4. Cognitive disorders

Question 1

research in late adulthood cognitive disorders

Answer 1

Late adulthood is the fastest growing but least researched segment of the population

More stereotypes about late adulthood than any other age group

Question 2

The ageing population in Australia

Answer 2

In 2004, Australians over the age of 65 made up 13% of the population, by 2051 this is projected to rise to 27%.

Question 3

Dementia

Answer 3

symptoms of any illness that causes a progressive decline in a person’s cognitive function

Question 4

Prevalence and age of dementia

Answer 4

Most people with dementia are over the age of 65 but only a small proportion of older people over 65 have dementia. However, the chance of developing dementia increases exponentially as we get even older (i.e., the oldest old)

Question 5

Stages of AD: Behavioural level

Answer 5

1. AD brain changes starts decades before symptoms show
2. Amnestic MCI: memory problems, other cognitive functions OK; brain compensates for changes
3. Cognitive decline accelerates afte AD diagnosed
4. Total loss of independent function

Question 6

Stages of AD: Bioligical level

Answer 6

1. Both genes and non-genetic factors contribute to each individual’s risk
2. A waste protein, beta-amyloid, probably begins to be deposited in the brain tissue in early adulthood
3. Early damage to some brain cells ay be present
4. Accumulating beta-amyloid forms plaques (insoluble deposits) that provoke inflammation, contributing to further brain cell injury
5. The disease, which has been slowly damaging the brain for decades, may be diagnosed
6. the patient loses the ability to function independently

Question 7

Old definition of AD

Answer 7

Symptom-based: Progressive decline in a person’s cognitive function

Question 8

causes of dementia

Answer 8

The most common cause of dementia is Alzheimer’s disease (AD), and accounts for approximately half of all cases of dementia. 
Vascular dementia (VaD) related to strokes is the next most common cause. 
Other forms include Frontotemporal dementia, and Dementia with Lewy bodies. 
Each form of dementia has its own pattern of symptoms, and correct diagnosis is important as treatment and management vary.

Question 9

Key features of AD

Answer 9

1- Memory Impairment (impaired ability to learn new info or recall previously known info)
2- One or more of the following:
-Aphasia
-Apraxia
-Agnosia
-Executive dysfuntion

Question 10

Neuopathology of AD

Answer 10

Alzheimer’s disease has one important characteristic feature in the brain: Neuritic plaques

Question 11

neuritic plaques

Answer 11

masses of dying neural material with a toxic protein that damages neurons, beta-amyloid, at their core

Question 12

Memory profile of AD

Answer 12

• Relatively spared STM and procedural memory (especially motor learning)
• Episodic and semantic memory deficits and impaired verbal and visual learning
• Lots of repetition and intrusion errors on list learning
• Not aided by cueing
• Loss of semantic network (no ‘semantic clustering’ during encoding)

Question 13

language profile of AD

Answer 13

• Anomic aphasia (impaired confrontation naming)

- General conversation skills relatively preserved until mid-late stages

Question 14

visuospatial profile of Ad

Answer 14

• Range of visuospatial and spatial orientation deficits

- Clock drawing

Question 15

Executive function profile of AD

Answer 15

Increased disorganisation
Perseveration
Impaired metacognitive awareness (poor self-monitoring)
Impaired time estimation

Question 16

Sensory functioning profile of AD

Answer 16

Preserved visual, auditory and tactile acuity

Question 17

Emotional function profile of AD

Answer 17

Depression highly comorbid

Behavioural and psychiatric disturbance

Question 18

Behavioural and psychiatric disturbances that occur as a result of AD

Answer 18

Insomnia
Persecutory ideation/delusion
Hallucinations
Apathy
Agitation
Irritability

Question 19

AD patients memorising abilities

Answer 19

For AD patients, initial false representation/memory lingers and is hard to revise

AD patients fail to take the richer context into consideration to support their sentence understanding/memory

Question 20

AD patient’s grammatical knowledge

Answer 20

Some part (subject-verb agreement) of grammatical knowledge remains intact among AD

However, AD patients fail to keep track the number of entities (singular/plural) in the discourse probably due to their memory loss

Question 21

Delirium

Answer 21

Delirium is an acute confusional state or episode characterised by a sudden onset of impaired cognition.
It is a serious medical problem that is often not recognised by health professionals.
Approximately 10-15% of people admitted to hospital have delirium, and a further 5-40% are thought to develop delirium once in hospital.

Question 22

Symptoms of delirium

Answer 22

decreased attention span, disorganised thought, rambling speech, and hallucinations and delusions may also develop.

Question 23

confusion in delirium

Answer 23

Confusion may fluctuate throughout the day, often with a disturbed sleep-wake cycle.

Question 24

onset of delirium

Answer 24

It has a rapid onset and family and carers may notice a sudden change in level of confusion and general wellbeing.

Question 25

level of consciousness in delirium

Answer 25

Level of consciousness may also vary, and the person may be hyperalert, with agitation and high levels of arousal, or conversely hypoalert, lethargic and non-responsive.

Question 26

common causes of delirium

Answer 26

``` Drug intoxication or withdrawal Sudden onset brain disease (e.g. Meningitis) Infections Electrolyte imbalance Anticholinergic drugs Heart, kidney, liver failure ```

Question 27

comorbidity of delirium and dementia

Answer 27

Delirium is different to dementia, although people with dementia are prone to episodes of delirium and both conditions may co-exist.

Question 28

What must carers and families be aware of in relation to delirium?

Answer 28

It is important for families and carers to note a sudden change in cognition and function as this may be due to delirium.

Question 29

dementia compared to delirium

Answer 29

Dementia is a progressive condition that has an onset of months to years. The symptom severity of a person with dementia does not appear to change throughout the day.

Question 30

Dementia and AD compared to normal memory loss

Answer 30

People over 65 are so anxious about having memory loss and developing Dementia, and the best way to distinguish Dementia and AD from normal cognitive declines is to ask yourself: it is probably OK to forget where you park your car or where your car key is this morning but you may want to get serious about it when you can’t remember you come in this morning in a car

Question 31

why study AD and dementia now?

Answer 31

Family and Societal Toll In face of financial cutdown for research worldwide, this is an area politicians and governments jump upon Technology vs. humanity Advancements in imaging technologies and VR/AR/MR “Add life to years NOT years to life” Stay hopeful! Denise Park’s quote: “I feel reasonably confident that the children of Boomer’s might not have this terrible scourge.” http://www.frtv.org/2012/07/brain-health-aging-and-alzheimers/