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Flashcards in 15 - AD clinical Deck (26):
1

dementia: def

loss of mental function (memory, learning, orientation, insight, judgement, language) that is severe enough to interfere with daily functioning and quality of life

2

how many ppl with AD (canada + alberta?)

quarter of a million in canada; 40 000 in AB, 12 000 in edmonton

3

criteria for diagnosis of probably AD

interference w/ ability to function; not explained by delerium or major psych disorder. cognitive impairment involving 2: memory, reasoning, language, visuospacial function, personality, behaviour, learning

4

2 examples of cognitive tests

MOCA: montreal cognitive assessment. MMSE mini mental status exam, not as sensitive or specific but scores are adjusted based on age/education

5

5 potential biomarkers for AD

AB accumulation = abnormal tracer retention, decreased CSF AB. neuronal degeneration = increased CSF tau, decreased FDG uptake on PET, atrophy on MRI.

6

differential digaonsis examples

depression, delirium, mild cognitive impairment, other dementias

7

ABCs?

want history of: activities of daily living, behavioural changes, cognitive changes

8

5 things that may defer AD?

cognitive activity, physical activity, social engagement, dietary management, vascular risk factor management

9

non modifable risk factors for AD

age, genetics

10

3 causative genes? what other genes associated?

PSEN1 and PSEN2 and APP = early onset. sporadic: apoE4, sortilin related receptor gene

11

6 other likely risk factors

vascular (smoking, diabetes, BP, cholesterol). depression . obesity. mild cognitive impairment. decreased social engagement. decreased physical activity.

12

mediterranean diet benefits?

lowers risk of cardiovascular disease. associated with decreased AD risk

13

physical activity benefits?

observational studies: more physically active = lower risk for dementia, strongest effect on attention and executive function

14

3 examples of cognitive intervention

cognitive stimulation. rehabilitation. training.

15

primary, secondary, tertiary functions of training?

1: enhance cognitive reserve + risk reduction in healthy adults. 2: restoration function to prevent further decline. 3: slow rate of decline

16

what is training (cogn intervention)?

repetitive practice directly training specified cognitive processes like memory, attention and problem solving

17

what cogn. interventions worked best?

grou based, frequent and longer than 30 mins

18

drug therapy for AD?

cholinesterase inhibitors for symptomatic treatment of mild to moderate AD: doesn't cure

19

drug therapy: if you stop? what is essential? toleration?

benefits lost in 6 weeks with stopping. early and continuous treatment essential. if one drug can't be tolerated, can be switched to another

20

6 side effects of CI

risk of blackouts. GI problems. incontinence. headaches. nightmares. dystonia.

21

memantine: does what? why?

blocks glutamate at NMDA-Rs: because damaged nerve cells release glutamtate = excitotoxic calcium influx, cell death

22

therapies that don't work

statins, gingko biloba, estrogen, vitamin E/B, anti-inflammatories, omega-3

23

other therpaeutic strageies

neurotrophic/neuroprotective agents, IV-Ig, intranasal insulin, DBS, TMS, epigenetic modifiers, mitochondria targeted therapies

24

what behaviours are less likely to respond to medications

wandering, pacing, exit seeking, repetitive mannerisms, inappropriate verbalization, hoarding, inappropriate disrobing or defacation, eating unedibles, resistance to care

25

symptoms that respond to medication

depression, apathy, delusions and hallucinations, anxiety, disturbed sleep, sexual disinhibition

26

concl: AD is detected via changes in? what is key? goal is?

ABCs: cognition, behaviour, function. delay onset. focus on specific symptoms + behaviours