Week 4 Flashcards
Dementia stats
how many living with dementia in AUS?
prevalence
342,800 Australians living with dementia – will increase to 400,000 in less than ten years and almost 900,000 by 2050
dementia stats
how many new cases per week
incidence
Each week, there are more than 1,800 new cases of dementia in Australia; approx. one person every 6 minutes (7,400 new cases each week by 2050)
Dementia stats: younger onset dementia
25,100 people in Australia with Younger Onset Dementia (a diagnosis of dementia under the age of 65; including people as young as 30)
Dementia stats: prevalence in elderly
Three in ten people over the age of 85 and almost one in ten people over 65 have dementia
Dementia:
Definition
A gradual ongoing decline in memory and related cognitive functions, such as language, reasoning and decision making skills
Dementia Symptoms
Progressive changes in: Orientation Memory and learning Verbal communication Perception Abstract thinking Judgement and social behaviour Motor behaviour Personality Decline in self-care, independence & interests
Types of Dementia:
Cortical
Cortical: Alzheimer’s disease
Multi-Infarct Vascular Dementia (2nd most common 10%)
Frontotemporal Dementia (Pick’s Disease)
Dementia with Lewy bodies (tiny spherical structures in neurons)
Types of Dementia: Subcortical
Parkinson’s Disease (tremor, stiffness in limbs and joints, difficulty in initiating movement)
Huntington’s Disease (irregular, involuntary movement)
Subcortical Vascular Dementia
Alzheimer’s Disease is what?
Degeneration of neurons due to:
Amyloid plaques: Beta amyloid (protein) => hard insoluble plaques between neurons
Neurofibrillary tangles: tau (protein)=> insoluble twisted fibres inside neurons
Risk factors of Alzheimer’s Disease
Age, being a first degree relative, Down syndrome, head injury, infection, exposure to toxic substances
Subcortical Dementia - Parkinson’s
Parkinson’s Disease:
Predominantly a motor disorder
Mean onset 60 years
80,000 people in Australia
Exact cause unknown
Deterioration of dopaminergic neurons in the substantia nigra
↓ Dopamine transferred to the caudate and putamen - inhibitory effect on movement
Parkinson’s Symptoms
Tremor (at rest, may reduce during purposeful activity), rigidity (spasticity to cogwheel symptoms), bradykinesia (freezing - poverty and slowness of movement)
Postural disturbance – head bowed, shoulders drooped, shuffling gait, small steps, poor balance
Cognitive dysfunction – slowed mentation,
—↓ attention/concentration, executive function, visuospatial deficits and ↓ memory (retrieval rather than learning)
Emotional Changes – apathy and depression
Parkinsons Diagnosis
Community Aged Care Assessment Team Medical history Medical laboratory tests Mental Status Examination Comprehensive neuropsychological assessment Brain scans (MRI) Diagnosis by exclusion (80-90%)
Mild Cognitive Impairment
MCI: a degree of cognitive impairment that is of insufficient severity to constitute dementia.
5 Stages of Dementia
Clinical Dementia Rating Scale
Stage 1 - CDR-0: No impairment
Stage 2 - CDR-0.5: Questionable Impairment
Stage 3 - CDR-1: Mild Impairment
Stage 4 - CDR-2: Moderate Impairment
Stage 5 - CDR-3 Severe Impairment
Stage 1 of Dementia (CDR-0)
Stage 1: CDR-0 or No Impairment:
no significant memory problems, fully oriented in time and place, normal judgment, can function out in the world, well-maintained home, and able to take care of personal needs.
Stage 2: CDR-0.5
Questionable Impairment:
A score of 0.5 on the CDR scale represents very slight impairments, such as minor memory inconsistencies or struggling to solve challenging problems. Performance may be slipping at work or when engaging in social activities. However, the person can still manage his/her own personal care without any help
Stage 3: CDR-1
Mild Impairment:
A score of 1, represents noticeable mild impairments in different areas. Memory loss for recent information and events disrupts everyday functioning in some way and the person is starting to become disoriented geographically and may have trouble with directions and getting from one place to another. He or she is like to have trouble functioning independently in activities outside the home. At home, chores may start to get neglected, and someone may need to remind them when it is time to take care of personal hygiene
Stage 4: CDR-2
Moderate Impairment:
A score of 2 represents moderately impaired. The person now needs help in taking care of hygiene, doing chores and attending social activities. Disorientation to time and space becomes more evident as people get lost easily and struggle to understand time relationships. Recent memory and new learning is seriously impaired (e.g., names of people they just met).
Stage 5: CDR-3
Severe Impairment:
The fifth stage of dementia (score of 3.0) is the most severe, as the person requires assistance with all aspects of functioning (bathing, dressing, feeding etc). They may no longer recognise familiar people and have extreme memory loss and disorientation to time and place. Activities outside of care are very limited due to both physical and cognitive decline
Prognosis and Treatment
alzheimer’s
Progressive and irreversible
Alzheimer’s dementia course: approximately 7- 10 years
Medications (ease symptoms and slow progression)
—-Aricept, Exelon, Reminyl (cholinergic drugs) increase level of neurotransmitter called acetylcholine and anti-inflammatory drugs
Caregiving
Education and support, memory aids, structure, monitor wandering, enhance communication, safe environment, exercise and stimulation
Parkinson’s Disease: Deep brain stimulation
Deep Brain Stimulation and Parkinson Disease
medications can stop working and side effects can be too impactful, at this stage DBS may be indicated.
DBS is a neurosurgical procedure involving the placement of a medical device called a neurostimulator (sometimes referred to as a ‘brain pacemaker’), which sends electrical impulses, through implanted electrodes, to specific targets in the brain (brain nuclei) for the treatment of movement disorders, including Parkinson’s disease, essential tremor, and dystonia. While its underlying principles and mechanisms are not fully understood, DBS directly changes brain activity in a controlled manner. (wiki)
DBS is used to manage some of the symptoms of Parkinson’s Disease that cannot be adequately controlled with medications.[9][10] It is recommended for people who have PD with motor fluctuations and tremor inadequately controlled by medication, or to those who are intolerant to medication, as long as they do not have severe neuropsychiatric problems.[11] Four areas of the brain have been treated with neural stimulators in PD. These are the globus pallidus internus, thalamus, subthalamic nucleus and the pedunculopontine nucleus. DBS of the globus pallidus internus improves motor function while DBS of the thalamic DBS improves tremor but has little effect on bradykinesia or rigidity. DBS of the subthalamic nucleus is usually avoided if a history of depression or neurocognitive impairment is present. DBS of the subthalamic nucleus is associated with reduction in medication. Pedunculopontine nucleus DBS remains experimental at present. Generally DBS is associated with 30–60% improvement in motor score evaluations. (WIKI)
Psychosocial approaches of parkinsons treatment
examples:
choir - People with parkinsons (PwP) demonstrated statistically significant improvement in the QoL domains of Stigma (p=.001), Social Support (p=.002), Emotional Well-being (p=.005), Activities of Daily Living (p=.006), and Mobility (p=.007), although they showed significantly worsened Bodily Discomfort domain (p=.000). No statistical significance was detected in PDQ39 Summary score, Cognitive impairments and Communication domains. Carers QoL did not demonstrate a statistically significant improvement.
dance:
eg. : Dance therapy improves motor and cognitive functions in patients with Parkinson’s disease - see danceforparkinsonsaustralia.org
Neuropsychological: Assessment: Purposes
Clinical purposes are unique (compared?) to imaging
- —Assist with diagnosis (onset & course)
- —Comprehensive description of cognitive abilities
- —Monitor recovery, course and effects of treatment
- —Guide treatment/management –
- ——-e.g., detect tumour recurrence and onset of dementia before imaging can, assist surgery for epilepsy
Understand everyday effects of brain damage or illness and support the person and their family
