S2 - Dementia Flashcards
Define dementia.
An umbrella term for the effects of diseases resulting in a syndrome of effects including some mix of the following symptoms and behavioral changes:
memory loss, aphasia, agnosia, apraxia, executive function decline.
Also, agitation, mood swings, aggression, depression, sundowning, perseveration, hallucination, apathy, confusion, wandering, etc.
Define aphasia.
Inability to speak
(a-phrase-ia)
Define agnosia.
Inability to recognize faces and symbols
(a-nose-ia)
Define apraxia.
Loss of fine motor skills and ability to perform practical motor tasks (e.g. buttoning shirt, tying shoes, brushing teeth)
(a-practical-ia)
What is sundowning?
The worsening of dementia symptoms as night falls
What are the main lobes of the cerebrum?
Frontal
Parietal
Temporal
Occipital
What is the function of the frontal lobe?
Executive function, planning, reasoning, planned motor functions
What is the main function of the parietal lobe?
Sensory interpretation and organization
What are the main functions of the temporal lobe?
Memory organization, auditory function
What is the main function of the occipital lobe?
Visual processing
What is the most common cause of dementia?
Alzheimer’s Disease (60 - 80% of dementia cases)
Where does Alzheimer’s Disease fall in the top 10 leading causes of death in the U.S.?
6
What are some common risk factors for Alzheimer’s Disease development?
Age
Gender (women make up 2/3 of cases)
Family history
Social isolation
Low educational attainment
Metabolic syndrome
How is Alzheimer’s Disease diagnosed (In a definitive manner)?
Only by death after autopsy
All other diagnoses made by exclusion
What is the usual age of onset for Alzheimer’s Disease?
65 and older
(Although it is important to remember that AD is NOT a part of the normal aging process)
What is the age of onset for early-onset Alzheimer’s Disease?
Younger than 65 years of age
What is the gene associated with Alzheimer’s Disease (although only a small percentage, ~10% of cases, are associated with it)?
Is there a protective isoform of this gene?
APOE-E4 (Apolipoprotein-E4)
Yes, APOE-E2
What genes are associated with early-onset Alzheimer’s Disease? In families in which early-onset AD is prevalent, what is the hereditary nature of the disease?
APP (Amyloid protein precursor)
PSEN1 (Presenilin-1)
PSEN2 (Presenilin-2)
Autosomal dominant (50% chance for offspring)
What are the two main pathophysiological aspects of Alzheimer’s Disease? Which is intracellular (inside the cell)? Which is extracellular (outside the cell)?
Beta-amyloid plaques (extracellular)
Tau-protein tangles (intracellular) - also known as neurofibrillary tangles
How do we stop or cure Alzheimer’s Disease?
There is no definitive treatment available yet
Although no definitive treatment exists, what are current recommendations around preventing or slowing Alzheimer’s Disease development?
Reduce metabolic syndrome factors
Learn as much as you can (Cognitive reserve hypothesis)
Describe the cognitive reserve hypothesis.
The more social interaction, education, and other activities that stimulate the brain, the more protected an individual is against the effects of Alzheimer’s Disease.
AKA more brain usage = more neural connections = more of a buffer against neuronal damage or loss
Are there any clinical tests that can help in the diagnosis of Alzheimer’s Disease and other forms of dementia?
Yes, the mini-cognitive test (mini-cog) and the mini-mental-state exam (MMSE)
Describe mild, moderate, and severe Alzheimer’s Disease.
Mild - Person still functions independently; mild cognitive decline; may be noticed by family and friends
Moderate - Longest stage; level of care required; sociobehavioral changes; increased cognitive impairment
Severe - Loss of ability to respond to environment; personality changes; comprehensive care-giving required; loss of awareness and physical abilities
What are the common first signs of Alzheimer’s Disease?
Mild cognitive impairment and loss of short-term memory
(This leads to difficulty in separating AD from the normal cognitive decline associated with the aging process)
What is the average length of life for an individual after diagnosis with Alzheimer’s Disease?
4-8 years (although this number can stretch out to up to 20 years)
What is a common cause of death in individuals with Alzheimer’s Disease?
Pneumonia or other respiratory issues associated with loss of proper swallowing ability
What is the second most common type of dementia?
Lewy body dementia
Note: In our review, I said vascular dementia was 2nd. There is some debate around this topic, and for the purposes of our class, Lewy body dementia is 2nd MC. However, vascular dementia is commonly cited as 2nd MC and Lewy body as 3rd MC.
What is the main dysfunction associated with Lewy body dementia?
Abnormal protein deposits (alpha-synuclein) in the brain, somewhat similar to AD
These deposits lead to a deficiency of dopamine and can cause some Parkinsonian symptoms
What is the main dysfunction of vascular/multi-infarct dementia?
Vascular damage or defects lead to loss of sufficient blood flow to the brain and subsequent brain damage
(Basically, stroke or other vascular insults damage the brain)
Describe Creutzfeldt-Jacob Disease.
An infectious disease caused by prions (misfolded proteins) that accumulate in the brain and cause neuronal degeneration
Describe Multiple Sclerosis.
An autoimmune attack on the myelin sheath that leads to scanning speech, incontinence, decreased motor ability, fatigue, nystagmus, etc.
(Remember, Multiple Sclerosis affects the Myelin Sheath)
Describe Parkinson’s disease.
Not characterized by dementia until the disease has severely progressed
Loss of dopamine-producing region of the brain (substantia nigra pars compacta in basal ganglia)
Characterized by rigidity, tremor, akinesia, shuffling walk
Describe Huntington’s Disease.
A hereditary, autosomal dominant genetic mutation with an onset between 20 and 50 years of age
Characterized by loss of motor inhibition, dementia, and depression
Describe the MIND diet.
A combination of the DASH (antihypertensive) and Mediterranean diets; it is thought to decrease inflammatory and metabolic processes and thus improve cognitive function
