WEEK 3: Dementia Flashcards
Define dementia.
Syndrome which refers to progressive decline in intellectual functioning severe enough to interfere with person’s normal daily activities and social relationship.
Syndrome which refers to progressive decline in intellectual functioning severe enough to interfere with person’s normal daily activities and social relationship.
There maybe behavior and personality dysfunction as a consequence of diffuse disease of the brain hemispheres, maximally affecting the cerebral cortex and hippocampus.
Discuss markers of dementia.
Marked by progressive decline in
*Memory
*Thinking
*Problem-solving / ability to carry out mathematical calculations
*Language and communication skills
*Perception / abstract thinking
Episodic memory, is the cognitive function most commonly lost; the ability to recall events specific in time and place,
Dementia may erode other mental faculties, including language, visuospatial, praxis, calculation, judgment, and problem-solving abilities.
Neuropsychiatric and social deficits also arise manifesting as depression, apathy, anxiety, hallucinations, delusions, agitation, insomnia, sleep disturbances, compulsions, or disinhibition.
- Depression:
Depression is a mood disorder characterized by persistent feelings of sadness, hopelessness, and loss of interest or pleasure in activities. It can affect how a person thinks, feels, and handles daily activities. - Apathy:
Apathy refers to a lack of interest, enthusiasm, or concern about things that others find meaningful or important. It can manifest as indifference or a diminished emotional response to situations. - Anxiety:
Anxiety is a feeling of worry, nervousness, or unease about something with an uncertain outcome. It is a natural response to stress but can become excessive or debilitating in some cases, leading to physical symptoms such as rapid heartbeat or sweating. - Hallucinations:
Hallucinations are perceptual experiences that occur without any external stimulus. They can involve seeing, hearing, smelling, or feeling things that are not real. Hallucinations can occur in various conditions, including schizophrenia, dementia, or substance abuse. - Delusions:
Delusions are false beliefs that persist despite evidence to the contrary. They are often irrational and may involve paranoid, grandiose, or persecutory themes. Delusions are commonly associated with psychotic disorders such as schizophrenia or delusional disorder. - Agitation: Agitation refers to a state of restlessness, irritability, or emotional distress. It can manifest as pacing, fidgeting, or verbal or physical aggression. Agitation may result from various factors, including psychiatric conditions, medical issues, or environmental stressors.
- Insomnia: Insomnia is a sleep disorder characterized by difficulty falling asleep, staying asleep, or experiencing non-restorative sleep despite adequate opportunity for sleep. It can lead to daytime fatigue, irritability, and impaired functioning.
- Sleep disturbances: Sleep disturbances encompass a range of disruptions to the normal sleep-wake cycle, including insomnia, nightmares, sleepwalking, or restless legs syndrome. These disturbances can impact the quantity and quality of sleep, leading to daytime impairment.
- Compulsions:
Compulsions are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession or according to rigid rules. They are often aimed at reducing distress or preventing perceived harm and are a characteristic feature of obsessive-compulsive disorder (OCD). - Disinhibition:
Disinhibition refers to a lack of restraint or inhibition in behavior, emotions, or impulses. It can manifest as impulsivity, poor judgment, or socially inappropriate actions. Disinhibition may occur in various neurological or psychiatric conditions, such as frontal lobe disorders or certain personality disorders.
Discuss the epidemiology of dementia.
*Dementia may occur at any age but is more common in the elderly.
*The prevalence in persons aged between 50 and 70 years is about 1% and in those approaching 85 years reaches 50%.
10% of persons age >70 years and 50% of individuals age >85 years have clinically identifiable memory loss.
Discuss the Clinical course of dementia.
The rate of progression depends upon the underlying cause.
The duration of history helps establish the cause of dementia:
*Alzheimer’s disease is slowly progressive over years, whereas encephalitis may be rapid over weeks.
*Dementia due to cerebrovascular disease appears to occur “stroke by stroke.”
-Each stroke experienced by the individual contributes to the deterioration of cognitive function and the onset or worsening of dementia symptoms.
Compare normal aging and was not normal aging.
NORMAL Aging
*Slower to think
*Slower to do
*Hesitates more
*More likely to ‘look before you leap’
*Know the person but not the name
*Pause to find words
*Reminded of the past
NOT Normal Aging
*Can’t think the same
*Can’t do like before
*Can’t get started
*Doesn’t think it out at all
*Can’t place the person
*Words won’t come – even later
*Confused about past versus now
Dementia can be reversible or irreversible.
Compare the 2.
Reversible
*Can be reversed or cured
*Temporary condition
*Brain regains lost functions when treated
Irreversible
*Result in permanent brain damage
*Cannot be reversed or cured
Outline the reversible causes of dementia.
D= Drugs, Delirium
E= Emotions (such as depression)
M= Metabolic Disturbances and endocrine disorders
E= Eye and Ear Impairments
N= Nutritional Disorders
T= Tumors, Toxicity, Trauma to Head
I= Infectious Disorders
A= Alcohol, Arteriosclerosis
Medications: Negative drug interactions, drug overdose
Depression: response to life’s stress, chemical imbalances in the brain
Metabolic or endocrine disorders: thyroid disease, hypo/hyperglycemia, renal failure, dehydration
Environmental changes: visual and hearing loss, loss of daylight and decrease in activities
Malnutrition: Vitamin A,C B12 AND FOLATE deficiency
Brain disease: tumors, hydrocephalus, subdural hematoma (trauma to the head)
Infection: produces fever, affecting brain’s cognitive abilities
Alcohol abuse
State the irreversible causes of dementia.
*Alzheimer’s Disease
*Vascular dementia
*Lewy Body Dementia
*Pick’s Disease (Fronto-temporal Dementia)
*Parkinson’s disease
*Head Injury
*Huntington’s Disease
*Creutzfeldt - Jakob Disease
Alzheimer’s Disease:
Alzheimer’s disease is the most common form of dementia, characterized by the progressive deterioration of memory, thinking, and behavior. It is associated with the accumulation of abnormal proteins in the brain, leading to the formation of plaques and tangles, which disrupt communication between brain cells.
Vascular Dementia:
Vascular dementia results from impaired blood flow to the brain, often due to stroke or other vascular conditions. Symptoms may include difficulties with reasoning, judgment, memory, and other cognitive functions. The severity and progression of symptoms can vary depending on the extent and location of the vascular damage.
Lewy Body Dementia:
Lewy body dementia is a progressive brain disorder characterized by the presence of abnormal protein deposits called Lewy bodies in the brain. It shares symptoms with both Alzheimer’s disease and Parkinson’s disease, including cognitive impairment, visual hallucinations, fluctuating alertness, and motor symptoms such as tremors and stiffness.
Pick’s Disease (Fronto-temporal Dementia):
Pick’s disease, also known as frontotemporal dementia, is a rare form of dementia that primarily affects the frontal and temporal lobes of the brain. It is characterized by changes in personality, behavior, and language, rather than memory loss in the early stages. Symptoms may include disinhibition, apathy, language difficulties, and repetitive behaviors.
Parkinson’s Disease:
Parkinson’s disease is a neurodegenerative disorder primarily known for its motor symptoms, such as tremors, stiffness, and bradykinesia (slowness of movement). However, cognitive impairment is also common in Parkinson’s disease, ranging from mild cognitive changes to dementia over time.
Head Injury:
Dementia resulting from head injury occurs when traumatic brain injury (TBI) leads to persistent cognitive deficits. The severity and type of symptoms depend on the extent and location of the brain injury. Cognitive impairment may include memory problems, difficulty with attention and concentration, and changes in behavior.
Huntington’s Disease:
Huntington’s disease is a genetic disorder characterized by progressive degeneration of nerve cells in the brain. It leads to a combination of movement, cognitive, and psychiatric symptoms, including involuntary movements (chorea), cognitive decline, and behavioral changes.
Creutzfeldt-Jakob Disease:
Creutzfeldt-Jakob disease (CJD) is a rare and rapidly progressive neurological disorder caused by abnormal prion proteins in the brain. It leads to a variety of cognitive and neurological symptoms, including rapidly worsening dementia, muscle stiffness, and involuntary movements.
Discuss Alzheimer’s disease.
The most common cause of dementia
Accounts for 60-80% of all dementia cases
Alzheimer’s is not a normal part of aging, although the greatest known risk factor is increasing age, and the majority of people with Alzheimer’s are 65 and older.
But Alzheimer’s is not just a disease of old age. Approximately 200,000 Americans under the age of 65 have younger-onset Alzheimer’s disease (also known as early-onset Alzheimer’s)
1st TYPE of dementia: ALZHEIMER’s
Early onset Alz – 40-50 year olds get it. Thorough examination in the doctor’s office may lead to a diagnosis
When Alzheimer’s disease is caused by deterministic genes, it is called “familial Alzheimer’s disease,” and many family members in multiple generations are affected.
Discuss Symptoms of Alzheimer’s disease.
The most common early symptom of Alzheimer’s is difficulty remembering newly learned information.
As Alzheimer’s advances through the brain it leads to increasingly severe symptoms, including disorientation, mood and behavior changes; deepening confusion about events, time and place; unfounded suspicions about family, friends and professional caregivers; more serious memory loss and behavior changes; and difficulty speaking, swallowing and walking.
Alzheimer’s disease leads to nerve cell death and tissue loss throughout the brain. Over time, the brain shrinks dramatically, affecting nearly all its functions.
Autopsy of a patient with Alzheimer’s disease compared to a normal brain
Describe the brain in Alzheimer’s disease.
The cortex shrivels up, damaging areas, involved in thinking, language, and remembering.
Shrinkage is especially severe in the hippocampus, an area in the cortex that plays a role in formation of new memories.
Ventricles grows larger.
**Presence of neurofibrillary tangles and amyloid plaques are hallmark of the disease.
Alzheimer’s tissue has fewer nerve cells and synapses than a healthy brain.
*Plaques, abnormal clusters of protein fragments, build up between nerve cells.
Dead and dying nerve cells contains TANGLES which are made up of twisted strands of another protein.
In the early stage of Alzheimer’s, a person may function independently. He or she may still drive, work and be part of social activities. Despite this, the person may feel as if he or she is having memory lapses, such as forgetting familiar words or the location of everyday objects.
In advanced Alzheimer’s disease, most of the cortex is seriously damaged. The brain shrinks dramatically due to widespread cell death. Individuals lose their ability to communicate, to recognize family and loved ones and to care for themselves.
These microtubules act like tracks, guiding nutrients and molecules from the body of the cell down to the ends of the axon and back.
A special kind of protein, tau, binds to the microtubules and stabilizes them.
In AD, tau is changed chemically. It begins to pair with other threads of tau, which become tangled together. When this happens, the microtubules disintegrate, collapsing the neuron’s transport system.
Describe the treatment of Alzheimer’s disease.
Currently, there is no cure for Alzheimer’s.
But drug and non-drug treatments may help with both cognitive and behavioral symptoms.
Researchers are looking for new treatments to alter the course of the disease and improve the quality of life for people with dementia.
Medications for memory
Treatments for behavior
Medications of Sleep changes
Alternative treatments
Discuss the function and MOA of cholinesterase inhibitors in Alzheimer’s disease.
All of the prescription medications currently approved to treat Alzheimer’s symptoms in early to moderate stages are from a class of drugs called cholinesterase inhibitors.
Cholinesterase inhibitors are prescribed to treat symptoms related to memory, thinking, language, judgment and other thought processes.
Prevent the breakdown of acetylcholine, a chemical messenger important for learning and memory. This supports communication among nerve cells by keeping acetylcholine levels high.
Delay or slow worsening of symptoms.
Side effects: Nausea, vomiting, LOA, increase frequency of bowel movements.
EXAMPLES
Donepezil
Memantine
Galantamine
Discuss Vascular dementia.
Considered the second most common cause of dementia, accounting for 20%
Defined as permanent cognitive impairment produced by vascular damage to the brain.
Vascular dementia is associated with focal damage in a variable patchwork of cortical and subcortical regions or white matter tracts that disconnect nodes within distributed networks.
Prevalence ranges from 1 – 4% in people over the age of 65.
Vascular dementia occurs when impaired blood flow to parts of the brain deprives cells of food and oxygen. This impairment typically follows stroke-induced blockage of one or more blood vessels.
Vascular damage often coexists with amyloid plaques and other neuropathologies associated with Alzheimer’s disease.
MRI findings of patients with Vascular Dementia
Following a stroke, a patient’s symptoms may remain constant for a while.
Then when he has another stroke, he may notice a sudden worsening of his symptoms. this is called step-like progression.
Describe diagnostic criteria for vascular dementia.
*Specific cognitive domains affected depend on stroke location
*Deficits in attention and execution function are common
*Memory loss may or may not be prominent, depending on whether the stroke affected memory areas
*Decline may appear relatively suddenly and may or may not progress
*Daily activities may be impaired
*Focal neurological signs consistent with stroke may be present
History of high blood pressure, increase cholesterol, vascular disease, diabetes or past strokes or heart attack.
