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ABPP > Aging & dementia > Flashcards

Aging & dementia Flashcards

1
Q

Aging depends on the interaction of which 3 variables

A

Time, genetic background, stochastic encounters with diverse events (e.g., HTN, stress, oxidation, trauma)

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2
Q

Correlates of successful aging

A

Educ achievement, early educ experiences, physical health status, exercise, perception of health & control, emotional state/life satisfaction

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3
Q

Brain changes associated with aging

A

Loss of synapses, neurons, neurochemical input, neuronal networks

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4
Q

In aging, atrophy due to neuronal loss (or cell shrinkage) is most/least pronounced in

A

Most - hippocampus & anterior dorsal frontal lobe

Least - occipital lobes

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5
Q

In aging, progressive decline in CBG is greatest/least in which brain areas?

A

Greatest - prefrontal & inferior temporal cortex

Least - occipital areas

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6
Q

Memory changes associated with normal aging

A

Reduction in amount of info that can be processesd at once

Decline affects recent > immediate or remote

Less efficient encoding due to reduced use of learning strategies, more difficulty retrieving info that has been encoded

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7
Q

Language changes associated with normal aging

A

Strengths: linguistic knowledge, lexical knowledge, expressive vs. receptive
Weaknesses: naming, precision of verbal description, drawing abstract inferences, drawing unstated principles from facts

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8
Q

Visuospatial changes associated with normal aging

A

Small changes in simple perception, slowed visual processing

Complex visual tasks produce large age effects (visual closure, integration, construction)

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9
Q

Executive functioning changes associated with normal aging

A

Decline in cognitive flexibility, application of abstract concepts

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10
Q

6 factors that should be taken into account when examining the geriatric population (Potter & Attix)

A

VIsion, hearing, motor fx, fatigue, literacy, rapport & motivation

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11
Q

DSM-IV definition of dementia

A

Deficit in memory AND 1+ of apraxia, agnosia, aphasia, exec fx

Decline from previous level of functioning

Interference w/ work, school, ADLs, or other social activities

Not delirium

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12
Q

Probable AD (NINCDS-ADRDA criteria)

A

Dementia established by clinical exam & cognitive tests
Deficits in 2+ areas of cognition
Progressive worsening of memory & other cog fx
No disturbance of consciousness
Onset between ages 40-90
Absence of systemic disorders/other disease that could account for symptoms

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13
Q

Pathological progression of Alzheimer’s

A

1) Medial temporal lobes
2) Basal temporal cortex extending over lateral posterior temporal cortex, parieto-occipital cortex, posterior cingulate gyrus
3) Frontal lobes

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14
Q

Anatomical changes associated with Alzheimer’s disease

A

Cerebral atrophy
Neuronal loss
Amyloid plaques
Neurofibrillary tangles

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15
Q

Where is cerebral atrophy most prominent in Alzheimer’s disease?

A

Parietal, inferior temporal, limbic cortex

Widespread cause of atrophy appears to be loss of dendritic arborization

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16
Q

Neuronal loss in Alzheimer’s disease is most prominent in

A

Nucleus basalis, septal nuclei, nucleus of the diagnoal band where cholinergic projections arise

Lesser extent in locus ceruleus (NE) & raphe nuclei (serotonin)

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17
Q

Amyloid plaques

A

Insoluble protein core containing beta-amyloid and ApoE surrounded by abnormal axons & dendrites called dystrophic neuritis

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18
Q

Neurofibrillary tangles

A

Intracellular accumulations of tau proteins

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19
Q

Cognitive decline accounts for only ____% of functional decline in Alzheimer’s disease

A

40

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20
Q

Declines in advanced IADLs predict

A

Frequency of hospital contact, nursing home placement, mortality

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21
Q

Basic ADLs rely on

A

Procedural memory skills & basic motor programming

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22
Q

Instrumental ADLs require

A

Controlled processing & executive function

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23
Q

What age group are at the highest risk of driving accidents?

A

Over 85

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24
Q

Performance in what cognitive domains is highly correlated with driving status & performance?

A

Visual search, selective attention, visuospatial perception & construction, exec fx

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25
Q

Alzheimer’s patients have an increase of _____x the normal concentration of aluminum in their brains

A

10-30x

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26
Q

Baseline tests that predict later cognitive decline in AD

A

Verbal tests of naming, verbal memory, fluency, abstraction

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27
Q

Baseline tests that predict later functional decline in AD

A

Nonverbal measures of visuospatial functioning & visual memory

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28
Q

What are some conditions or comorbidities that should be considered when making a diagnosis of AD?

A

Thyroid, B12 or folate levels, CVD, stroke & other neuron conditions; kidney, liver, endocrine fx

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29
Q

Diagnostic criteria for probable vascular dementia (NINDS-AIREN)

A

Evidence of dementia
Evidence of cerebrovascular disease
Relationship b/t dementia & CVD
Other features that support include gait disturbance, falls, incontinence, pseudobulbar palsy, mood changes

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30
Q

Neary et al. diagnostic criteria for frontotemporal dementia

A

Insidious onset & gradual progression, early decline in social interpersonal fx, early impairment in regulating personal conduct, early emotional blunting, early loss of insight

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31
Q

What are some features that support a diagnosis of frontotemporal dementia?

A

Behavioral disorder, speech/language disorder, physical signs, diagnostic procedures

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32
Q

Lund & Manchester groups diagnostic criteria for frontotemporal dementia

A 
Behavioral symptoms (loss of personal awareness, disinhibition, mental inflexibility, perseverations, impulsivity)
Affective symptoms (indifference, depression, aspontaneity)
Speech symptoms (repetition of phrases, echolalia, mutism)
33
Q

Histopathological subtypes of frontotemporal dementia

A

1) Microvacuolar subtype: spongiform degeneration, loss of large cortical neurons in frontal & temporal cortices
2) Pick body subtype

34
Q

Primary progressive aphasia

A

Early difficulties in word retrieval, decreased fluency, anomia; comprehension generally intact in early stages; later in disease, other aspects of cognition are impaired

35
Q

Semantic dementia

A

Fluent speech but substantial impairments in word comprehension & word-finding; difficulty on semantic memory tests

36
Q

Pick’s disease

A

Atrophy of frontal & temporal lobes

See personality changes, stereotyped verbal output, Kluver-Bucy symptoms

37
Q

Diagnostic criteria for dementia with Lewy Bodies

A

Fluctuating levels of consciousness/cognition with pronounced variations in arousal level/attention; spontaneous parkinsonian motor features; visual hallucinations that are typically well-formed & recurring

38
Q

Neuropathology of dementia with Lewy bodies

A

Diffuse & widespread Lewy bodies across cortex, nucleus basalis of Meynert, & substantia nigra; most case also show senile plaques & possibly NFTs

39
Q

Creutzfeldt-Jakob’s disease

A

Caused by rapidly progressive viral infection (prion) of nervous system which usually leads to death w/i 6 mos of onset

40
Q

Clinical triad of Creutzfeldt-Jakob

A

Dementia, involuntary movements, periodic EEG sharp wave activity

41
Q

Name 3 other prion related dementias

A

Kuru, fatal familial insomnia, bovine spongioform encephalopathy

42
Q

Criteria for MCI

A

Subjective memory complaints & objective evidence of mild memory impairment (<1.5 SD), normal intellectual fx & normal ADLs

43
Q

Predictors of progression from MCI to dementia

A

Hippocampal atrophy, genetic susceptibility (ApoE-4)

44
Q

7 conditions that are potentially reversible causes of dementia

A

NPH, hypothyroidism, B12 deficiency, thiamine deficiency, depression-related, sleep-disordered breathing, medication effects

45
Q

Depression vs. AD

A 
Recognition memory is relatively intact, fewer false-positive errors, more DK errors
Poorer effort, more variability across tasks of similar difficulty
Better performance with semantic organization & prompting
Intact awareness (complaint of memory problems)
46
Q

Risk factors for Alzheimer’s disease

A

Age, female gender, lower education, family hx, Apoe4, Down’s syndrome, head injury, psychiatric illness, alcohol abuse, risk factors of heart disease

47
Q

Neuropathology of progressive nonfluent aphasia

A

Greater degeneration of left posterior frontal cortex, anterior insula, basal ganglia

48
Q

Neuropathology of semantic dementia

A

Polar & inferolateral temporal cortex

49
Q

Neuropsychological profile of NPH

A

Gait instability (shuffling apraxic gait), urinary incontinence, bradyphrenia, confusion & disorientation

Early deficits in attention & exec fx, memory encoding (recognition improves recall), visuoconstructional deficits

50
Q

What are the cardinal features of Alzheimer’s disease?

A

Social withdrawal, poor memory w/ rapid forgetting, dysnomia, constructional apraxia

51
Q

What are the cardinal features of frontotemporal dementia

A

Onset typically in 50s, personality changes early with ‘frontal’ signs, language deficits in PPA

52
Q

What are the cardinal features of dementia with Lewy bodies?

A

Variable MS, parkinsonian motor symptoms (tremor not predominant), visual hallucinations

53
Q

What are the cardinal features of vascular dementia?

A

Motor/sensory abnormalities, poor attention, recognition cues improve recall, apraxias common

54
Q

What are the cardinal features of dementia in Parkinson’s disease?

A

Slowed processing speed, attention deficits, constructional apraxia, learning slow but retention can be normal, parkinsonian motor features

55
Q

What are the cardinal features of progressive supranuclear palsy

A

Vertical gaze palsy, falling backwards, ‘applause sign’, frontal/subcortical cognitive deficits

56
Q

What are the cardinal features of corticobasal dengeneration?

A

Ideomotor apraxia, asymmetric parkinsonian rigidity & bradykinesia, alien hand sign, later dementia

57
Q

What are the cardinal features of depression-related cognitive impairment?

A

Complaints of memory problems, good description of perceived difficulties, withdrawn, speech fluent & articulate, no apraxias

58
Q

Alcoholic dementia

A

Frontal lobe signs including apathy, poor hygiene, poor judgment, lower cog. efficiency, attention, & recent memory, flattened affect

Clinically similar to neurosyphilis

Assoc. w/ enlarged cerebral ventricles, frontal atrophy, thinning of cortex

59
Q

Dementia pugilistica

A

Characterized by forgetfulness, slowness in thought, dysarthria, wide-based unsteady gait

Flattened affect & parkinsonian extrapyramidal features also common

60
Q

Mattis Dementia Rating Scale (DRS)

A

Assesses 5 cognitive domains - attention, construction, initiation/perseveration, conceptualization, memory

61
Q

Mayo Older Age Normative Study (MOANS)

A

Normative data for a # of NP measures for individuals aged 55-97

62
Q

How do older non-demented individuals perform on list learning tasks?

A

Reduced learning, particularly as the length of the list increases

Recall, however, is as good as younger patients (in contrast to clear impairment in AD)

63
Q

What is the most likely syndrome associated with the visual spatial type of dementia?

A

AD

64
Q

Clinical features that suggest something other than AD

A

Sudden onset
Focal neurological findings
Seizures & gait disturbance @ onset

65
Q

DLB vs AD on neuropsych testing

A

Hard to distinguish, but DLB has slightly better memory & slightly worse exec fx

66
Q

What is the annual incidence of HIV dementia after the diagnosis of HIV?

A

7% per year

67
Q

Neuropsychological profile of HIV dementia

A

Prominent psychomotor slowing, memory (in early stages worse recall than recognition), visual constructional skills w/o other parietal signs like anomia or dyscalculia

68
Q

Carphologia

A

Lint picking or aimless plucking at clothing as if picking off thread, frequently accompanied by chewing movements; ST seen in patients with AD

69
Q

Approximately what percent of dementias are reversible?

A

5% (others say 10-15%)

70
Q

Functional neuroimaging in late-life depression

A

Bilateral frontal lobe hypometabolism

71
Q

Prevalence of dementia across lifespan

A

Age 65 = 1.5%, doubles every 4 years afterward, 30% by age 80

72
Q

Neuropsychological profile of early Lewy Body dementia

A

Marked deficits in attention & exec fx, visuospatial impairments, constructional difficulties

73
Q

Behavioral deficits in Lewy Body dementia (compared to AD)

A

> apathetic, > distractible, greater tendency toward perseveration, confabulations, intrusions, more environmentally triggered errors (suggestibility)

74
Q

In aging, _____ intelligence increases, while _____ intelligence decreases.

A

Crystallized, fluid

75
Q

Areas of cognitive that are relatively preserved with aging

A

Simple attention, primary & tertiary memory, everyday language communication

76
Q

What area of the cortex shows the most cell loss in AD?

A

Entorhinal cortex

77
Q

Differences between Pick’s disease & AD

A

Less memory, calculation, & visuospatial impairments; more extravagant personality alterations; greater tendency to produce stereotyped verbal output; Kluver-Bucy symptoms

78
Q

Clinical triad of Creutzfeldt-Jakob

A

Dementia, involuntary mvmts (esp. myoclonus), periodic EEG

79
Q

Atrophy associated with normal aging generally reflects a loss of

A

Myelin

ABPP (34 decks)

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