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Neuropsychology > Lecture 10: Dementia 2: Chapter 20 > Flashcards

Lecture 10: Dementia 2: Chapter 20 Flashcards

1
Q

How does NMDA-antagonist (Memantine) work? (hint = glutamate) Explain in 3 steps

A
  1. Early dementia: large amount of glutamate activates NMDA receptors
  2. Excess of glutamate causes this receptor to be overstimulated, causing broken connections or death of neurons
  3. NMDA antagonists inhibit this process by blocking the receptor
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2
Q

What are 4 aspects of the cognitive profile of NCD due to vascular disease?

A
  1. Mental and psychomotor slowing
  2. Problems with initiating, planning and mental flexibility
  3. Relative intact memory and language skills
  4. Sometimes personality changes, loss of insight
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3
Q

What are the 2 main differences between vascular dementia and Alzheimer?

A

Vascular:
- Mental/psychomotor slowing. Motor symptoms (difficulty walking and keeping balance)
- Intact memory and language skills

AD:
- Main symptom is memory problems
- Less issues with mood and personality changes, only later on

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4
Q

What is the prevalence of AD, VD, FTD and LBD in the Netherlands?

A

65% Alzheimer
22% Vascular Dementia
4% Frontotemporal Dementia
2% Lewy Bodies Dementia

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5
Q

Fill in the percentage:

Within 3-12 months after a stroke approximately … % of the patients are classified with a major NCD/Dementia

A

25%

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6
Q

Pure variants of the dementia types are mostly diagnosed among ….

A

Young patients

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7
Q

What are 2 possible explanations for varying prevalence rates of vascular dementia?

A
  1. Culture (e.g. lifestyle)
  2. Ethnic risk factors (e.g. hypertension)
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8
Q

What are 2 possible causes of vascular dementia? Which one is most common?

A
  1. One or more strategic strokes (multi infarct dementia)
  2. Small vessel disease (SVD)
    –> most common
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9
Q

What is the small vessel disease (SVD)?

A

Umbrella term covering a variety of abnormalities related to small blood vessls in the brain

The abnormalities are often widespread white matter lesions

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10
Q

How does small vessel disease look on an MRI?

A

As very white tissue

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11
Q

What are 3 types of risk factors for vascular dementia?

A
  1. Increasing age (rare before age 65, higher risk at 90s)
  2. History of cardial problems, strokes or TIAs
  3. Vascular damage (blockage or narrowed vessels)
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12
Q

What are 5 things vascular damage is associated with?

A
  1. High blood pressure
  2. High cholesterol (high LDL)
  3. Smoking
  4. Obesity
  5. (Comorbid) somatic diseases (diabetes)
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13
Q

Risk factors of vascular dementia are similar to…

A

Heart diseases and strokes! Always ask for history of cardial problems

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14
Q

What is the beginning of the course of decline for the different types of vascular dementia?

A
  1. Strategic/multiple minor strokes: sudden onset
  2. Small Vessel Disease: begin slowly over time
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15
Q

Why is vascular dementia so heterogeneous?

A

Severity and localization of vascular damage disease is different for everyone

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16
Q

What does it predict when someone with VaD has had a history of depression?

A

More at risk to develop depression during vascular dementia, not only due to loss of independence

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17
Q

What are 3 clinical characteristics in which Alzheimer’s and VaD are similar?

A

Issues with memory, language or visuoperceptual/spatial functioning after strokes or further progression of small vessel disease

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18
Q

When can a burn out be a sign for dementia?

A

When people are older than age 65 and they get their first burn-out in life, this can be a sign

People can get burned out as a consequence of their poorer cognition (can’t keep up)

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19
Q

What is the MRI Fazekas score?

A

It’s a score for white matter pathology, ranging from 0 to 3

A high score means more white matter changes than normal for the person of that age

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20
Q

What are multiple lacunar infarcts?

A

Multiple strokes

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21
Q

When testing someone with VaD on tests, what type of tests have the lowest scores? (4)

A

Abnormal results in executive functioning, complex attention, psychomotor speed tests and visual constructive functioning

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22
Q

What is the figure of ray task and what does it indicate?

A

Copying picture –> if not great, visuoperceptual problems

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23
Q

What does it mean when someone is bad at connecting 1A-2B- etc.?

A

Poor divided attention, poor executive functioning

24
Q

What is the meander task and what does it measure?

A

Copy a pattern in a line (hard for people with VaD)

25
Q

What are the 2 main types of frontotemporal neurocognitive disorders?

A
  1. Behavioral variant
  2. Language variant

Frontotemporal dementia is very heterogeneous and there are continuous discoveries of other types of this dementia

26
Q

What is the difference between the behavioral and the language variants of FTD?

A

Behavioral: progressive disturbances in personality, emotion and behavior

Language: primary progressive aphasia (PPA): gradual impairment of language. Language are the initial problem and most disabling

27
Q

What is primary progressive aphasia (PPA)?

A

Gradual impairment of language in FTD

28
Q

What is typically the onset of FTD?

A

75-80% starts before age 65

Of the early onset dementias, FTD is the most frequently diagnosed type

29
Q

What is the heritability of FTD?

A

40% of FTD patients has a positive family background (all early dementias are often quite heritable)

30
Q

What are 4 symptoms of the behavioral variant of FTD?

A

Behavioral symptoms are most salient and disabling
1. Disinhibition, impulsivity, hyperactivity
2. Apathy/inertia
3. Loss of empathy/sympathy
4. Perseverative, stereotype behavior or compulsive/ritualistic behavior

31
Q

Why is behavioral FTD often undetected at an early stage?

A

Patients aren’t aware of their changed problems and/or see no issue with it

32
Q

What are the 3 types of primary progressive aphasia (PPA) in language FTD?

A
  1. Semantic
  2. Logopenic
  3. Nonfluent-agrammatic
33
Q

What is the difference between FTD and AD?

A

Localization is different:
- FTD: atrophy frontotemporal
- AD: atrophy hippocampus

34
Q

What is inertia?

A

Lack of interest, willingness, activity

35
Q

At which symptom should you NOT look when trying to distinguish VD from FTD?

A

Apathy and inertia

36
Q

What are 2 symptoms of semantic dementia? What are they still able to do?

A
  1. Deficits in naming (low frequency words progressing to higher frequency words)
  2. Impaired single word comprehension: people lose knowledge of words, can’t read or write irregular

Able: to speak fluently with intact grammar and intact repetitions of words or sentences

37
Q

What are 5 ways of assessment of semantic dementia?

A
  1. Observe and listen for impaired comprehension and language mistakes
  2. Comprehensive language tests (CAT)
  3. Object naming test (boston naming and reading test (regular/irregular words))
  4. Comprehension tests (Token test)
  5. Word fluency tasks
38
Q

What is paraphasia?

A

Production of an unintended word, phrase or sound

39
Q

What are 3 types of paraphasia?

A
  1. Semantic paraphasia
  2. Neologisms
  3. Phonemic paraphasia
40
Q

What is semantic paraphasia? Give an example

A

Entire word is substituted for the intended word

(saying son instead of daughter)

41
Q

What is a neologism? Give an example

A

Use of non-real words in place of the intended word

(toothbrush is called a slunker)

42
Q

In what type of aphasia are neologisms common? (2)

A
  1. Wernicke’s aphasia
  2. Fluent aphasia
43
Q

What is phonemic paraphasia? Give an example

A

When a sound substitution or rearrangement is made, but the stated word still resembles the intended word

E.g. hat instead of that
tephelone instead of telephone

44
Q

When is paraphasia seen in VD and AD?

A

In later stages
(FTD early stages)

45
Q

How does wernicke-korsakoff dementia work?

A

Years of alcohol abuse + nutrition problem –> thiamine deficiency –> brain damage

46
Q

What are the symptoms of the wernicke part of wernicke-korsakoff dementia? (2)

A
  1. Double vision
  2. Cerebellum disturbances leading to motor coordination problems
47
Q

What are the symptoms of the korsakoff part of wernicke-korsakoff dementia? (4)

A
  1. Very weak memory encoding
  2. Memory retieval deficits for recent and long term memories (black holes)
  3. Executive problems and personal changes
  4. Lack of insight in problems/denial or covering up (confabulation) or forgetfulness
48
Q

What is confabulation and which type of dementia fits this symptom best?

A

Covering up problems

In wernicke-korsakoff dementia

49
Q

How can you help someone in the wernicke phase of WKD?

A

Give vitamins and help person get rid of alcohol problem stops the progression of the disease

50
Q

What is a clear observable characteristic of someone with WKD?

A

They live in the moment with very severe memory impairment

51
Q

In which type of dementia could cognitive deterioration be stopped or even be partially reversible?

A

in WKD

Can occur when alcohol use stops and vitamins are suppleted

52
Q

When is neuropsychological assessment particularly helpful?

A

In the early phases of behavioral and cognitive changes. You can monitor the deterioration and need for support

53
Q

What are 3 functions of neuropsychological assessment in people with dementia?

A
  1. Monitor and support people
  2. Important info gathered to find and train compensatory strategies
  3. Psycho education can provide relieve
54
Q

What is economy of speech?

A

People with language FTD tend to speak less as the disease advances

55
Q

What is progressive non-fluent aphasia? (PNFA)

A

Isolated and gradually progressive deterioration in language production. No impact on language comprehension, show insight into own functioning and attempt self correction.

Later on frustration, irritability and depression may occur

Neuropsychology (16 decks)

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