Lecture 14 Flashcards
What are the Symptoms of Dementia?
- Loss of Intellectual Ability
- Memory Impairments
- Other higher cortical disturbances
- Not Delirium
- Specific or Presumed Organic factor
How are IQ norms established?
By age group
How is memory impaired with Dementia?
Recent events impaired more than historical events
What other disturbances of higher cortical functioning would someone with Dementia experience? Besides memory impairments
- Impaired Abstract thinking
- Impaired judgement
- Aphasia, Apraxia, Agnosia, Construction Difficulty
What is difficulty finding words called?
Aphasia
What is the inability to recognize things called?
Agnosia
What is disordered motor planning called?
Apraxia
What is the inability to reproduce things, for example copy a drawing called?
Construction Difficulty
How is Dementia measured?
What is a normal score?
Using the Mini Mental Status examination
Above 25
What is the most common form of Dementia? What % of dementia does it account for?
Alzheimer’s
64%
What are the two types of Alzheimer’s? Which is most common?
Early Onset
Late Onset
What explanation did Prof. Pihl give for the higher number of women with Alzheimer’s?
Alzheimer’s is related to level of cognitive functioning and the current population of women being diagnosed were not as educated as men
What are the 4 categories of the MMSE?
- Orientation (time and place)
- Registration (identify objects, Attention/calculation)
- Recall
- Language (follow command, write sentence etc…)
Approximately how long does it take for Alzheimer’s to progress from very mild to very severe?
8-10 years
What is the Diagnostic criteria for Alzheimer’s?
More or less the same as for Dementia
How heritable is Alzheimer’s?
Much more heritable for early (autosomal) than late onset
What is another name for early onset Alzheimer’s? What % of cases?
Autosomal Alzheimer’s
5% of cases
What does Alzheimer’s do to the brain?
Plaques and Tangles develop in the entorhinal cortex, then the hippocampus and finally the neocortex
What causes tangles?
Excess Phosphorous
What causes plaques?
build up of beta amyloid
What happens when there is an abnormality in the Tau protein?
tangles
What is the most important gene that has been identified in early onset Alzheimer’s?
Amyloid precursur gene
What are tangles?
twisted tubules in the neuron that provide nutrition
What is the Debate about Alzheimer’s?
Is it different from the norm? or is it a part of normal aging? (normal curve that shifts over as age increases)
What is present in 50% of people with late onset Alzheimer’s vs. 10% in normal population?
APOE 4 allele: involved in the transportation of phosphorous and lipids to the brain
Why do some people point to the IGF pathway to explain Alzheimer’s?
IGF pathway is an insulin pathway
lack of insulin in the brain has been shown in labs to affect the buildup of plaques and tangles
What other gene has been looked at recently to explain Alzheimer’s? (related to calcium)
What is your risk if you have no copies of this gene?
one copy?
two copies?
CALHM1 gene Controls calcium concentrations in nerve cells
Also leads to more amyloid plaques
no copies: 1 in 20
one copy: 1 in 14
two copies 1 in 10
What is the criteria for Mild Neurocognitive Disorder? What is the problem with this?
- Evidence of modest cognitive decline: that is producing concern in the individual or their loved ones
- Modest Impairment: Does not interfere with the person’s life (remain independent)
- Not delirium
- not another mental disorder
Problem: This describes everyone
Is there a Gold Standard for Alzheimer’s? What study shows this?
No
Brains of nuns and priests donated their brains which were examined after their death for signs of Alzheimer’s. they all were normal yet had a significant amount of plaques and tangles
What 3 conclusions does Prof Pihl come to about Alzheimer’s?
- Cognitive Decline and Alzheimer’s result from the same physiological mechanisms and are characterized by the same physical signs (plaques and tangles)
- As life expectancy increases Alzheimer’s may become the norm
- Alzheimer’s is simply a normal consequence of living long
Until when does Myelination of the prefrontal and associated areas continue?
continues into late 50’s
What % of ALZ patients are cared for at home?
What is the risk for depression if caring for someone with mild dementia? moderate dementia?
50% cared for at home
caregiver risk for depression
mild dementia: 16%
moderate dementia: 40%
How did they predict which nuns would develop Alzheimer’s?
Their original letter of intent written when they were young
Complexity of sentences
more concrete thoughts = more likely
more abstract thoughts = less likely
What personality trait predicts Alzheimer’s?
Conscientiousness:
Low = more likely to develop alzheimer’s
High = less likely
What is someone who has excess fluid around the brain called?
Hydrocephalic
