Neurocognitive Disorder I: Dementia Flashcards
exam 2
onset before age 65
early-onset
neuropathologic hallmark of alzheimer’s disease
amyloid plaques, neurofibrillary tangles plus loss of connections between neurons
cognitive decline from previous level of performance– it is acquired deficit not developmental
dementia
is more than one cognitive domain affected in dementia?
yea
dementia is a specific illness
nope; a syndrome
not all patients with dementia have alzheimer’s dx. but al alzheimers pt. have dementia
true that
alz is ___ leading cause of death after heart disease and cancer
3rd
six cognitive domains
- complex attention
- executive function
- learning and memory
- language
- perceptual- motor
- social cognition
sundowing
more confused at dusk
Alz. requires evidence of insidious onset, gradual progression of impairment and significant cognitive decline from a previous level of performance in ___ or more of the six cognitive domains
2
evidence of 1 or 2 for Alz.
- genetic- rare
2. memory and learning steady decline with no evidence of mixed etiology
MCD (mild neurocognitive disorder do to Alz.): The cognitive deficits do/does not interfere with capacity for independence in everyday activities.
Does not
most common cause of psychosis in the lederly
MCD due to Alz.
amyloid cascade hypothesis
amyloid precursor protein leading to beta amyloid aggregation and neurotoxicity
most recent strategy for Alz.
use of monoclonal ab directed against beta amyloid very early in the course of the illness
APOE allele increase or decrease risk?
increase especially if homozygous leading to possible early onset of the disease
down’s increase or decrease?
highly increased risk for developing Alz
are females at high risk?
disagreement
modifiable risk factors
- head trauma
- low educational levels
- vascular risk factors
biomarkers for Alz.
- beta-amyloid deposition
- increased CSF tau
- glucose uptake in parietal/temporal cortex
- atrophy on MRI in parietal/frontal cortex
- PET tau imaging
use multiple biomarkers to improve
sensitivity and specificity
FDA approved medications
- cholinesterase inhibitos
2. NMDA partial receptor antagonists
cholinesterase inhibitors
inhibits the enzyme that normally breaks down the ntt acetylcholine, thereby enhancing cholinergic ntt.
NMDA antagonist
blocks the excessive ntt of the excitatory ntt glutamate
Medications for Alz are disease modifying?
nope, wish it were but we are not there yet
Anticholinergic burden reduction in elderly subjects with dementia reduces BPSD and caregiver burden
yep
major frontotemporal neurocognitive disorder
dominated by personality change but decline often faster than Alz
- onset is often before 65
Lewy Body dementia
fluctuating cognition with pronounced variations in attention and alertness
visual hallucinations are prominent in early course
Lewy body Dementia
what do you find in lewy body dementia
alpha-synuclein throughout cerebral cortex
differenrial dx. for parkinson dx.
motor symptom clearly pre-date the cognitive decline
vascular dementia
cognitive deficit due to one or more cerebrovascular events
vascular dementia can have some improvement
yes
Which CSF biomarker pattern is most consistent with Major Neurocognitive Disorder due to Alzheimer’s Disease (Dementia, Alzheimer’s type)?
- ↑ beta amyloid, ↑ tau
- ↓ beta amyloid, ↓ tau
- ↑ beta amyloid, ↓ tau
- ↓ beta amyloid, ↑ tau
- ↓ beta amyloid, ↑ tau
Alzheimer’s disease is the most common cause or form of dementia.
true
Patients with dementia-related apathy are also likely to be depressed and will respond nicely to antidepressants.
false
Which dementia often initially presents with vivid visual hallucinations?
- Alzheimer’s
- Parkinson’s
- Lewy Body
- Frontotemporal
- Lewy Body
Which dementia often initially presents with personality change?
- Alzheimer’s
- Vascular
- Lewy Body
- Frontotemporal
- Frontotemporal
