late life disorders Flashcards
the ‘old’ population is that aged over
65
the different classes of old are
65-74 - young old
75 - 84 old-old
85+ OLDEST old
the old population is;
a) increasing
b) decreasing
c) stable
d) none
A - is the fastest growing population
older adulthood is labelled based on social obligation rather than biological age
(T/F)
True
forgetfulness is a _____ part of ageing
NORMAL
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 - 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
The MOST prominent + FIRST cognitive function to suffer from ageing is
Information processing
3 DSM neurocognitive disorders
Mild cognitive disorder
Major cognitive disorder
delirium
MAJOR cognitive disorder defined as;
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
MILD cognitive disorder defined as ;
a) mild cognitive decline from prior functioning (determined by self report + assmt)
b) problems do NOT interfere with daily activities
= is a MCI
MCI is________ and is considered a __________ stage
Mild Cognitive impairment (WITHIN 1.5 SD away from pop norm);
prodromal for later Ncog imparments.
Do NOT have dementia
The 2 types of MCI are________ and are classified based on
Amnestic / non Amnestic; whether or not memory impairments are present
of those with MCI, ____% are likely to get dementia, more people with ___MCI type are likely to get dementia
20-40%; aMCI 8.5x more likely.
Diagnosis of MCI = onset of neurocognitive disorder (T/F)
False - 20% remission, may be exacerbated by MDD = treat that and MCI may disappear
The current TMT for MCI is
there is none, BUT may advise;
exercise, cognitive stimulation, good diet (healthy FATS); meds (cholinergic meds)
Which is NOT a risk factor for MCI;
a) APOE allele
b) cardiovascular disease + hypertension
c) diabetes
d) smoking
e) marriage status
diabetes.
Dementia is _____in prevalence and we_______ treat it
INCREASING; cannot
The major types of dementia are
Alzheimers
frontotemporal
vascular
lewy body
Dementia is a new disorder and thus has a growing prevalence (T/F)
False - more awareness, more people seeking help, growing older population
Dementia and MCI have the same prognosis (T/F)
False - dementia will be fatal.
MCI is a type of MILD neurocog disorder
Dementia is a type of MAJOR neurocog impairment = cant have both
Alzheimers Disease affects ______ cognitive domains
Memory; language; visuospatial skills, executive function;
AD has a _____onset
insidious / gradual
A major issue with treating AD is that ________
by the time client SELF-REPORTS issues with cognition, it is already too late
Typical changes accompanying AD are
Different sleep + appetite
fatigue
depression
social withdrawal
the earliest physiological markers of AD are
amyloid B plaques
tau protein related injury
structural changes (hippocampus/ventricles)
Early behavioural presentations may be
cant remember right word/ name
struggle with tasks MORE in social / work settings
forgetting something you just read
trouble with planning + organising
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 - we DO produce it naturally
How are beta-A plaques made?
a) after used, enzymes break Beta-A into fragments
b) Fragments do not get metabolised correctly
c) CLUSTERS of plaques accumulate
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
C - transmisison FAILS
What causes the synaptic transmission issues observed in AD?
a) memory decline
b) Beta-amyloid plaques
c) Tau tangles
d) enlarged ventricles
C - cell death + loss of connectivity due to Tau protein tangles
Amyloid plaques start in _________, whereas Tau starts________
PFC (language, exec function); hippocampus (memory)
By targeting the EARLIEST sign of AD (Beta-A), we would be able to stop development of AD (T/F)
False, Tau prteins are the ones that cause the MOST damage. Beta A is just its precursor
Which is NOT a genetic factor for AD?
a) 79% heritability
b) 10 candidate genes
c) APOE-4 in chromosome 19
d) DA hypersensitivity
D.
Frequency among families + similar age of onset = genetic association
Having APOE-4 gene + number of copies = EARLIER onset. Associated with Beta-A plaques
The ‘nun study’ showed________ and supports idea that______
LOW linguistic ability predicted AD = ‘use it or lose it’ need to engage brain
Empirical evidence shows ________can protect against the rate of AD
Puzzles
Vascular dementia is classified as ______neurocogitive impairment
MAJOR
AD differs from VD in that
VD is caused by reduced BLOOD FLOW to the brain, from a carebrovascular event i.e. stroke = onset of dementia symptoms
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
C - wrong, 15-20% of demenita cases
Vascular dementia often has varying clinical presentations (T/F)
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
fronto-temporal dementia involves neuronal loss ________lobes
Frontal + temporal lobes
Which dementia has the worst prognosis?
Frontotemporal, because causes death <10 years and EARLIEST onset (45-65)
Frontotemporal dementia affects males and females equally (T/F)
False -14:3 male /female ratio
The cause of FTD is________
Pick’s disease - presence of pick bodies (spherical inclusions) within neurons
High levels of Tau -
strong genetic component
3 types of FTD
Behavioural variant (50%) Semantic dementia - memory/language Progressive non-fluent aphasia - break down in language PRODUCTION
Major distinction between behavioural / language sybtypes of FTD_____________
Behavioural = decline in interpersonal / executive / social skills, impulsive, inattentive.
FTD is diagnosed with__________
during interview with clinician, often not captured by battery testing
Treatments for dementia__________
cholinergic drugs
antipsychotics
antidepressants
sedatives
Behavioural tmts / preventatives for dementia;
psychotherapy, exercise, cognitive training, education, hearing loss, smoking, hypertension, obesity, depression, social isolation, obesity
Interventions should also be created for caregivers of those with dementia (T/F)
True
What are the NORMAL age related changes to sleep?
a) circadian timing EARLY, sleep/wake earlier
b) reduced SWS
c) more FRAGMENTED sleep
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
ALL ARE RIGHT
Sleep is directly related to Beta-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
SWS is important for_________functions
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
What is the relationship between DLMO and dementia?
those with a GREATER difference between DLMO and sleep time (melatonin secretion to actual sleep time) had greater subjective decline
How do rest-activity cycles relate to cognitive decline
MORE variability = more impairment i.e. sleeping/waking at odd times in 24h
Delirium is ____________
- 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
Differences in dementia/delirium
- 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
Suggested causes of delirium______________
a primary illness = treat that and delirium should pass malnourished drugs/meds extreme stress infections/fever i.e. UTI sleep disturbances
The 2 types of studies for ageing are___________
longitudinal + cross sectional
an issue when diagnosing older populations with the DSM is
many disorders specify ‘not in the presence of another illness’ but 80% of older people have illnesses
DSM-5 criteria for mild cognitive disorder is
LOW performance on only ONE test of function
Death after AD typically occurs after _________
12 years
In AD __________memory gets impacted whereas_________gets preserved
WM - worse
LTM - ok
Beta-AMyl plaques / tau can be spooted_______before symptom onset and looked at by ________device
10-20y prior; PET scan
meaured through CSF, PET
__________ areas are unaffected by AD
motor + sensory
a core feature of FTD is memory loss (T/F)
FALSE
Dementia is an umbrella term encompassing deficits in memory (T/F)
FALSE - cognitive decline
Dementia with Lewy Bodies (DLB) hallmark feature is
accumuation of lewy body proteins in brain
Symptoms of DLB are
FLUCTUATING cognition, alertness
visual hallucinations
spontaneous motor features of parkinsonism
intense dreams accompanied with
vocalizing as if they are acting in their dreams
DLB is distinct from dementia in Parkinsons bc
DLB diagnosis is made BEFORE or alongside PD whereas Dementia with PD is when person has well established PD already
Dementias caused by injury________
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
Antipsychotics for AD are;
a) effective
b) ineffective
c) moderately effective
d) increase chance of death
Both C/D, moderate for reducing agitation
Delirium physiological features ___________
Fever, Flushed face, dilated pupils, tremors, rapid
heartbeat, elevated blood pressure, incontinence of urine and faeces, lethargy
Mortality of delirium is ___________-
low, BUT if untreated, very high
