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Neurology Yr2 > Normal Cognitive Ageing and Dementia > Flashcards

Normal Cognitive Ageing and Dementia Flashcards

1
Q

What are dementia and cognitive impairment not part of?

A

They are not part of the normal aging process; they are diagnosable conditions.

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2
Q

Name what happens with normal cognitive aging.

A
  • slower to think
  • slower to do
  • hesitates more
  • more likely to “look before you leap”
  • know the person not the name
  • pause to find words
  • reminded of the past.
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3
Q

What are NOT characteristics of normal cognitive aging, that people often think are?

A
  • confused about past vs. now
  • words can’t be retrieved, even later
  • can’t place a person
  • doesn’t think speech out at all
  • can’t think the same
  • can’t do like before
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4
Q

As we age there are _____________ to the _______.

A

Structural changes to the brain.

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5
Q

Name the structural changes to the the brain in healthy aging.

A

Loss of brain volume

Expansion of the ventricles

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6
Q

the pattern of brain change in aging is _________.

A

heterogeneous (diverse)

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7
Q

What happens to grey matter as we age?

A

The volume of grey matter declines.

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8
Q

When does grey matter volume begin to decrease?

A

After the age of 20.

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9
Q

Older people have greater decreases in _______ structures.

A

Cortical.

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10
Q

Where is atrophy most prominent?

A

The prefrontal cortex.

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11
Q

There are more moderate age-related changes in the _______ lobe. What does it involve and cause?

A

Temporal.

Involves decrease in hippocampus volume- memory issues expected.

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12
Q

________________ volume decreases are much greater than grey matter volume decreases (with increasing age).

A

White Matter

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13
Q

What does decreased parahippocampal white matter lead to?

A

Decreased communication with hippocampal structures- this may cause memory decline/impact how we access memory.

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14
Q

Where are the most marked age- related declines?

A

In the anterior white matter.

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15
Q

What does decline of anterior white matter cause?

A

deficits in executive function.

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16
Q

What may mediate age-related cognitive decline (eg. speed of processes)?

A

Loss of integrity of the central portion of the corpus callosum.

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17
Q

Name the 4 possible causes for normal cognitive aging.

A
  • Accumulation of Beta-amyloids
  • Morphological changes in neurons likely to contribute to the reduction of synaptic density (eg. dendrite length)
  • A decrease in neuron size and the number of connections between them
  • Neuronal Death
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18
Q

What are high levels of beta-amyloiad associated with?

A
  • Decreased hippocampal volumes

- Episodic memory

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19
Q

What is cognition?

A

The mental action or process of acquiring knowledge and understanding through thought, experience and the senses.

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20
Q

What does cognition refer to?

A
  • our information processing systems

- our stored knowledge

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21
Q

Name the 3 parts of cognition’s mission :)

A
  • Analyse Sensation
  • Use experience to guide behaviour
  • Detect and remember irregularities in incoming sensory information
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22
Q

Cognitive change is a _______ process of aging.

A

Normal.

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23
Q

What concepts describe the patterns of cognitive change over our lifetimes?

A

Crystallised Intelligence

Fluid Intelligence

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24
Q

What is crystalised intelligence?

A

Skills, abilities and knowledge that are well practiced, overlearned and familiar.

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25
Q

Name examples of crystalised intelligence.

A

Vocabulary

General Knowledge

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26
Q

What happens to crystallised intelligence as we get older?

A

It remains stable or can even gradually improve through the 6th and 7th decades of life :)

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27
Q

What is fluid intelligence?

A

Abilities to problem solve and reason about things less familiar or independent of what one has learned.

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28
Q

Fluid intelligence includes the innate ability to process and learn _____ _________, solve ________ and attend to and _______ your ________.

A

New Information
problems
manipulate, environment,

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29
Q

Executive function, _____ speed, _____ and psychomotor ability are considered ______ cognitive domains.

A

Processing
Memory
Fluid

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30
Q

Abstract thinking is an example of ___________.

A

Fluid intelligence.

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31
Q

Is Crystal or fluid intelligence more susceptible to aging?

A

Fluid intelligence is more susceptible to aging.

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32
Q

Name the 6 components of cognition.

A
  • Executive Functioning
  • Processing Speed
  • Attention
  • Visuospatial Abilities
  • Language
  • Memory
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33
Q

Name this:

Th speed with which cognitive activities are performed as well as the speed of motor response.

A

Processing Speed.

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34
Q

When does processing speed decline begin?

A

In the 3rd decade of life (20’s) and continues throughout the lifespan.

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35
Q

Reduced processing speed can have _____ across a variety of _______ domains.

A

Implications.

Cognitive.

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36
Q

Many cognitive changes reported in healthy older adults are the result of slowed ______ _________.

A

Processing Speed.

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37
Q

What is Attention?

A

The ability to concentrate and focus on specific stimuli.

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38
Q

Simple auditory ________ ______ measured by a string of digits, only shows a slight decline in late life.

A

Attention span.

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39
Q

In terms of attention, when is there a noticeable age effect?

A

When performing more complex attention task.

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40
Q

Name and define the two types of attention.

A

Selective attention- all attention on 1 thing

Divided attention- attention on 2 things at once.

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41
Q

Older adults also perform worse than younger adults on tasks involving ______ __________.

A

Working Memory.

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42
Q

Name this:

The ability to understand space in 2 and 3 dimensions.

A

Visuospatial Abilities/ Visual Construction.

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43
Q

________ construction skills decline over time.

A

visual

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44
Q

Visual construction skills decline over time, what remains in tact?

A

Visuospatial abilities remain intact.

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45
Q

Name this:

Capacities that allow a person to successfully engage in independent, appropriate, purposive and self-serving behaviour.

A

Executive functioning.

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46
Q

Give some examples of executive functioning.

A

Reasoning, organisation, problem solving, self-monitoring etc.

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47
Q

What aspects of executive functioning decline with age, especially after 70? What do they have the tendency to do?

A
  • Concept Formation
  • Abstraction
  • Mental Flexibility

Tendency to think more concretely.

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48
Q

Executive abilities requiring a _______ _______ component are particularly susceptible to age effects.

A

speeded motor.

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49
Q

Aging also negatively affects ________ _____________, the ability to inhibit an automatic response in favour of producing a novel response.

A

Response Inhibition.

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50
Q

__________ with unfamiliar material declines with age.

A

Reasoning

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51
Q

Other types of executive functioning remain stable throughout lifetime, give some examples.

A
  • ability to appreciate similarities
  • describe the meaning of proverbs
  • reason about familiar material
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52
Q

Language is everything that allows ________ _______________.

A

Meaningful Communication.

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53
Q

Overall what happens to language as we age?

A

It remains intact with aging.

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54
Q

_________ remains stable and even improves overtime.

A

Vocabulary.

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55
Q

Visual confrontation naming (word finding) is stable until age ______, then declines in subsequent years.

A

70.

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56
Q

Verbal ______ (semantic field) shows decline with aging.

A

Fluency.

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57
Q

What may age related memory problems be related to?

A
  • slowed processing speed
  • reduced ability to ignore irrelevant information
  • decreased use of strategies to improve learning and memory.
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58
Q

Is this memory stable with age?

  • Non-declarative memory
  • Retention
  • Recognition memory: ability to retrieve info when given cue
A

Yes it’s stable with age.

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59
Q

Is this memory stable with age?

  • Temporal Order memory: memory for the correct time or sequence of past events.
  • Procedural Memory: memory of how to do things.
A

Yes it’s stable with age.

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60
Q

Is this memory stable with age?

  • Declarative (explicit) memory
  • Semantic Memory
  • Episodic memory
  • Acquisition
A

No it declines with age.

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61
Q

Is this memory stable with age?

  • Retrieval
  • Delayed free recall: spontaneous retrieval of information from memory without a cue.
A

No, it declines with age.

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62
Q

Is this memory stable with age?

  • Source memory: knowing the source of the learned information
  • Prospective memory: remembering to perform intended actions in the future.
A

No, it declines with age.

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63
Q

Name the structures that play a role in memory.

A 
Prefrontal Cortex
Basal Forebrain
Mediodorsal nucleus
Amygdala
Hippocampus
Inferotemporal cortex
Cerebellum
Rhinal Cortex.
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64
Q

The input goes to the _______________memory.

A

Sensory.

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65
Q

What happens to the info in the sensory memory?

A

It is either forgotten (decay) or passed to the central executive.

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66
Q

What 3 components that make up the central executive?

A
  • Visuo-spatial scratch pad
  • Phonological Loop (articulatory control, phonological store)
  • Episodic Buffer
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67
Q

From the visuo-spatial scratch pad, episodic buffer and phonological loop, where does the info go?

A

It goes to the long term-memory.

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68
Q

What is between sensory and long term memory?

A

Working memory (the central executive).

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69
Q

Long term memory is split into ________ and ___- ____ memory.

A

Declarative and non-declarative .

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70
Q

What is declarative (explicit) memory?

A

Knowing that.

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71
Q

What is non-declaritive (implicit) memory?

A

Knowing how.

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72
Q

Give examples of declarative/ explicit memory.

A
  • Episodic
  • Semantic
  • Lexical
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73
Q

Give examples of non-declarative/ implicit memory.

A
  • Habits
  • Procedural
  • Cognitive skills
  • Priming
  • conditioned response.
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74
Q

The term dementia was first used in 1801 by Phillipe Pinel, with a patient presenting with loss of ___________ and ________ function.

A

Cognitive

Physical

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75
Q

What does demence refer to?

A

Incoherence or loss of mental function.

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76
Q

What does dementia refer to?

A

Dementia refers to a group of diseases characterised by progressive and, in the majority of cases, irreversible decline in mental functioning.

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77
Q

How are cognitive abilities lost?

A

Due to damage of neurons in certain areas of the brain.

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78
Q

In dementia what is the loss of cognitive abilities often accompanied with?

A

Deterioration in emotional control, social behaviour and motivation.

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79
Q

In dementia, the effects of the damage to the brain…

A

Intensify over time and are disabling & terminal.

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80
Q

Dementia is an _____ term used to define over 100 different conditions that impair ________, ___________ and thinking.

A

Umbrella

Memory, Behaviors.

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81
Q

Name the most common causes of dementia.

A
  • Alzheimer’s Disease
  • Lewy Body Dementia
  • Frontal temporal Dementia
    etc. ….
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82
Q

In Scotland, 90,000 people live with dementia, why is this number expected to increase by 2020?

A

Due to aging population (more older people)

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83
Q

Globally dementia has a stable or declining ____________.

A

Prevalence.

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84
Q

What is another name for dementia (DSM 5) ?

A

Major Neurocognitive Disorder.

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85
Q

Why was the terminology “dementia” changed by DSM 5?

A

to. ..
- avoid negative connotation
- distinguish between disorders that have cognitive impairment as their primary feature and those that don’t.
- more accurately reflect the diagnostic process.

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86
Q

What criteria is used to assess dementia?

A

DSM 5 Diagnostic Criteria.

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87
Q 
The DSM-5 Diagnostic Criteria is...
one or more acquired significant impairment in cognitive domains such as:
-\_\_\_\_\_\_\_\_\_\_
-Language
-\_\_\_\_\_\_\_\_\_\_\_
-\_\_\_\_\_\_\_\_\_\_ of purposeful movement
-\_\_\_\_\_\_\_ control
A

Memory
Recognising/Familiarity
Execution
Self

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88
Q

Where does assessment normally take place for over 65s?

A

In regional memory clinics.

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89
Q

After an initial ______, where are people with suspected dementia reffered?

A

Review

referred for an appointment with neuropyschology, psychiatry or for MRI scan.

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90
Q

It is important to implement ______ after a dementia diagnosis.

A

Support.

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91
Q

This assessment proccess is very lengthy:

  1. Take __________ _____________
  2. ___________ exam
  3. ______________ evaluation (including mood)
  4. _______ examination eg. mental status
  5. ___________ Testing
  6. Labs
  7. ______imaging
  8. Rarely, but sometimes analyse _______.
  9. _________ interview.
A 
Case/Medical History
Physical
Psychiatric
Cognitive
Neuropsychological
Neuroimaging
CSF
Caregiver
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92
Q

What does neuropsychology address?

A

The link between brain and behaviour.

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93
Q

What is an objective way to quantify and characterise cognitive, behavioural and emotional changes following a brain disease?

A

Neuropsychological assessment.

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94
Q

In what examination can they get you to draw?

A

A cognitive examination.

95
Q

Name the domains of dementia that are examined.

A
  • Memory
  • Attention
  • Visuospatial
  • Language
  • Effort/Motivation
  • Executive Functions
  • Praxis
  • Mood
  • Premorbid function
96
Q

In early stages, ____________________ dieseases show a ______ for certain brain regions with relative sparing of others.

A

Neurodegenerative

Preference.

97
Q

Neurodegenerative diseases have ______ cognitive profiles associated with the distributuion of the neuropathology.

A

Recognisable.

98
Q

What do profiles do?

A

Theyhelp with the diagnosis process and differentiation from other dementias.

99
Q

What information must we gather in order to make a profile, to then diagnose?

A
  • Detailed Medical History
  • Onset and Course of progression
  • Profile of cognitive impairment
  • Presence of non-cognitive symptoms such as behavioural disturbance, hallucinations and delusions.
  • Carer involvement
100
Q

Reversible Causes and progressive decline may be slowed/stopped due to ______ diagnosis.

A

Differential.

101
Q

Why is differential diagnosis so important?

A
  • different impairments an retained abilities,so in need for different advice to carers and informed management.
  • Facilitates legal processes and advanced care planning.
102
Q

Why are legal processes and advanced care planning beneficial?

A
  • The family knows what that person’s wishes were (before they progress further)
  • Causes family less distress.
103
Q

The Clinical Dementia Rating (CDR)
The Global Deterioration Scale for aging and dementia (GDS)

What are these?

A

Severity rating scales.

104
Q

CDR 0 means you are _______.
CDR 0.5 means you have _______________.
CDR 1 means you have ______.

A

Healthy (no dementia)
questionable dementia
mild dementia

105
Q

GDS Stage 1 means _________
Stage 2 is __________ deficits.
Stage 3 is _______ deficits.
Stage 4 is _______ deficits and means you have _______.

A

You are normal
Subjective
Subtle
Clear, mild dementia.

106
Q

For management, the 5 ____________ _ _______________ are used.

A

pillars of support.

107
Q

Name the 5 pillars of support.

A
  • Understanding Illness and managing symptoms
  • Planning for future decision making
  • Supporting community connections
  • Peer Support
  • Planning for future care.
108
Q

What are these?

  • Dementia Coordinator
  • support for carers
  • personalised support
  • community connections
  • environment
  • mental health care and treatment
  • General Health Care and treatment
  • Therapeutic interventions to tackle symptoms of the illness.
A

8 pillars of community support.

109
Q

What are the main roles in the MDT for Dementia?

A
  • Support patient and family
  • Help patient stay in familiar environment for as long as possible
  • Help with symptoms
  • Don’t overstep role, but help with other things.
110
Q

How is dementia managed?

A
  • Prevention
  • Pharmacological- drugs
  • Behavioural
  • Rehabilitation
  • Psychosocial interventions
  • caregiver support, training and education
111
Q

What can delay the onset of dementia?

A

Intervention.

112
Q

___________ can be used because people with dementia can learn, it’s just more difficult.

A

Rehabilitation.

113
Q

Cholinesterase Inhibitors are drugs used for _____________ _________________.

A

Cognitive Functioning.

114
Q

Name some other drugs used to manage dementia.

A

Anti-depressants and anti-psychotics.

115
Q

What is the down side to medication?

A

Often side effects.

116
Q

There is no ________ to stop or cure dementia.

A

Medication/Drug.

117
Q

What is psychosocial intervention?

A

Different ways to support people to overcome challenges and maintain good mental health.

118
Q

What do psychosocial interventions do?

A

Help maintain independence, quality of life, maintain cognitive function and reduce anxiety and depression.

119
Q

Psychosocial intervention must be tailored to….

A

Individual needs

120
Q

Name some non-pharmacological interventions for behavioural and psychological symptoms of dementia.

A 
Cognitive Behavioural Therapy (CBT)
Environmental Design
Physical Activities
Art Therapy
Simulated Presence
Validation therapy
Reminiscence therapy
family/caregiver intervention programmes.
121
Q

What is simulated presence?

A

Playing recordings of loved ones voices etc.

122
Q

What therapy is this an example of?

Patient thinks they are in a hotel and staff go along with it.

A

Validation Therapy.

123
Q

Talking about the past is known as __________ therapy.

A

Reminiscence.

124
Q

Name the 4 types of dementia.

A

Cortical eg. Alzheimers Disease

Subcortical

Mixed cortical-subcortical eg. frontotemporal dementia, lewy body dementia

Treatable eg. infections.

125
Q

What is the most common form of dementia?

A

Alzheimer’s Disease.

126
Q

Define Alzheimer’s Disease.

A

A chronic neurodegenerative diseas with an isidious onset and progressive but slow decline.

127
Q

What neuropathology do people with Alzheimer’s Disease present with?

A

Plaques in the brain
Neurofibrillary Tangles
Neuronal loss

128
Q

What is the aetiology of Alzheimers disease?

A

Nobody knows;

  • Possibly genetic factor
  • Possibly cholesterol and homocysteine levels
  • Possibly Vitamin E and C
129
Q

What is the most common and older theory behind the neuropathology of Alzheimer’s Disease?

A

The Amyloid Hypothesis:
Excess Amyloid peptides
Build up = diffuse plaque
Plaque causes inflammation which leads to formation of neuritic plaques
This causes synaptic and neuritic injury and cell death,

130
Q

A newer, less common theory suggests that Alzheimer’s Disease is caused by abnormal aggregation of the ____________. What does this accumulation cause?

A

Tau Protein

Tau accumulates into intraneuronal masses (plaques and tangles)

131
Q

The tau protein has direct links to _______ disruption.

A

Functional.

132
Q

AD deficits progress in a relatively…

A

Predictable pattern.

133
Q

What are symptoms of AD?

A
  • Memory Problems (recent)
  • Language problems (verbal fluency, word finding)
  • Visuospatial dysfunction
  • Progressive Deterioration of performing every day tasks
  • Behavioural Disturbance (wandering, agitation, inappropriacy)
134
Q

What memory is affected in Early/Mild AD?

A

Episodic Memory
Semantic Memory
Attention/executive function.

135
Q

What symptoms usually appear later on inm the progression of AD?

A

Visuospatial deficits

Praxis (motor planning)

136
Q

Name some possible risk factors for AD.

A
  • Down’s Syndrome
  • Advanced Age
  • Female
  • Genetic Predisposition
  • Family history
  • Elevated homocystine levels
  • History of TBI
  • Lifestyle factors.
137
Q

Name some protective factors for AD.

A
  • Education
  • Cognitive Stimulation
  • Possibly tobacco
  • Wine and Coffee
  • Exercise
  • Food containing vitamin E
  • Aspirin?, anti-inflammatory drugs?
138
Q

What are the main behavioural and psychological symptoms of alzheimer’s disease?

A 
Anxiety
Aggression
Hallucination
Depression
Agitation
Wandering
Delusions.
139
Q

What do these provide us with?:
The National institute on Aging and the Alzheimer’s Association Workgroup (2011)
The National Institut of Neurological and Communicative Disorders and Stroke-Alzheimer’s Disease and Related Disorder Association (2012)

A

Diagnostic criteria.

140
Q

A diagnostic criteria is that the onset must be __________.

A

insidious.

141
Q

AD can be diagnosed from ______ - ______ years.

A

40, 90

142
Q

In AD diagnosis, what must there be an absence of?

A

Any strokes or other brain diseases capable of producing dementia syndrome eg. delirium.

143
Q

What is the pharmalogical goal to find for AD?

A

To find a drug that will either cure AD or to delay the degenration of AD.

144
Q

What is the prognosis for AD?

A

Natural course of progression decline with some plateaus.

145
Q

What is the ultimate destination for AD?

A

Death.

146
Q

What is mild cognitive impairment?

A

Can be a transition stage between normal aging and dementia.
It’s a syndrome where cognitive decline is greater than expected for an individual’s age and education level but that doesn’t interfere with activities of daily life.

147
Q

What are the subtypes of mild cognitive impairment?

A

Amnestic and non-amnestic.

148
Q

What can Mild Cognitive Impairment affect?

A

many areas eg. language, attention, judgement, but most commonly affects memory (often leads to alzheimer’s)

149
Q

In mild cognitive impairment, what is usually unaffected?

A
  • Normal perception
  • Reasoning skills
  • normal activities of daily living

All not affected :)

150
Q

What may mild cognitive impairment cause?

A

Depression, irritability, anxiety and aggression.

151
Q

Mild cognitive impairment has the same neuropathological changes as ________ but to a ______ extent.

A

Alzheimer’s

Lesser

152
Q

Name the neuropathology of mild cognitve impairment.

A
  • Plaques
  • tangles
  • shrinkage of hippocampus
153
Q

What in people with Mild Cognitive Impairment (MCI) predicts conversion to AD?

A

Elevated beta-amyloid in people with MCI.

154
Q

What are some risk factors for MCI?

A
  • Genetic Predisposition
  • High Blood Pressure
  • Diabetes
  • Low levels of physical, social and mental activity
  • few years education
155
Q

What subtype of MCI can lead to AD?

A

Amnestic subtype.

156
Q

What affects cognitive performance in elderly populations?

A
  • education
  • vascular risk factors
  • psychiatric status
  • genetic background
  • hormonal changes
  • anti-cholinergic drugs.
157
Q

What is vascular dementia?

A

When executive functions are more affected than memory. Motor and mood changes seen early.

158
Q

In vascular dementia, what changes can be seen early?

A

Motor and mood changes can be seen early.

159
Q

In vascular dementia, symptom onset may be ________.

A

abrupt.

160
Q

What is a feature of symptom presentation of vascular dementia?

A

There may be periods of sudden decline followed by relative stability.

161
Q

Because of periods of plateau, what is the decline in vascular dementia often known as?

A

stair-step decline

162
Q

For Vascular Dementia- there’s vascular pathology cause to both ____ and _____ matter; infarction, _______, ______ and small vessel changes.

A

grey and white
ischaemia
haemorrhage

163
Q

In the pathophsiology of VAD, often people have multiple large _______ or small ______ in strategic areas.

A

Infarcts

Infarcts

164
Q

Another pathophsiology of VAD is;
-loss of axons, myelin and oligodendrocytes
-damage to the capillaries with breakdown of blood-brain barrier and protein leakage.
What is this called?

A

leukoaralosis.

165
Q

In VAD, people can have large _________ in the basal ganglia (secondary to hypertension), or small ______ in the cortex and white matter (secondary to amyloid angiopathy.

A

Haemorrhages

Haemorrhages.

166
Q

Vascular Dementia can often co-occur with _____________, what is this known as?

A

Mixed Dementia.

167
Q

The Ninds-Airen diagnostic criteria os often used in diagnosing _____________.

A

VAD

168
Q

What is the difference between VAD and AD?

A

Vascular Dementia- most likely to have:

  • abrupt onset
  • fluctuating course
  • may include some degree of recover past an episode
  • history of stroke
  • focal neurological symptoms and signs
169
Q

Describe cognitive functioning in VAD.

A
  • Preserved recent memory
  • More diverse language profiles than AD
  • Test scores decline less than AD over time.
170
Q

_________ VAD presents with:

  • poor general ___________ functioning
  • High _______
  • _______________
A

Subcortical
Cognitive
Insight
Depression

171
Q

What is the treatment for vascular dementia?

A

To prevent vascular injury to the brain (prevention of a stroke).

172
Q

What is the prognosis for VAD?

A

Life expectancy is significantly shortened with a similar mortality to alzheimer’s disease.

173
Q

Dementia is _____________.

A

Irreversible.

174
Q

Dementia with ______________ ________________ is another type of dementia.

A

Dementia with lewy bodies.

175
Q

Dementia with lewy bodies is an umbrella term- it includes lewy bodies (LBD) with and without ______ ______.

A

Parkinson’s Disease.

176
Q

Dementia with ___________ _______________accounts for approx.10% of cases of __________________.

A

Lewy Bodies

Dementia.

177
Q

What type of dementia was only recently recognised as a disease entity in its own right?

A

Dementia with lewy bodies.

178
Q

What is the aetiology for dementia with lewy bodies?

A

Unkown. Some indicators of genetic involvement but most are sparadic.

179
Q

What is dementia with lewy bodies characterized by?

A

Cognitive Decline with a combination of fluctuating cognition, recurrent visual hallucinations, spontaneous extrapyramidal signs, rem sleep behavioural disorder and antipsychotic sensitivity.

180
Q

What do people with DLB exhibit?

A
  • prominent dysexecutive syndrome

- visuo-perceptive disturbances

181
Q

______________ and _____________ ________________________ are more affected in DLB than in AD.

A

Attention

Visual Perception.

182
Q

What may not occur early in DLB?

A

Detectable memory loss.

183
Q

In DLB, what types of memory are impaired and what are less impaired?

A

Impaired: procedural memory and motor skill learning

Less impaired: episodic memory

184
Q

A person with DLB may have marked day to day _________________ in functioning and transitory episodes of _________________________.

A

Fluctuating

Confusion

185
Q

In DLB what may occur?

A

Paranoid Delirium

186
Q

Why can people with DLB be dangerous in their sleep?

A

They can act out in their sleep.

187
Q

What is DLB characterised by?

A

An accumulation of lewy bodies in vulnerable sites, lewy bodies displace nerve cell structures leading to impairments.

188
Q

_______ ________ are beta-amyloid plaques aggregates of alpha-synuclein protein.

A

Lewy Bodies

189
Q

In DLB, where do Lewy bodies start?

A

In cortical areas.

190
Q

In parkinsons disease dementia (PDD) describe where lewy bodies acccumulate and what this causes.

A
  • Lewy Bodies Begin to accumulate in upper brainstem (substantia Nigra)
  • Leading to tremor, rigidity and slowed movement
  • Iewy bodies can sometimes spread to cortical areas (especially frontal) and to basal nucleus to cause cognitive decline
191
Q

Treatment for DLB is __________.

A

Symptomatic.

192
Q

What is the main goal for the management of DLB?

A

Stabilise Condition, Behaviour and ADLs (activities of daily living).

193
Q

If a person with DLB has increased sensitivity to ___________ medication, it should be avoided.

A

Antipsychotic.

194
Q

Describe DLB’s progression.

A

Dementia with Lewy Bodies is a progressive disease with steady decline in functioning.

195
Q

What is the prognosis for DLB?

A

Survival of 5-7 years after symptom onset.

196
Q

What is the second most frequent type of dementia after Alzheimer’s Disease?

A

Frontotemporal Dementia. (FTD)

197
Q

FTD is a ______- it includes _____ and ______ variants.

A

Spectrum

Behavioural and Language

198
Q

When does frontotemporal dementia typically appear?

A

Mid-life around 53-58 years old.

199
Q

What are some prominent early symptoms of frontotemporal dementia (FTD)?

A

Progressive coursening of personality, social behaviour, self regulation (of emotions, drives and behaviour) and language.

200
Q

Name the type of dementia:

The person seems to change personality; gambles, is sexually inappropriate at times.

A

Frontotemporal Dementia.

201
Q

In FTD big changes in _______ ______ and _________ are seen.

A

Social Behaviour

Language

202
Q

What are some symptoms of FTD?

A
  • indifference to self care
  • indifference to other’s needs
  • loss of speech and comprehension
  • loss of empathy
  • distractibility
  • impulsiveness
203
Q

Often in FTD, what is needed for the family?

A

Counselling for family.

204
Q

When can frontotemporal diagnosis be definitely diagnosed?

A

From post-mortem examination of the brain.

205
Q

The 2 groups in pathology of FTD are:
FTD-_______ group
FTD-_______ group

A

Tau

Ubiquitin

206
Q

Pathophysiology shouldn’t be considered in isolation, what should also be considered?

A

Symptom Formation.

207
Q

What FTD variant has the subtypes:

  • Apathetic
  • Disinhibited
  • Stereotypic
A

Behavioural variant.

208
Q

What FTD variant has the subtypes:

  • Semantic
  • Non-fluent/Agrammatic
  • Logopenic
A

Language Variant with PPA.

209
Q

You can also have FTD with or without _______________.

A

Parkinsonism.

210
Q

What is the behavioural variant of FTD also known as?

A

Frontal Variant FTD or fvFTD.

211
Q

What do people with fvFTD present with?

A

an insidious disorder of personality and behaviour.

212
Q

What major changes does fvFTD cause?

A

It causes major changes in personality with stereotyped behaviour (repetitive), change in eating preferences (non food items), disinhibition (lack of restraint) and loss of empathy.

213
Q

fvFTD has relative preservation of day to day -__________________ __________________.

A

Episodic memory.

214
Q

In fvFTD, _________ _____________ may be present eg. mood disorder, paranoia.

A

Psychiatric Phenomena.

215
Q

What must be absent in order to diagnose somebody with fvFTD?

A

must exclude:

  • head injury
  • stroke
  • chronic alcohol abuse
  • major psychiatric illness
216
Q

What is the treatment for frontotemporal dementia based on?

A
  • Ensuring safety of patient and others
  • Provide reassurance and support for patient and carers
  • Provide guidance and supervision of care team.
217
Q

Treatment for FTD is ______ care and ________ magangement, there’s no available disease modifying treatments.

A

Supportive

Symptom

218
Q

What is the prognosis for FTD?

A

Disease progression differs across the variants. Median survival from diagnosis is 6-7 years.

219
Q

What is PPA?

A

Primary progressive aphasia (PPA) is a form of cognitive impairment that involves a progressive loss of language function.

220
Q

What is PPA caused by?

A

PPA is caused by degeneration in the parts

of the brain that are responsible for speech and language.

221
Q

In PPA what areas of the brain are impacted quickly?

A

Tempero-parietal areas.

222
Q

How is the patterns of degeneration of the brain monitored in PPA?

A

Through Neuroimaging using an MRI Scan.

223
Q

Name some other causes of dementia.

A
  • HIV
  • Huntigton’s Disease
  • Prion Disease
  • Traumatic Brain Injury
  • Substance Induced (alcohol) major cognitive disorder.
224
Q

Name some treatable causes of dementia.

A
  • Normal Pressure Hydrocephalus
  • Chronic Subdural Haematoma
  • Benign Tumours
  • Metabolic and Endocrine Disturbances
  • Infections
225
Q

What should dementia be differentially diagnosed from?

A
  • Depression

- Acute confusional state

226
Q

If something isn’t actually dementia but can kind of seem like it, what is this called?

A

pseudodementia

227
Q

What is the role of an SLT with dementia patients?

A

assess and manage cognitive, communicative and swallowing disorders.

228
Q

What is the problem with SLT intervention in dementia?

A

It’s a progressive disease therefor treatment outcomes are limited to the maintenance of existing functions :)

229
Q

What is delirium?

A

An acute (hours or days), usually reversible, metabolically induced state of consciousness.

230
Q

What is the difference between delirium and dementia?

A 
Delirium = Rapid changes in the level of consciousness and orientation
Dementia= Slow progression of memory and functioning decline
231
Q

Delirium has an ______ onset of attentional abnormalities.

A

abrupt.

232
Q

What can delirium cause?

A

Disorders of:

  • perception
  • thinking and memory
  • psychomotor activity
  • sleep-wakefulness cycle.
233
Q

Delirium involves fluctuations in _____ performance and behaviour.

A

Cognitive.

Neurology Yr2 (9 decks)

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