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AIM - The Brain > Neurocognitive Disorders - Dementia > Flashcards

Neurocognitive Disorders - Dementia Flashcards

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The Brain flashcards
1
Q

dementia

A

cognitive DECLINE (AQUIRED deficit, not developmental)

  • more than one cognitive domain affected
  • social/occupational functioning impairment
  • static or progressive
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2
Q

All patients w/ Alzheimer’s have _____

A

All patients w/ Alzheimer’s have DEMENTIA

but NOT all pts w/ dementia have Alzheimer’s.

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3
Q

Neurocognitive Disorders (NCDs), major and minor

A

include delirium, conditions involving substantial decline in a single cognitive domain, conditions affecting younger individuals (e.g. TBI, HIV) as well as previously described dementias

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4
Q

6 cognitive domains

A
  1. complex attention
  2. executive function
  3. learning and memory
  4. language
  5. perceptual - motor
  6. social cognition
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5
Q

Major Neurocognitive Disorder due to Alzheimer’s disease (DSM-V)`

A
  1. evidence of INSIDIOUS onset, GRADUAL progression of impairment, and significant cognitive DECLINE from a previous level of performance in 2 or more of the 6 cognitive domains, based upon:
    - -> Concern of decline expressed by the individual/others
    - -> Substantial impairment in cognitive performance (standardized testing, etc)
  2. either evidence of gene mutation OR memory/learning affected domains
  3. cognitive deficits interfere w/ daily independence
  4. cognitive deficits do NOT occur exclusively in context of delirium
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6
Q

Mild Neurocognitive Disorder due to Alzheimer’s disease (DSM-V)

A

The cognitive deficits do NOT interfere with capacity for independence in everyday activities

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7
Q

NCD due to Alzheimer’s is the most common cause of _____ in the elderly.

A

NCD due to Alzheimer’s is the most common cause of psychosis in the elderly.

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8
Q

MCD due to Alzheimer’s prominent behavioral sx

A
  • depression
  • apathy
  • irritability
  • paranoid
  • visual hallucinations
  • agitation
  • sleep disturbance
  • wandering
  • combativeness
  • misidentification sx (thinks husband is imposter)
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9
Q

Amyloid cascade hypothesis

A

Amyloid Precursor Protein (APP)
1. cleaved by alpha-secretase to a benign breakdown product in the non-amyloidogenic pathway

OR
2. cleaved by beta-secretase and then gamma-secretase to form beta amyloid/amyloid-beta/A-beta/Αβ –> AGGREGATION and NEUROTOXICITY

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10
Q

Strategies to reduce beta-amyloid

A
  • reduce production, vaccinate, facilitate clearance, prevent aggregation of beta amyloid
    recent: use of monoclonal Abs directed against beta amyloid very early in the course of the illness
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11
Q

MCD due to Alzheimer’s unmodifiable risk fx

A
  1. Advancing age
  2. Family history and genetics
    - first degree relative affected
    - Apolipoprotein E (APOE) genotype
    - Rare autosomal dominant “deterministic” genes
  3. Down’s syndrome –> highly increased risk
  4. Female gender (some disagreement)
  5. head trauma
  6. low educational levels
  7. vascular risk fx (sedentary/obesity/smoking/HTN etc.)
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12
Q 
Apolipoprotein E (APOE) genotypes
(which increases risk? neutral? protective?)
A

APOE-4 allele, esp. homozygous –> inc risk (earlier onset, possibly via impaired Beta amyloid clearance)

APOE-3 allele, neutral

APOE-2 allele, may be PROTECTIVE

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13
Q

MCD due to Alzheimer’s biomarkers

A
  1. Measures of brain beta-amyloid deposition
    - diminished CSF beta-amyloid (not getting cleared)
    - positive amyloid in PET imaging
  2. Measures of neurodegeneration
    - inc CSF tau (tangles)
    - dec glucose uptake in parietal/temporal cortex (FDG PET)
    - structural imaging (MRI)
    - PET tau imaging
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14
Q

MCD due to Alzheimer’s:

FDA approved meds

A

Cholinesterase Inhibitors

N-methyl-D-aspartate (NMDA) Partial Receptor Antagonists
- blocks xs glutamate (excitatory)

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15
Q

In elderly pts w/ dementia, how are Behavioral and Psychological Symptoms of Dementia (BPSD) and caregiver burden reduced?

A

Anticholinergic burden reduction (by reducing or eliminating medications with CNS anticholinergic side effect)

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16
Q

Does beta-amyloid increase or decrease in CSF?

A

Decrease. Less clearance.

17
Q

Major Frontotemporal Neurocognitive Disorder

previously Frontotemporal Dementia

A
  1. Symptomatology often dominated by PERSONALITY change:
    - social inappropriateness - behavioral disinhibition - apathy
    - impaired judgment and insight
    - perseverative, compulsive behavior
    - hyperorality, such as overeating
  2. Onset before 65 y/o
  3. Decline often faster than Alzheimer’s
18
Q

Major Neurocognitive Disorder with Lewy Bodies

formerly Lewy Body Dementia

A
  • fluctuating cognition, variations in attn/alertness
  • VISUAL hallucinations early on
  • Parkinson sx, marked sensitivity to antipsychotic medication side effects
  • REM sleep disorder (dreams acted out)
  • autonomic dysfunction (falls, syncope, orthostatic hypotension)
  • Lewy bodoes (alpha-synuclein) cerebral cortex
19
Q

differential dx of Major Neurocognitive Disorder with Lewy bodies

vs. Parkinson’s

A

in Parkinson’s, motor sx clearly PRE-date cognitive decline

20
Q

Major Vascular Neurocognitive Disorder

formerly Vascular Dementia

A
  • cognitive deficits may be related to one or more cerebrovascular events
  • course sometimes uneven w/ decline followed by periods of stability and maybe some improvement
  • Pathophys of NCD due to Alzheimer’s and Vascular disease may overlap
  • Patients over 85 often have NCD due to Alzheimer’s and cerebrovascular disease
21
Q

Other Major/Minor Neurocognitive Disorders can be due to…

A

traumatic brain injury, substance/medication use, HIV infection, Prion disease, Parkinson’s Disease, Huntington’s Disease, another medical condition, or multiple etiologies

22
Q

The most common cause or form of dementia

A

Alzheimer’s disease

23
Q

T/F

Pts w/ dementia-related apathy are also likely to be depressed and will respond well to antidepressants

A

FALSE

24
Q

Which dementia often initially presents w/ vivid visual hallucinations?

A

Major Neurocognitive Disorder with Lewy Bodies

25
Q

Which dementia often initially presents w/ personality change?

A

Major Frontotemporal Neurocognitive Disorder

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