Lecture 8.1: Ageing and Cognitive Function

Question 1

What is Dementia?

Answer 1

Not a specific disease but is rather a general term for the impaired ability to remember, think, or make decisions that interferes with doing everyday activities

Question 2

What are the 6 Cognitive Domains?

Answer 2

• Memory
• Language
• Perception
• Attention
• Number
• Praxis

Question 3

‘Crystallised’ vs. ‘Fluid’ Intelligence

Answer 3

Highly learnt skills and general knowledge vs. problem solving without prior training or exposure

Question 4

What doe Diagnosis of Dementia require? (5)

Answer 4

• Multiple cognitive deficits (including
  amnesia)
• Functional impairment
• Clear consciousness
• Change from previous level
• Long duration (> 6 months)

Question 5

What is Braak Staging?

Answer 5

Refers to two methods used to
classify the degree of pathology in Parkinson and Alzheimer’s disease

Question 6

Alzheimer’s Disease: Pathology? Primary Site/Features?

Answer 6

• Amyloid plaques and tau tangles
• MTL, parietal lobes -> frontal

Question 7

Vascular Dementia: Pathology? Primary Site/Features?

Answer 7

• Vascular Pathology
• Can be anywhere, sudden changes

Question 8

Fronto-Temporal Dementia: Pathology? Primary Site/Features?

Answer 8

• Several sub-types; tau, TDP-43, FUS
• Frontal variant (behav), temporal
  variant (semantic/aphasia)

Question 9

Dementia with Lewy Bodies: Pathology? Primary Site/Features?

Answer 9

• Lewy Bodies
• Motor symptoms
• Sleep disturbance

Question 10

Dementia with Parkinson’s: Pathology? Primary Site/Features?

Answer 10

• Degenerative disorder of the Central
  Nervous System
• Targets the dopamine cells in the
  substantia nigra compacta
• Motor symptoms

Question 11

MMSE (Mini-Mental State Examination)

Answer 11

• 30-point questionnaire that is used
  extensively in clinical and research
  settings to measure cognitive.
  impairment
• Maximum score 30
• MCI < 27; AD < 25

Question 12

ACE-R (Addenbrooke’s Cognitive Examination Revised)

Answer 12

• A brief exam that provides evaluation of
  six cognitive domains (orientation,
  attention, memory, verbal fluency,
  language and visuospatial ability)
• Maximum score = 100
• AD < 88

Question 13

MOCA (Montreal Cognitive Assessment)

Answer 13

• Maximum score 30
• Normal Controls = 25-29
• MCI = 19-25
• Alzheimers Disease = 11-21

Question 14

Investigations in Dementia (to rule out other conditions)

Answer 14

• TFTs
• Urea and Electrolytes (severe
  disturbances can cause cognitive
  impairment e.g. renal failure and
  hyperuraemia)
• LFTs
• CT Scan
• MRI
• EEG
• Lumbar Puncture (to check for prions)

Question 15

Medical Management of Dementia

Answer 15

• Replacement of low-level
  neurotransmitter chemicals seen in
  some dementias (e.g. ACh inhibitors)
• L-dopa (can help with Parkinsonism,
  only helps 1/3 of those
• Avoid anti-psychotics (can increase risk
  of seizures, can worsen any
  movements associated disorders)

Question 16

Current Focus of Dementia Research

Answer 16

Prevention:
* Neuroprotective treatment
* Predictive biomarkers

Preservation of cognitive health;
* Lifestyle
* Non-pharmacological interventions

Question 17

Counteracting Ageing (Flowchart Explained)

Answer 17

• Cognitive Stimulation OR Exercise OR
  Dietary Restriction/Dietary
  Phytochemicals
• Leads to Cellular Stress Response
• Production of BDNF, GDNF, HSP70,
  GRP78
• Neuroprotection, Synaptic Plasticity &
  Neurogenesis OR Improved Glucose
  Metabolism and Cardiovascular Health
• Leads to Resistance to.
  Neurodegenerative Disorders AND
  Resistance to Cardiovascular Disease

Question 18

What Cognitive Domains are not affected by normal ageing?

Answer 18

• Crystallised Intelligence
• Semantic Memory
• Skill Learning

Question 19

How are the changes in the state of the
CVS are communicated to the brain? What receptors?

Answer 19

• Via afferent nerves
• Baroreceptors (high pressure side of
  system)
• Atrial receptors (low pressure side of
  system)
• Alters activity of efferent nerve