unit 8b Flashcards
Dementia
Mild cognitive impairment (MCI)
transition stage b/t mild cognitive decline ↓ of normal aging & more serious problems of dementia
- abt 50% progress to dementia
Dementia
progressive decline in cognitive func. due to damage/disease in the body beyond what might be expected f/ normal aging
Delirium
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)
Positive symptoms of DELIRIUM
include increased ↑ activity/thought (HYPERACTIVE)
ex: agitation, hallucination, combativeness, delusions, disorg. thoughts
Negative symptoms of DELIRIUM
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
Types of neuropsychiatric testing
- Mini Mental State Exam (MMSE)
- specific ranges are set to help determine severity of dementia
- normal >27/30 - Clinical Dementia Rating (CDR)
- 5 point scale used to characterize 6 categ. or cognitive & functional performance.
Normal pressure hydrocephalus (NPH)
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
Alzheimer’s Disease (AD)
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
Early AD
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)
Moderate AD
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)
Severe AD
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)
Activities of Daily Living (ADL)
routine activities that ppl tend to do everyday w/o needing assistance
6 basic ADLs:
- eating
- bathing
- dressing
- toileting
- transferring (walking)
- continence
Wandering
for Alzheimer’s patients, this specifically refers to patients wandering away/ escaping f/ home
Sundowning
Alteration (worsening) in behavior in sync w/ circadian rhythm
- co-occurs w. wandering
- may come from fatigue and/or lower light lvls
Labile affect
Excessive displays of emotion
- or expressed emotions that do not match the situation
Plaques
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**
Tau protein
the intracellular transport system
- organized in parallel strands somewhat like railroad tracks
Helps tracks stay straight
Neurofibrillary tangles
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
Possible causes of Alzheimer’s Disease
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?
Attempted Treatments of AD
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
Acetylcholinesterase inhibitors
molecules that block the breakdown of the neurotransmitter: acetylcholine
NDMA receptor antagonist
a molecule that acts on the glutamatergic system to block the overstimulation of NDMA receptor (which has a role in long term potentiation)
Antibody-based immunotherapies
used antibodies & other immune modulation to target plaques/tangles for clearance
BACE inhibitors
novel drug class that interrupts Aβ production (= stop plaque formation)
- current trails not going well
Demential w/ Lewy bodies (DLB)
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
Fronto-Temporal Lobar Dementia (FTLD)
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
Fronto-temporal dementia
(frontal & temporal lobes)
Personality changes, disinhibition, apathy, repetitive behavior
Semantic dementia
Anterior temporal lobes
- progressive problems w/ naming
Progressive non-fluent dementia
Left Broca’s area
- quiet, trouble w/ word production
- AKA primary progressive aphasia
Posterior Cortical Atrophy (PCA)
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)
Secondary Dementias
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**
Wernicke’s Encephalopathy
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
Vascular/Multi-Infarct Dementia
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
Dementia Pugilistica (chroni traumatic encephalopathy)
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