the ageing brain and dementia REVISE Flashcards
what is the cost of dementia to the UK economy?
bigger than cancer and heart disease combined
in which sort of countries are the vast majority of new dementia cases recorded?
low/middle income countries
is dementia a disease?
no
it is an overall term describing a group of symptoms (e.g memory loss) associated with decline in cognitive functioning leading to an increasing inability to cope
a major neurocognitive disorder
how many types of demetia are there?
over 100 types
what are the 2 main criteria for dementia diagnosis?
decline in cognitive functioning
leading to an increase in inability to cope and independetly function
what is the difference in the diagnostic criteria for those with a mild or major neurocognitive disorder?
mild - modest cognitive decline but doesn’t interefere with capability for independence
modest - significant cognitive decline leading to lack of ability to act independently and to cope
what is dementia more feared than?
heart disease, stroke, diabetes and cancer
what is the prevalence of dementia in england in 2011?
670 000
compared to estimated 884 000
what are the percentage probabilities that a randomly seleceted elderly person will have dementia?
6.5% england, 2011
8.3% england, 1991
40% Torbay memory clinic, 2015
65% england care homes, 2011
what is the biological process cause of dementia?
misfolded proteins accumulate into amyloid plaque (either producing too much or unable to clear it)
which can occur both inside and outside neurons in the cerebral cortex and certain subcortical regions (occurs in everyone but some bodies better at breaking this down)
when this occurs inside neurons, they will die as do the synapses connected between them
the rate of neuronal loss can cause the onset of dementia after 10-20 years (middle age wen develop)
what are tell tale signs that someone has dementia from looking at the brain?
brain shrinkage (atrophy) and gapping due to neuronal loss, especially in memory and language areas and hippocampus
reduction of brain activity due to neuronal loss which has occured (detected predominantly by a CT scan but MRI scans can also be used)
what percentage of dementia patients have Alzheimer’s disease?
60-80%
most common form
what are some early signs and symptoms of Alzheimer’s disease?
memory loss problems with language changes in mood or behaviour changes in personality misplacing things
what is the second most common form of dementia?
vascular dementia
what is the cause of vascular dementia?
series of strokes (ischemic) causing clot
impairs circulation of blood to the brain
causes cell death
what 3 elements is cognition made up of?
thinking, memory and reasoning
what are the 2 main continuums for types of dementia
alzheimers - vascular (can be a combination of the 2 known as ‘mixed dementia’)
dementia with Lewy Bodies - Parkinson’s
what is the cause of dementia with Lewy Bodies?
results from clumps of alpha-synuclein and ubiquitin protein
what are some of the symptoms of dementia with Lewy Bodies?
cognitive:
fluctuating cognition
visual hallucinations
motor:
spontaneous parkinsonism
what differentiates dementia with Lewy Bodies from Parkinson’s?
if there are more cogntive components of parkinson’s than motor then diagnosed with dementia with Lewy Bodies
why is frontotemporal dementia easy to misdiagnose as a psychiatric disorder?
due to mood and behaviour disturbances
display ‘odd’ social behaviour
euphoria and apathy
repetitive compulsive behaviour
which brief cognitive assessments are there for assessing dementia?
the Mini Mental State Examination (MMSE)
the Montreal Cognitive Assessment (MOCA)
what are the main cognitive assessments used by GPs and why
have only around 8 mins to see a patient
Memory Impairment Screen (MIS)
GPCOG Screening Test
why is it hard to accurately measure cognition in cognitive assessments?
testing effects e.g tired and also no comparison to previous cognition so might normally be lower and therefore no change
what is the most telling cognitive test at the beginning of dementia?
delayed recall and also clock drawing
what is an issue with cognitive assessments?
in some there are cultural and educational biases within the questions and tasks
how often is the GPCOG used by GPs
50% of referrals as takes less than 10 mins
drug treatments available
medication which reduces numbers of plaque don’t improve symptoms
medications mainly used to treat psychological symptoms
3 types of medication:
cholinesterase inhibitors
NMDA receptor antagonsists
antipsychotics (only used with severly distressed patients or those at risk of harm to themselves or others)
best treatment for dementia as identified by NICE?
psychological
intervention for cognitive symtpoms of dementia?
cognitive stimulation
interventions for non-cognitive symptoms of dementia and challenging behaviour?
aromatherapy, multisensory stimulation, therapeutic use of music and/or dancing, animal-assisted therapy, massage
is dementia more common with men or women?
women
risk factors for dementia
stroke hypertension diabetes obesity smoking depression physical inactivity cognitive inactivity vitamin D deficiency mediterranean diet
what is hypertension?
when blood pressure increases to over 140/90 mm Hg
this damages target organs (if the brain then can lead to dementia)
what is the controversy over the link between hypertension and dementia?
midlife hypertension associated with increased dementia risk
BUT
late-life hypertension inversely associated with dementia risk
how many people in the world have vitamin D deficiency or insufficiency?
1 billion
what is the threshold risk of vitamin D?
around 50 nmol/L
how does the mediterranean diet link with dementia?
greater adherence to the diet associated with slower cognitive degeneration and reduced risk of dementia
could be to do with oily fish containing vitamin D
what is the link between alcohol consumption and dementia?
it appears light to moderate drinkers are at the lowest risk and heavy drinkers are at the highest risk (nondrinkers at the highest risk for Alzheimer’s disease)
and history of alcohol use disorders more than double the odds of severe memory impairment
HOWEVER this could be due to the general lifestyle choices that these people take e.g heavy drinkers may not exercise as frequently etc.
what does the NHS recommend in terms of drinking and physical activity?
at least 150 minutes of moderate aerobic activity every week and strength exercises on 2+ days working all major muscles
don’t exceed 14 units a week and space over at least 3 days
heritability of Alzheimer’s disease?
genes which may incur an increased risk?
79% (79% of variance in onset of disease related to genetics)
may be related to having 1 or 2 E4 alleles
