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Clinical & Neuropsychology 2 > NP: Lecture 10 Dementia II > Flashcards

NP: Lecture 10 Dementia II Flashcards

1
Q

dsm 5 minor and major neurocognitive disorders

A

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

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2
Q

6 neurocognitive domains in dementia

A

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

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3
Q

wat is de heeeele globale criteria voor dementia

A

evidence for cognitive impairment in one or more domains

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4
Q

major or minor ncd is due to:

A

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

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5
Q

wat is posterior cortical atrophy…

A

a subtype of alzheimers disease

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6
Q

posterior cortical atrophy waar

A

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

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7
Q

clinical characteristics of posterior cortical atrophy

A

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

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8
Q

posterior cortical atrophy waarom lastig te diagnosticeren

A

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

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9
Q

hoe meten van pca

A

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

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10
Q

prevalentie dementie soorten in nl

A

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

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11
Q

vascular dementia globaal

A

one or more strategic strokes (=multi infarct dementia)

or

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

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12
Q

frontotemporal dementia variants

A

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

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13
Q

behaviour variant symptoms

A

progressive disturbances in personality, emotion and behaviour

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14
Q

language variants symptoms

A

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

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15
Q

pervalence of ftd nummers

A

2-10 per 100.000

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16
Q

in welke categorie is ftd de meest gediagnosticeerde vorm van dementia

A

bij early onset, dus < 65 jaar

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17
Q

hoeveel % van ftd begint vroeg

A

rond de 70-80%

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18
Q

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

A

5%

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19
Q

hoeveel van ftd is genetisch

A

40%

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20
Q

wat zie je op een mri of spect scan bij ftd

A

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

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21
Q

even kijken naar mri scan van verschillende soorten ftd

A

oke

22
Q

wat is de meest salient en impairing variant of ftd

A

behavioural variant

23
Q

waarom vaak een late detectie bij ftd

A

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

24
Q

4 kern symptomen van ftd

A

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

25
Q

waar hebben mensen bij bvftd ook last van naast personality

A

working memory
planning
conceptual reasoning
mental flexibility
complex attention

26
Q

wat is apathy

A

geen interest meer!!!

27
Q

non-fluent agrammatic variant PPA

A

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

28
Q

hoe meet je impaired comprehension of complex sentences

A

token test

29
Q

wat is gespaard bij non-fluent agrammatic variant of PPA

A

single word comprehension
object knowledge

30
Q

waar is atrophy bij nonfluent PPA

A

left posterior frontoinsular atrophy

31
Q

semantic dementia PPA symptoms

A

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)

32
Q

wat kunnen mensen met semantic variant nog wel

A

speak fluently with intact grammar and repetition of words and sentences

33
Q

pnfa wat zie je bij mensen

A

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.

34
Q

wat zie je bij mensen met sd

A

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

35
Q

dus verschil in praktijk

A

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

36
Q

logopenic aphasia

A

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

37
Q

wat zie je bij patienten met logopenic aphasia

A

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

38
Q

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

A

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

39
Q

wat is spared bij logopenic aphasia

A

motor speech
single word comprehension
and object knowledge
geen agrammatism

40
Q

lewy bodies zijn…

A

aggregates of alpha synucleine in the brain

41
Q

lewy body dementia lijkt een beetje op een combi tussen

A

alzheimers en parkinson

42
Q

hoeveel % diagnoses ldb

A

2%

hoewel post mortem: 20-35%!

43
Q

symptoms of lewy body disease

A

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

44
Q

wat was er met LBD en antipsychotics

A

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

45
Q

hypokinesia =

A

minder beweging

46
Q

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

A

oke

47
Q

2 factoren voor Wernicke

A

alcohol + thiamine deficiency from vitamine B1

48
Q

wat zijn symptoms van wernicke

A

double vision
cerebellar disturbances + motor coordination problems

49
Q

korsakoffs symptoms

A

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

50
Q

wat is handig bij wernicke en korsakoff

A

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

51
Q

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.

A

oke

Clinical & Neuropsychology 2 (30 decks)

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