NP: Lecture 10 Dementia II Flashcards
dsm 5 minor and major neurocognitive disorders
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
6 neurocognitive domains in dementia
executive functions
complex attention
perceptual-motor function
language
learning and memory
social cognition
wat is de heeeele globale criteria voor dementia
evidence for cognitive impairment in one or more domains
major or minor ncd is due to:
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
wat is posterior cortical atrophy…
a subtype of alzheimers disease
posterior cortical atrophy waar
atrophy in visual cortex and sometimes in the cerebellum
ook plaques and tangles
clinical characteristics of posterior cortical atrophy
progressive visuoperceptual problems:
visual field
not recognizing objects, faces, letters
reading
optic ataxia (pointing or reaching for objects)
visual and spatial orientation problems
posterior cortical atrophy waarom lastig te diagnosticeren
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
hoe meten van pca
visuele perceptie object & ruimte
rivermead behaviour inattention test
perceptual organisation test
visuoconstructive tasks
perceptomotor task
prevalentie dementie soorten in nl
alzheimers 65%
vascular 22%
frontolobar degeneration 4%
lewy bodies dementia 2%
vascular dementia globaal
one or more strategic strokes (=multi infarct dementia)
or
small vessel disease (variety of abnormalities related to small blood vessels in the brain)
frontotemporal dementia variants
behavioural variant (bvFTD)
language variants: primary progressive aphasia (PPA) met de: semantic variant (svFTD); non-fluent-agrammatic variant and logopenic variant
behaviour variant symptoms
progressive disturbances in personality, emotion and behaviour
language variants symptoms
there is a gradual (!) impairment of language, not just speech (language problems are the most important and disabling feature)
pervalence of ftd nummers
2-10 per 100.000
in welke categorie is ftd de meest gediagnosticeerde vorm van dementia
bij early onset, dus < 65 jaar
hoeveel % van ftd begint vroeg
rond de 70-80%
at autopsy … of the dementia cases turned out to be ftd
5%
hoeveel van ftd is genetisch
40%
wat zie je op een mri of spect scan bij ftd
typical atrophy patterns or signs of hypoperfusion or hypometabolism in medial frontal lobes and/or temporal lobes
even kijken naar mri scan van verschillende soorten ftd
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wat is de meest salient en impairing variant of ftd
behavioural variant
waarom vaak een late detectie bij ftd
omdat patienten het zelf niet door hebben, moet echt vanaf fam etc komen
4 kern symptomen van ftd
disinhibition, impulsivity
apathy or inertia (luiheid)
loss of empathy
perseverative, stereotype behaviour or compulsive/ritualistic behaviour
waar hebben mensen bij bvftd ook last van naast personality
working memory
planning
conceptual reasoning
mental flexibility
complex attention
wat is apathy
geen interest meer!!!
non-fluent agrammatic variant PPA
non-fluent effortful speech
grammar mistakes
phonological mistakes through apraxia of speech
impaired comprehension of complex sentences
hoe meet je impaired comprehension of complex sentences
token test
wat is gespaard bij non-fluent agrammatic variant of PPA
single word comprehension
object knowledge
waar is atrophy bij nonfluent PPA
left posterior frontoinsular atrophy
semantic dementia PPA symptoms
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)
wat kunnen mensen met semantic variant nog wel
speak fluently with intact grammar and repetition of words and sentences
pnfa wat zie je bij mensen
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.
wat zie je bij mensen met sd
bijvoorbeeld als je vraagt mag ik de schaar, dan weten ze niet wat schaar betekent. soms herkennen ze een schaar ook niet eens meer.
dus verschil in praktijk
pnfa: zal heel langzaam er over doen.
sd: zal je niet begrijpen of hele gekke woorden zeggen voor bijvoorbeeld banaan
logopenic aphasia
impaired single word retrieval
impaired repetition of phrases and sentences
speech sound errors
wat zie je bij patienten met logopenic aphasia
bijvoorbeeld geen boeken lezen
soms kunnen ze bepaalde woorden niet op komen. soms ook wel.
dus globale verschil tussen nonfluent PPA, semantic PPA en logopenic PPA
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
wat is spared bij logopenic aphasia
motor speech
single word comprehension
and object knowledge
geen agrammatism
lewy bodies zijn…
aggregates of alpha synucleine in the brain
lewy body dementia lijkt een beetje op een combi tussen
alzheimers en parkinson
hoeveel % diagnoses ldb
2%
hoewel post mortem: 20-35%!
symptoms of lewy body disease
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
wat was er met LBD en antipsychotics
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
hypokinesia =
minder beweging
Substance abuse in combinations with
malnutrion are frequently encountered
comorbidities among elderly patients
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2 factoren voor Wernicke
alcohol + thiamine deficiency from vitamine B1
wat zijn symptoms van wernicke
double vision
cerebellar disturbances + motor coordination problems
korsakoffs symptoms
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
wat is handig bij wernicke en korsakoff
cognitive deterioration can sometimes be stopped or reversible when alcohol use stops + vitamins are suppleted
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.
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