Session 9 - Dementia Ia Flashcards
Central Nervous System consists of…
- Brain
- Spinal Cord
- Retina
General anatomy of the brain
Dorsal, Caudal, Rostral, Ventral
The brain is composed of:
Neutrons, Glial cells (“support cells’), astrocytes (neurochemical support), oligodendrocytes (insulation), microglia (immunology), ependymal cells (secretion)
Neutrons are outnumbered by support cells…
86 Billion Neurons…860 Billion Support Cells
200-400x10 9 stars @ Milky Way
6x10 22 stars @ universe
Circulation of the Cerebro-spinal fluid…
1) CSF is produced by the choroid plexus of each ventricle.
2) CSF flows through the ventricles and into the subarachnoid space via the median and lateral apertures. Some CSF flows through the central canal of the spinal cord.
3) CSF flows through the subarachnoid space.
4) CSF is absorbed into the rural venous sinuses via the arachnoid granulations.
Features of Cerebro-spinal fluid…
Physico-chemical properties - Clear, Colorless, Almost similar to plasma
Functions of Cerebro-spinal fluid…
Buoyancy, Protection, Homeostasis, Clearing ‘waste’
Main functions of the brain…
To process, transmit and detect information
A neural circuit model within the visual cortex (occipital lobe)…
White: Pyramidal Neurons
Black: Interneurons
Connection between 2 neurons
Synapse, electric signals (voltage,current), chemical signals (neuro transmitters)
Electro-chemical synapse
Allows transmission of information from one neuron to another.
Neurodegenrative diseases
Dementia
What is dementia?
It describes the pattern of deteriorating intellectual function- particularly (although not exclusively)in the elderly - that can occur as a result of various neurological disorders
Different types of dementia…
Alzheimer’s disease, vascular dementia, Lewy body disease, frontotemporal dementia (pick’s disease), mixed dementia
Age-related cognitive decline (ARCD)
Clinically recognised syndrome, step-wise diagnostic process, impairments in several brain functions.
Diagnosis can be difficult as symptoms in the early stages share similarties with ARCD
How many people are living with dementia globally?
50 milllion
Dementia may be linked with income…
Between 2015 and 2050, the numbers of people with low income countries will increase 264% by 227% .
Common symptoms of dementia
Lack of motivation, forgetfulness, losing track of time, sleep disturbance, behavioural changes, unable to recognise familiar people, reduced mobility, inability to perform day-to-day tasks, relying on permanent care (later stages)
ARCD, Affects ages…
40% of >60 years old
Age-related cognitive declines (ARCD) observations…
Reduced brain weigh/volume, loss of neural bodies, expanded sulci, increased ventricular volume, decreased synaptic density.
Age-related cognitive declines (ARCD) affects which region?
Pre frontal cortex, medical temporal lobe, lambic system (hippocampus)
Types of stroke
Ischemic vs hemorrhagic
Dementia can result from a stroke. (Vascular Dementia) A stroke can….
Induce short and long term consequences.
Vascular dementia occurs
In 25-30% of patients of stroke.
Symptoms of vascular dementia:
Impaired judgment, loss of memory, problems with abstract thinking, problems with speech, issues with orientation, difficulties in planning and performing familiar tasks, changes in desonality, mood and behaviour, loss of initiative, slowness
Lewy body disease & Parkinson’s disease affects which memory or motor issue…
Can affect both motor control and memory, is memory issue occurs first → lewy body diseases, if motor issue occur first → Parkinson disease
Symptoms of lewy body disease & Parkinson’s disease…
Dementia, hallucinations, movement disorders, sleep problems, anxiety, depression, delusions, agitation, paranoia
Lewy body disease & Parkinson’s disease is associated with…
Slow deterioration in social behaviour, problems using language, intellectual impairments, personality change.
Fronto-temporal dementia (pick’s disease) are caused by neurones responding to dopamine are often affected, it is often associated with…
Slow deterioration in social behaviour, problems using language intellectual impairment, personality change.
Alois Alzheimer 1864-1918 was working at the “asylum for lunatics and epileptics”
He performed post-mortem pathologies, and recorded the results
1906: brain pathology and symptoms of presenile dementia
1907: Wrote a paper detailing the disease and his findings
1910: AD named by Kraepelin as “Alzheimer’s disease’
1911: Alzheimer’s description of the disease was being widely used
Alzheimer’s disease damages the brain’s functions…
Memory, orientation, calculation, etc.
Alzheimer’s disease
Predominantly seen in patients > 60 years of age
Earliest stages of Alzheimer’s Disease:
short-term memory is affected
patient finds it hard to learn and retain new information
older or distant memory is gradually lost
becomes difficult to recover memories of events and people from earlier life
other symptoms include:
difficulty in putting thoughts into words
difficulty in carrying out simple directed acts
difficulty in recognising well-known faces or objects
Progression of Alzheimer’s disease in the brain…
The hippocampus shrinks noticeably… Widening of suici and narrowing of gyri. Gyri are ridges on the surface of the brain, each surrounded by fissures known as sulci. Gyri are unique structures and increase the surface area of the brain (totalling at 2000 cm2).
gyri are typical brain features of “higher species”
Risk factors of Alzheimers disease:
Genetic factors, history of head trauma (injury), females, lower educational level
Symptoms of Alzheimer’s disease
Slowly progressive neurodegeneration, loss of neutrons & synapses in the cerebral cortex and certain subcortical regions, potential trigger
Early Stage of Alzheimer’s disease
Duration period 2 - 4 years
Frequent memory loss, particularly of recent events
Repeated questions, some problems expressing and understanding language
Writing and using objects become difficult
Depression and apathy can occur
Drastic personality changes may parallel functional decline
Need reminders for daily activities (day-to-day tasks)
Difficulties with sequencing > impaired driving
Second stage of Alzheimer’s disease
Duration 2 - 10 years
Pervasive and persistent memory loss (impacts life across all settings)
Rambling speech, unusual reasoning, confusions (events, time and place)
Potential to become lost in familiar settings
Sleep disturbances
Behavioral symptoms accelerate
Nearly 80% of patients exhibit emotional and behavioral problems which are aggravated by stress and change
Slowness, rigidity, tremors and gait problems > impaired mobility and coordination
Need structure, reminders, and assistance with activities of daily living
Third stage of Alzheimer’s disease
Increased memory loss and confusion
Problems recognizing family and friends
Inability to learn new things
Difficulty carrying out tasks that involve multiple steps (such as getting dressed)
Problems coping with new situations
Delusions and paranoia
Impulsive behavior
Morphopathologic manifestations > cerebral cortex
Last (severe) stage of Alzheimer’s disease
Duration 1 - 3 years
Confused about past and present
Loss of recognition of familiar people and places
Generally incapacitated
Severe to total loss of verbal skills
Unable to self-care (falling, immobility)
Problems with swallowing, incontinence, and illness.
Extreme problems with mood, behavioral problems, hallucinations and delirium
Patients need total support and care (24/7)
10
Death
Diagnostic of Alzheimer’s disease…
Neuropsychological, imaging
Diagnostic of dementia…
Clinical, post-mortem
Anti-psychotic therapies…
Block d2 recaptors in dopaminergic pathways, less neurotransmitter available
