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Brain Disorders > unit 8b > Flashcards

unit 8b Flashcards

Dementia

1
Q

Mild cognitive impairment (MCI)

A

transition stage b/t mild cognitive decline ↓ of normal aging & more serious problems of dementia
- abt 50% progress to dementia

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2
Q

Dementia

A

progressive decline in cognitive func. due to damage/disease in the body beyond what might be expected f/ normal aging

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3
Q

Delirium

A

the acute, common symptomatic manifestation of early brain dysfunction
- for any reason; rapid; fluctuating course; may be hyperactive or hypoactive

Positive symptoms (hyperactive)
negative symptoms
(hypoactive)

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4
Q

Positive symptoms of DELIRIUM

A

include increased ↑ activity/thought (HYPERACTIVE)
ex: agitation, hallucination, combativeness, delusions, disorg. thoughts

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5
Q

Negative symptoms of DELIRIUM

A

include decr. ↓ activity/thought (HYPOACTIVE)

ex: flat affect (no emotion), little speech, lack of motivation, inability to converse or focus attention or follow a command

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6
Q

Types of neuropsychiatric testing

A
  1. Mini Mental State Exam (MMSE)
    - specific ranges are set to help determine severity of dementia
    - normal >27/30
  2. Clinical Dementia Rating (CDR)
    - 5 point scale used to characterize 6 categ. or cognitive & functional performance.
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7
Q

Normal pressure hydrocephalus (NPH)

A

Important to rule out NPH when considering diagnosis of dementia

NPH is a chronic type of communicating hydrocephalus in which the increase in intracranial pressure due to incr. ↑ cerebrospinal fluid (CSF) reaches a somewhat stable pt w/ only slightly incr ↑ intracranial pressure & no heartache or loss of consciousness in the patient

However, brain tissue becomes compressed → leading to cognitive issues resembling dementia

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8
Q

Alzheimer’s Disease (AD)

A

Most common form of dementia, w/ initial problems in learning, memory, & planning that expand to include language, recognition, personality changes, + motor deficits
- associated w/ early onset in Down’s syndrome

Early, Moderate, Severe

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9
Q

Early AD

A

initial mild problems w/ learning, memory (esp. more recently learned facts/info), planning, language problems (shrinking vocab. decr ↓ word fluency), problems w/ fine motor tasks (apraxia)

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10
Q

Moderate AD

A

memory problems now interfere w/ work/social life

Personality changes, problems recog. family/friends, more apparent problems w/ language (comprehension/production), inability to perform ACTIVITIES OF DAILY LIVING, urinary incontinence, impaired LTM, WANDERING, SUNDOWNING, LABILE AFFECT, delusional misidentification syndromes (Capras, Fregoli)

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11
Q

Severe AD

A

Much of cortex atrophied
- loss of ability to communicate, recog. ppl, care for self, single-world language use, extreme apathy & exhaustion, bedridden until death f/ complications (eg pneumonia)

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12
Q

Activities of Daily Living (ADL)

A

routine activities that ppl tend to do everyday w/o needing assistance

6 basic ADLs:
- eating
- bathing
- dressing
- toileting
- transferring (walking)
- continence

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13
Q

Wandering

A

for Alzheimer’s patients, this specifically refers to patients wandering away/ escaping f/ home

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14
Q

Sundowning

A

Alteration (worsening) in behavior in sync w/ circadian rhythm
- co-occurs w. wandering
- may come from fatigue and/or lower light lvls

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15
Q

Labile affect

A

Excessive displays of emotion
- or expressed emotions that do not match the situation

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16
Q

Plaques

A

Occurs in Alzheimer’s disease
- EXTRACELLULAR

From when ‘sticky’ protein pieces called beta-amyloid clump together
- Beta-amyloid comes f/ larger protein found in myelin

May block cell-to-cell signaling at synapses + may also activate immune syst. cells →leads to inflammation & cell death

May be some assoc. amyloid-related mechanism that prunes neuronal connections

** 2006 study suggested beta-amyloid plaques are important part of pathogenesis of Alzheimer’s have been shown to been FABRICATED in SUMMER 2022**

17
Q

Tau protein

A

the intracellular transport system
- organized in parallel strands somewhat like railroad tracks

Helps tracks stay straight

18
Q

Neurofibrillary tangles

A

Occur in Alzheimer’s disease
- INTRACELLULAR

Tau protein collapses into twisted strands called tangles
→ which cause intracellular cell-transport system tracks to fall apart & disintegrate

Transport of nutrients + other essential supplies across cell body & axons is interrupted

19
Q

Possible causes of Alzheimer’s Disease

A

Changes in chrolinergic pathways?
- deficiency in nuerotrans. acetylcholine

Amyloid protein misfolding?
- beta amyloid related, but vaccine that clears amyloid protein does NOT help

Tau protein misfolding?
- do tangles cause neurodegeneration?

Herpes simplex virus role?
- long-term inflammation is correlated w/ neurodegeneration

Changes in serotonergic pathways?
- SSRI may slow progression of AD

Sleep deprivation?
- Makes AD worsen faster

Changes in REST?
- a protein active during fetal brain develop. switches back on later inline to protect aging neurons f/ various stresses
→ REST protein has decr. ↓ func. in AD patients

Role of long-term inflammation from any cause?

20
Q

Attempted Treatments of AD

A

Nothing yet signif. delays/ reverses disease
- Prevention: mental stimulation, exercise, diet

-Drugs to help symptoms
→ Acetylcholinesterase inhibitors
→ NMDA receptor antagonist

  • Drugs to modify disease
    → Antibody-based immunotherapies
    → BACE inhibitors
    → RAGE inhibitors, tau-aggregation inhibitors, Ca-channel cblockers

-Drugs to prevent disease: same as disease-modifying drugs BUT used very early in disease

21
Q

Acetylcholinesterase inhibitors

A

molecules that block the breakdown of the neurotransmitter: acetylcholine

22
Q

NDMA receptor antagonist

A

a molecule that acts on the glutamatergic system to block the overstimulation of NDMA receptor (which has a role in long term potentiation)

23
Q

Antibody-based immunotherapies

A

used antibodies & other immune modulation to target plaques/tangles for clearance

24
Q

BACE inhibitors

A

novel drug class that interrupts Aβ production (= stop plaque formation)
- current trails not going well

25
Q

Demential w/ Lewy bodies (DLB)

A

dementia characterized by fluctuating cognition w/ great variation in attention & alertness f/ hr to hr, recurrent visual hallucinations, & motor features of Parkinsonism

Levy bodies = abnormal protein clumps seen inside cells in cases of DLB

26
Q

Fronto-Temporal Lobar Dementia (FTLD)

A

heterogeneous dementia disorders assoc. w/ atrophy in frontal & temporal lobes
- w/ sparing of the parietal & occipital lobes

Symptoms include: personality changes, problems w/ executive funcs, language problems w/ naming or fluency

Subtypes:
- fronto-temporal dementia
- semantic dementia
- progressive non-fluent dementia

27
Q

Fronto-temporal dementia

A

(frontal & temporal lobes)

Personality changes, disinhibition, apathy, repetitive behavior

28
Q

Semantic dementia

A

Anterior temporal lobes
- progressive problems w/ naming

29
Q

Progressive non-fluent dementia

A

Left Broca’s area
- quiet, trouble w/ word production
- AKA primary progressive aphasia

30
Q

Posterior Cortical Atrophy (PCA)

A

Dementia w/ initial prominent visual symptoms such as problems w/ visual; field defects, contrast sensitivity, color discrimination, & feature recog. of complex objects, acalculia, & little initial decline in memory (previously known as Alzheimer’s disease)

31
Q

Secondary Dementias

A

dementias that arise as side effect f/ another primary medical condition, such as problems w/ blood vessels, trauma, toxins, infection

  • Vascular/Multi-Infarct Dementia
  • Dementia Pugilistica (chronic traumatic encephalopathy)
  • Wernicke’s Encephalopathy**
32
Q

Wernicke’s Encephalopathy

A

Abrupt onset of encephalopathy (brain disorder), ophthalmoplegia (eye paralysis), + ataxia (loss of coordination)
- induced by thiamine deficiency, usually f/ extreme dietary deficiency, often assoc. w/ chronic alcoholism

REVERSIBLE w/ thiamine treatment
→ compared to irreversible Korsakoff’s syndrome

33
Q

Vascular/Multi-Infarct Dementia

A

dementia w/ symptoms include. problems w/ recent memory, wandering, shuffling walk, loss of bladder or bowl control, emotional lability, difficulty w/ instructions, & problems handling money

major risk factors: High blood pressure, high cholesterol, Diabetes

34
Q

Dementia Pugilistica (chroni traumatic encephalopathy)

A

Severe form of chronic traumatic brain injury f/ repeated concussions, resulting in declining mental ability, problems w/ memory, Parkinsonism, tremors, lack of coordination, speech problems, unsteady gait, & inappropriate/ explosive behavior

Brain Disorders (18 decks)

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