NP: Lecture 10 Dementia II

Question 1

dsm 5 minor and major neurocognitive disorders

Answer 1

There is evidence of substantial cognitive decline from a previous level of performance in one or more cognitive domains, based on the concerns of the individual, a knowledgeable informant, or the clinician; and a decline in neurocognitive performance, typically involving test performance in the range of two or more standard deviations below appropriate norms (i.e. below the third percentile) on formal testing or equivalent clinical evaluation.

interfere with independence (at least minimal assistance)
not due to delirium
not due to other mental disorder

Question 2

6 neurocognitive domains in dementia

Answer 2

executive functions
complex attention
perceptual-motor function
language
learning and memory
social cognition

Question 3

wat is de heeeele globale criteria voor dementia

Answer 3

evidence for cognitive impairment in one or more domains

Question 4

major or minor ncd is due to:

Answer 4

alzheimers disease
vascular disease
frontolobar degeneration
lewy bodies
huntingtons disease
parkinsons disease
hiv infections
prion disease (creutzveld jacob)
traumatic brain injury
medication/substance use
other somatic causes
multiple ethiologies
unspecified

Question 5

wat is posterior cortical atrophy…

Answer 5

a subtype of alzheimers disease

Question 6

posterior cortical atrophy waar

Answer 6

atrophy in visual cortex and sometimes in the cerebellum
ook plaques and tangles

Question 7

clinical characteristics of posterior cortical atrophy

Answer 7

progressive visuoperceptual problems:
visual field
not recognizing objects, faces, letters
reading
optic ataxia (pointing or reaching for objects)
visual and spatial orientation problems

Question 8

posterior cortical atrophy waarom lastig te diagnosticeren

Answer 8

plastig, want atypical complaints:
pt say they cant see when their behaviour is good (blind sight)
objects suddenly appear or dissapear
objects seem distorted
not recognizing objects at close distance, but no problems far away
letters that are distorted or missing
patients sometimes have anosognosia

Question 9

hoe meten van pca

Answer 9

visuele perceptie object & ruimte
rivermead behaviour inattention test
perceptual organisation test
visuoconstructive tasks
perceptomotor task

Question 10

prevalentie dementie soorten in nl

Answer 10

alzheimers 65%
vascular 22%
frontolobar degeneration 4%
lewy bodies dementia 2%

Question 11

vascular dementia globaal

Answer 11

one or more strategic strokes (=multi infarct dementia)

or

small vessel disease (variety of abnormalities related to small blood vessels in the brain)

Question 12

frontotemporal dementia variants

Answer 12

behavioural variant (bvFTD)
language variants: primary progressive aphasia (PPA) met de: semantic variant (svFTD); non-fluent-agrammatic variant and logopenic variant

Question 13

behaviour variant symptoms

Answer 13

progressive disturbances in personality, emotion and behaviour

Question 14

language variants symptoms

Answer 14

there is a gradual (!) impairment of language, not just speech (language problems are the most important and disabling feature)

Question 15

pervalence of ftd nummers

Answer 15

2-10 per 100.000

Question 16

in welke categorie is ftd de meest gediagnosticeerde vorm van dementia

Answer 16

bij early onset, dus < 65 jaar

Question 17

hoeveel % van ftd begint vroeg

Answer 17

rond de 70-80%

Question 18

at autopsy … of the dementia cases turned out to be ftd

Answer 18

5%

Question 19

hoeveel van ftd is genetisch

Answer 19

40%

Question 20

wat zie je op een mri of spect scan bij ftd

Answer 20

typical atrophy patterns or signs of hypoperfusion or hypometabolism in medial frontal lobes and/or temporal lobes

Question 21

even kijken naar mri scan van verschillende soorten ftd

Answer 21

oke

Question 22

wat is de meest salient en impairing variant of ftd

Answer 22

behavioural variant

Question 23

waarom vaak een late detectie bij ftd

Answer 23

omdat patienten het zelf niet door hebben, moet echt vanaf fam etc komen

Question 24

4 kern symptomen van ftd

Answer 24

disinhibition, impulsivity
apathy or inertia (luiheid)
loss of empathy
perseverative, stereotype behaviour or compulsive/ritualistic behaviour

Question 25

waar hebben mensen bij bvftd ook last van naast personality

Answer 25

working memory planning conceptual reasoning mental flexibility complex attention

Question 26

wat is apathy

Answer 26

geen interest meer!!!

Question 27

non-fluent agrammatic variant PPA

Answer 27

non-fluent effortful speech grammar mistakes phonological mistakes through apraxia of speech impaired comprehension of complex sentences

Question 28

hoe meet je impaired comprehension of complex sentences

Answer 28

token test

Question 29

wat is gespaard bij non-fluent agrammatic variant of PPA

Answer 29

single word comprehension object knowledge

Question 30

waar is atrophy bij nonfluent PPA

Answer 30

left posterior frontoinsular atrophy

Question 31

semantic dementia PPA symptoms

Answer 31

semantic anomia: niet meer objecten of woorden kunnen benoemen. begint bij rare low frequency words en progresses naar common high frequency words. impaired single word comprehension: lose knowledge or words, cannot write or read irregular written words (surface dyslexia or dysgraphia)

Question 32

wat kunnen mensen met semantic variant nog wel

Answer 32

speak fluently with intact grammar and repetition of words and sentences

Question 33

pnfa wat zie je bij mensen

Answer 33

dus heel langzaam, met veel pauzes etc. vaak ook in stressvolle situaties. bijv ook lastig aan telefoon, want dan kan je geen handgebaren etc gebruiken.

Question 34

wat zie je bij mensen met sd

Answer 34

bijvoorbeeld als je vraagt mag ik de schaar, dan weten ze niet wat schaar betekent. soms herkennen ze een schaar ook niet eens meer.

Question 35

dus verschil in praktijk

Answer 35

pnfa: zal heel langzaam er over doen. sd: zal je niet begrijpen of hele gekke woorden zeggen voor bijvoorbeeld banaan

Question 36

logopenic aphasia

Answer 36

impaired single word retrieval impaired repetition of phrases and sentences speech sound errors

Question 37

wat zie je bij patienten met logopenic aphasia

Answer 37

bijvoorbeeld geen boeken lezen soms kunnen ze bepaalde woorden niet op komen. soms ook wel.

Question 38

dus globale verschil tussen nonfluent PPA, semantic PPA en logopenic PPA

Answer 38

Whereas someone with nonfluent PPA may have trouble pronouncing words and stringing sentences together, someone with logopenic PPA may find it difficult to retrieve words from memory. Meanwhile, someone with semantic PPA may get lost in conversations, unable to comprehend what words mean. dus nonfluent = pronouncing words and making sentences logopenic = niet op komen terwijl zij praten semnatic = niet begrijpen wat een woord betekent

Question 39

wat is spared bij logopenic aphasia

Answer 39

motor speech single word comprehension and object knowledge geen agrammatism

Question 40

lewy bodies zijn...

Answer 40

aggregates of alpha synucleine in the brain

Question 41

lewy body dementia lijkt een beetje op een combi tussen

Answer 41

alzheimers en parkinson

Question 42

hoeveel % diagnoses ldb

Answer 42

2% hoewel post mortem: 20-35%!

Question 43

symptoms of lewy body disease

Answer 43

fluctuating cognition, vooral attention and alertness repeated visual hallucinations parkinsonism: dual sided hypokinesia, rigidity falling a lot rem-sleep behaviour disorder oversensitivity for antipsychotic medication

Question 44

wat was er met LBD en antipsychotics

Answer 44

soms krijgen mensen antipsychotics tegen de visual hallucinations -> maar niet goed! want hier kunnen ze niet goed tegen. may also worsen symptoms and be fatal

Question 45

hypokinesia =

Answer 45

minder beweging

Question 46

Substance abuse in combinations with malnutrion are frequently encountered comorbidities among elderly patients

Answer 46

oke

Question 47

2 factoren voor Wernicke

Answer 47

alcohol + thiamine deficiency from vitamine B1

Question 48

wat zijn symptoms van wernicke

Answer 48

double vision cerebellar disturbances + motor coordination problems

Question 49

korsakoffs symptoms

Answer 49

learning new information (weak encoding) memory retrieval (both recent and long term -> black holes) executive functions and personality changes (disinhibition or apathy) confabulation (covering up the disease) + anosognosia forgetfullness

Question 50

wat is handig bij wernicke en korsakoff

Answer 50

cognitive deterioration can sometimes be stopped or reversible when alcohol use stops + vitamins are suppleted

Question 51

Neuropsychological assessment is particular helpful in the early phases of behavioral and cognitive changes, also to monitor further deterioration and need for support in the first years. Neuropsychological findings might be useful informations to find and train compensentory strategies. Moreover,many patients are referred because of their incapacitating fears for dementia (sometimes induced by the media, or their excessive worries about ageing). A neuropsychological assessment and psychoeducation might provide relief.

Answer 51

oke