau protein related injury
structural changes (hippocampus/ventricles)

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26
Q

Early behavioural presentations may be

A

cant remember right word/ name
struggle with tasks MORE in social / work settings
forgetting something you just read
trouble with planning + organising

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27
Q

Incorrect is -

a) Beta-amyloid are only produced in AD
b) Beta amyloid is a naturally produced protein
c) Beta amyloid is important for wakefulness and cell metabolism
d) Pathological Beta-Amyloid accumulates when it is not metabolised coreectly

A

A - we DO produce it naturally

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28
Q

How are beta-A plaques made?

A

a) after used, enzymes break Beta-A into fragments
b) Fragments do not get metabolised correctly
c) CLUSTERS of plaques accumulate

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29
Q

INCORRECT regarding Tau protein tangle;

a) stabilise neruron’s axon
b) disintegrate in AD, crumple in on themselves
c) decreased length increases transmission
d) neuron eventually becomes non-functional + dies

A

C - transmisison FAILS

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30
Q

What causes the synaptic transmission issues observed in AD?

a) memory decline
b) Beta-amyloid plaques
c) Tau tangles
d) enlarged ventricles

A

C - cell death + loss of connectivity due to Tau protein tangles

31
Q

Amyloid plaques start in _________, whereas Tau starts________

A

PFC (language, exec function); hippocampus (memory)

32
Q

By targeting the EARLIEST sign of AD (Beta-A), we would be able to stop development of AD (T/F)

A

False, Tau prteins are the ones that cause the MOST damage. Beta A is just its precursor

33
Q

Which is NOT a genetic factor for AD?

a) 79% heritability
b) 10 candidate genes
c) APOE-4 in chromosome 19
d) DA hypersensitivity

A

D.
Frequency among families + similar age of onset = genetic association

Having APOE-4 gene + number of copies = EARLIER onset. Associated with Beta-A plaques

34
Q

The ‘nun study’ showed________ and supports idea that______

A

LOW linguistic ability predicted AD = ‘use it or lose it’ need to engage brain

35
Q

Empirical evidence shows ________can protect against the rate of AD

A

Puzzles

36
Q

Vascular dementia is classified as ______neurocogitive impairment

A

MAJOR

37
Q

AD differs from VD in that

A

VD is caused by reduced BLOOD FLOW to the brain, from a carebrovascular event i.e. stroke = onset of dementia symptoms

38
Q

Which is incorrect;

a) Vascular dementia occurs on a spectrum from MCI
b) There is great (50%) overlap with AD = comorbid
c) VD accounts for 50% dementia cases
d) clinical features include gait disturbance + history of falls

A

C - wrong, 15-20% of demenita cases

39
Q

Vascular dementia often has varying clinical presentations (T/F)

A

True - because the cereborvascular lesion i.e. stroke can appear in ANY PLACE of the brain = different symptoms. but overall shares a marked decline in cognition + impacts functioning

40
Q

fronto-temporal dementia involves neuronal loss ________lobes

A

Frontal + temporal lobes

41
Q

Which dementia has the worst prognosis?

A

Frontotemporal, because causes death <10 years and EARLIEST onset (45-65)

42
Q

Frontotemporal dementia affects males and females equally (T/F)

A

False -14:3 male /female ratio

43
Q

The cause of FTD is________

A

Pick’s disease - presence of pick bodies (spherical inclusions) within neurons
High levels of Tau -
strong genetic component

44
Q

3 types of FTD

A 
Behavioural variant (50%)
Semantic dementia - memory/language 
Progressive non-fluent aphasia - break down in language PRODUCTION
45
Q

Major distinction between behavioural / language sybtypes of FTD_____________

A

Behavioural = decline in interpersonal / executive / social skills, impulsive, inattentive.

46
Q

FTD is diagnosed with__________

A

during interview with clinician, often not captured by battery testing

47
Q

Treatments for dementia__________

A

cholinergic drugs
antipsychotics
antidepressants
sedatives

48
Q

Behavioural tmts / preventatives for dementia;

A

psychotherapy, exercise, cognitive training, education, hearing loss, smoking, hypertension, obesity, depression, social isolation, obesity

49
Q

Interventions should also be created for caregivers of those with dementia (T/F)

A

True

50
Q

What are the NORMAL age related changes to sleep?

A

a) circadian timing EARLY, sleep/wake earlier
b) reduced SWS
c) more FRAGMENTED sleep

51
Q

Dementia is NOT associated with;

a) increased day time sleepiness
b) difficulty falling asleep (insomnia like)
c) difficulty initiating/staying asleep
d) early morning awakening
e) ‘sun downing’ - confusion from losing day /night distinction during early night

A

ALL ARE RIGHT

52
Q

Sleep is directly related to Beta-A ___________

A

a) sleep disruption = more time awake
wakefulness = propelled by Beta A proteins
More Beta-A = greater chance of plaques
b) reduced SWS in old age = reduced toxin clearance
= more accumulation of plaques/tau
c) rhythm disruption = greater cog stress + decline

number of awakenings + duration predicts for cognitive decline

53
Q

SWS is important for_________functions

A

executive function, verbal fluency, memory. Amount of sleep maps on to grey matter volume.
Cortical atrophy may occur regardless of ageing BUT SWS is what determined who got memory problems

54
Q

What is the relationship between DLMO and dementia?

A

those with a GREATER difference between DLMO and sleep time (melatonin secretion to actual sleep time) had greater subjective decline

55
Q

How do rest-activity cycles relate to cognitive decline

A

MORE variability = more impairment i.e. sleeping/waking at odd times in 24h

56
Q

Delirium is ____________

A
  • disturbance of awareness/ attention
  • develops rapidly i.e. hours & fluctuates during the day
  • change in cognitive ability i.e. memory, language, spatial, perceptual deficit
  • IS LIKELY CAUSED BY ANOTHER MEDICAL CONDITION
57
Q

Differences in dementia/delirium

A
  • slow/rapid onset
  • memory/attention deficits ‘cant remember where I am’ vs ‘I am in [different] place’ = confusion
  • primary/secondary condition
  • progressive / fluctuates
  • older age / anyone with weakened immunity
58
Q

Suggested causes of delirium______________

A 
a primary illness = treat that and delirium should pass 
malnourished
drugs/meds
extreme stress
infections/fever i.e. UTI 
sleep disturbances
59
Q

The 2 types of studies for ageing are___________

A

longitudinal + cross sectional

60
Q

an issue when diagnosing older populations with the DSM is

A

many disorders specify ‘not in the presence of another illness’ but 80% of older people have illnesses

61
Q

DSM-5 criteria for mild cognitive disorder is

A

LOW performance on only ONE test of function

62
Q

Death after AD typically occurs after _________

A

12 years

63
Q

In AD __________memory gets impacted whereas_________gets preserved

A

WM - worse

LTM - ok

64
Q

Beta-AMyl plaques / tau can be spooted_______before symptom onset and looked at by ________device

A

10-20y prior; PET scan

meaured through CSF, PET

65
Q

__________ areas are unaffected by AD

A

motor + sensory

66
Q

a core feature of FTD is memory loss (T/F)

A

FALSE

67
Q

Dementia is an umbrella term encompassing deficits in memory (T/F)

A

FALSE - cognitive decline

68
Q

Dementia with Lewy Bodies (DLB) hallmark feature is

A

accumuation of lewy body proteins in brain

69
Q

Symptoms of DLB are

A

FLUCTUATING cognition, alertness
visual hallucinations
spontaneous motor features of parkinsonism
intense dreams accompanied with
vocalizing as if they are acting in their dreams

70
Q

DLB is distinct from dementia in Parkinsons bc

A

DLB diagnosis is made BEFORE or alongside PD whereas Dementia with PD is when person has well established PD already

71
Q

Dementias caused by injury________

A 
Encephalitis - inflammaion of brain tissue from virus 
Meningitis - inflamamtion in membrane covering brain 
HIV
head trauma
Vit B deficincy/ nutrition
kidney/liver failure
endochrine issues
SUD
72
Q

Antipsychotics for AD are;

a) effective
b) ineffective
c) moderately effective
d) increase chance of death

A

Both C/D, moderate for reducing agitation

73
Q

Delirium physiological features ___________

A

Fever, Flushed face, dilated pupils, tremors, rapid

heartbeat, elevated blood pressure, incontinence of urine and faeces, lethargy

74
Q

Mortality of delirium is ___________-

A

low, BUT if untreated, very high

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