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YR2 - Clinical Psychology and Mental Health > 8. Dementia > Flashcards

8. Dementia Flashcards

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1
Q

In Schaie’s (1985; 1996; 2005) Seattle longitudinal study, 4,000 people were monitored over 30 years. They found in the absence of a specific disease, c____ a____ change very little before age __

A

cognitive abilities, 75

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2
Q

Fluid abilities:
- E____ functioning, processing s____, e____ memory, STM c____, a____ reasoning, some aspects of l____
- Sensitive to a____, d____ in older adulthood
- Rate of decline differs by c____ d____

A
  • Executive functioning, speed, episodic, capacity, abstract reasoning, language
  • Ageing, deteriorate
  • cognitive domain
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3
Q

Crystalised abilities:
- A_____ knowledge and abilities, p____ over years: g____ knowledge, p____ s____ skills, s____ memory, l____
- Relatively s____ until approximately __s
- V____ and f____ i____ with age
- U____ in majority

A
  • Acquired, practiced, general, problem solving, semantic, language
  • stable, 70s
  • vocabulary, fluency improve
  • unimpaired
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4
Q

Dementia includes g____ i____ of higher order c____ f____

A

global impairment, cortical functions

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5
Q

Dementia includes impairments in:
1. M____ and l____
2. Everyday p____ s____
3. Correct use of s____ s____
4. Control of e____ r____

A
  1. memory, language
  2. problem solving (activities of daily living; ADLs)
  3. social skills
  4. emotional reactions
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6
Q

Causes of dementia include:
1. A____
2. D____
3. Brain i____
4. V____ or h____ i____
5. D____ (including a____)

A
  1. Age
  2. Disease
  3. Brain injury
  4. Vitamin, hormone imbalance
  5. Drugs, alcohol
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7
Q

Dementia can be c____ or a____

A

Chronic vs acute

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8
Q

Primary causes of dementia:
1. A____
2. V____ (multi-infarct)
3. F____-t____ dementia
4. Dementia with L____ b____
5. M____
6. P____-related dementia

A
  1. Alzheimer’s
  2. Vascular
  3. Fronto-temporal
  4. Lewy bodies
  5. Mixed
  6. Prion-related
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9
Q

Secondary causes of dementia:
1. P____ disease
2. H____
3. T____ brain i____
4. W____-K____
5. D____ s____
6. H____ C____

A
  1. Parkinson’s
  2. HIV
  3. Traumatic, injury
  4. Wernicke-Korsakoff
  5. Down’s syndrome
  6. Huntington’s Chorea
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10
Q

Alzheimer’s disease accounts for over __% of all dementias

A

60%

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11
Q

Alzheimer’s disease (AD) can be e____-o____ AD or l____-o____

A

early-onset
late-onset

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12
Q

Symptoms of Alzheimer’s disease include:
1. I____ onset
2. P____ cognitive impairments and p____ change
3. G____, i____ progression
4. Impaired ‘A____ of D____ L____’
5. Impaired in __ or more c____ domains

A
  1. Insidious (proceeding in a gradual, subtle way, but with very harmful effects)
  2. Progressive, personality
  3. Gradual, irreversible
  4. Activities of Daily Life
  5. 2, cognitive
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13
Q

People with Mild Cognitive Impairment experience a____ memory for their a____. Criteria includes:
1. S____ memory complaint
2. O____ memory impairment for age
3. Relatively preserved g____ c____
4. Essentially intact a____ of d____ l____
5. No d____

A

abnormal, age
1. subjective
2. objective
3. general cognition
4. activities, daily life
5. dementia

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14
Q

The primary clinical symptom of neurocognitive disorder is c____ i____ in one or more c____ d____: not restricted to m____ and l____.

A

cognitive impairment, cognitive domains, memory, language

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15
Q

Major vs minor neurocognitive disorder (NCD):
1. Differentiated by significance of d____, and impairment in s____ or o____ functioning (independence)
2. Not due to delirium or other m_____ d____
3. Due to a____ as well as d____ neurological causes, a____-a____

A
  1. decline, social, occupational
  2. mental disorder
  3. acquired (trauma, HIV), degenerative, age-agnostic
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16
Q

Basic Activities of Daily Living (ADLs) are regular activities needed to f____ including b____, grooming, t____, d____, mouth care and e____

A

function, bathing, toileting, dressing, eating

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17
Q

Instrumental ADLs s____ daily life within the h____ and c____. They include f____ management, s___, c____, taking m____, housekeeping and making p____ c____

A

support, home, community
financial, shopping, cooking, medication, phone calls

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18
Q

AD Stages of decline:
1. Phase I (m____)
2. Phase II (m____)
3. Phase III (s____)
4. Phase IV

A
  1. mild
  2. moderate
  3. severe
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19
Q

Brain atrophy and disease progression:
1. Commonly looked at using s____ m____ r____ i____ (MRI) or p____-m____
2. AD brain weighs around ___g less than normal
3. Loss of n____ (g____ and w____ matter volume): r____ and e____ beyond normal ageing
4. P___- cell loss = regions involved in m_____ and l____, including h____
5. T____ p____: medial t____ lobe –> wider t____ region, p____ and f____ areas –> widespread a____ (V____ and m____ areas spared until late stages)

A
  1. structural magnetic resonance imaging, post-mortem
  2. 140g
  3. neurons (grey, white), rate, extent
  4. Primary, memory, language, hippocampus
  5. Topographical progression, temporal, temporal, parietal, frontal, atrophy, visual, motor
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20
Q

Neurochemical changes:
1. Most significant neurochemical changes in the c____ system
2. C____ converted by c____ a____ into a____
3. Chronic s____ cell loss of c____ neurons in the b____ f____ bundle
4. Reduced cortical c____ a____ activity correlates with clinical dementia rating
5. Reduced and extent of dysfunction correlates with p____/t____ density
6. Clinically s____ but not c____

A
  1. cholinergic
  2. Choline, choline acetyltransferase, acetylcholine
  3. subcortical, cholinergic, basal forebrain
  4. choline acetyltransferase
  5. plaque, tangle
  6. significant, causal
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21
Q

Neuroathological changes:
1. AD is a n____ disease
2. U____ m____ of AD are seen at post-mortem
3. Neuronal loss due to abnormal changes in p____
–> A____-b____ and s____/a____ p____
–> T____ and n____ t____ (NFTs)
3. I____ vs e____

A
  1. neurodegenerative
  2. unique markers
  3. proteins
    –> Amyloid-beta, senile/amyloid plaques
    –> Tau and neurofibrillary tangles
  4. Intracellular vs extracellular
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22
Q

Amyloid-beta is a cell m____ p____. It is generated by s____ e____ processing of larger Amyloid P____ P____ (APP) and b____- and g____-secretases. There are two different l____ of amyloid-beta and they have different t____.

A

membrane protein
sequential enzymatic
Amyloid Precursor Protein
beta-, gamma-secretases
lengths –> Aβ42 & Aβ40 peptide fragments
toxicity (Aβ42 especially toxic)

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23
Q

Senile/amyloid plaques:
1. Aβ-42 fragments aggregate to form e____ d____
2. Disrupt cell f____ - d____ and d____ neuronal processes

A
  1. extracellular deposits
  2. function - displace, distort
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24
Q

Amyloid positivity can be seen around __ decades before AD diagnosis

25
Aβ levels: C____ d____ correlates with conversion from MCI to AD (not as tightly linked to cognitive profile as t____)
cortical density, tau
26
__-__% of healthy older adults have significant levels of Aβ. Aβ correlates with cognitive decline in healthy older adults - e____ and s____ memory, v____, g____
25-30% episodic, semantic, visuospatial, global
27
Tau is a m____-a____ p____
microtubule-associated protein
28
Abnormal tau leads to small pieces of Tau that form s____ or threads that t____ together i____ neurons
strings, tangle, inside
29
H____ Tau interferes with s____ t____
Hyperphosphorylated, synaptic transmission
30
Neurofibrillary tangles (NFTs) are not specific to AD, but are a h____ feature. They are i____ a____ of h____ Tau that interfere with normal s____ t____. They are associated with: 1. P____ d____ of the neuron 2. Reduced e____ of function 3. Eventual n____ cell d____ They are highly i____ and i____, so it is very hard to shift the d____ once it has formed
hallmark intracellular aggregates, hyperphosphorylated synaptic transmission 1. Progressive degeneration 2. efficacy 3. neuronal, death inert, insoluble, deposit
31
Abnormal tau accumulates in specific brain regions involved in m____ in a very specific t____ p____ called B____ staging
memory, topographical progression, Braak
32
C____ d____ of p-tau correlates with clinical dementia rating
cortical density (p-tau = phosphorylated tau)
33
In a longitudinal cohort, __% of adults without dementia at autopsy with moderate-severe tangles, showing people can have pathology without demonstrating AD symptoms.
64%
34
There is an i____ between amyloid-beta and tau. It seems likely Aβ d____ Tau protein problems
interplay, drives
35
Plasma biomarkers have a high d____ a____ for Alzheimer's disease. It involves a blood test that looks at: 1. R____ of Aβ42:Aβ40 2. P____ 181, p____ 217 3. N____ light 4. GFAP
diagnostic accuracy 1. Ratio 2. P-tau, p-tau 3. Neurofillament (= marker of general neuro degradation (non-specific) – something that is released by neurons when damaged so don’t know cause but shows neuronal damage)
36
Advantages of plasma biomarkers: 1. Scalable, n____-i____, relatively c____ 2. Accesible in p____ c____ (GP) 3. Early d____ and administration of t____ 4. C____ trial enrichment
1. non-invasive, cheap 2. primary care 3. diagnosis, treatment 4. clinical
37
What are two issues with plasma biomarkers? 1. Need for f____-u____ assessments and m____? 2. Biomarkers e____ for d____?
1. follow-up, monitoring 2. enough, diagnosis
38
There is a considerable overlap in n____ in older adults. Only __% of older adults with cognitive impairment have AD pathology a____.
neuropathology, 9%, alone
39
There is an argument for Alzheimer's and Vascular dementia being treated as a c____, due to the considerable overlap in r____ f____.
continuum, risk factors
40
The top three fixed risk factors for AD are: 1. A____ 2. S____ 3. G____
1. AGe 2. Sex 3. Genetics
41
Deterministic genes in AD: 1. Chromosome 21 - D____ s____ (three copies of the gene coding Aβ protein leads to Aβ o____) 2. Chromosome 1 and 14 - F____ AD (a____ d____ inherited gene mutations. Presenilin mutations alter the specificity of y-secretase that leads to Aβ 42 o____ and a____)
1. Down's syndrome, overexpression (100% of people with DS will develop AD pathology) 2. Familial, autosomal dominant, overexpression, aggregation
42
Risk genes in AD: 1. Associated with a higher incidence of s____ AD, but not s____ to cause it 2. Chromosome 19 - A____ 3. P____ risk
1. sporadic, sufficient 2. APOE 3. polygenic
43
APOE can be E__, E__, or E__. We have 2 copies of the allele. 63% of the population have E__E__ genotype. Those with a E__E__ or E__E__ genotype have an increased risk of AD.
E2, E3, E4 E3E3 E3E4, E4E4 (E4E4 biggest risk)
44
Most AD is not s____ g____ i____. Familial AD account for __% of cases vs sporadic AD accounting for __%
simple genetic inheritance 5%, 95%
45
E____ events and l____ modify genetic susceptibility of AD. This is called p____
Environmental, lifestyle, polyaetiology
46
A Lancet dementia report (2024) concluded that: 1. There are __ modifiable risk factors of AD 2. __% of dementias are preventable
1. 14 2. 45%
47
Physical activity leads to increased a____ c____, h____ p____, n____ and perfusion. Even starting activity in l____ l____ is still p____ against dementia
amyloid clearance, hippocampal plasticity, neurogenesis later life, protective
48
Whitehall II cohort study found that more frequent s____ c____ at __ years led to a lower dementia risk
social contact, 60
49
Kuiper et al. (2015): Meta-analysis of 19 longitudinal cohorts found that: 1. Low social p____, less frequent s____ and greater l____ increases risk for dementia 2. No association between s____ of s____ g____ and dementia
1. participation, socialising, loneliness 2. size, social group
50
Longitudinal: social network structure & quality study found: 1. Q____ of relationships was the only emerging predictive risk factor: - Satisfied with relations = __3% reduced dementia risk - Received more support than gave = __5% reduced dementia risk
1. Quality - 23% - 55%
51
Cognitive engagement: 1. English Longitudinal Study of Ageing found i____ l____ a____ associated with reduced dementia incidence 2. C____ s____ activities across lifespan, particularly early and middle life, associated with lower a____ 3. Wisconsin Registry for Alzheimer’s Prevention found p____ and g____ in high-risk midlife cohort associated with increased g____-m____ volume in MTL + better c____
1. intellectual leisure activities 2. cognitively stimulating, amyloid 3. puzzles, games, grey-matter, cognition
52
Someone who engages in protective factors has a higher c____ r____
cognitive reserve
53
High s____ c____ and untreated h____ increase AD risk
serum cholesterol, hypertension
54
Three barriers to diagnosis are: 1. Lack of i____ of s____ 2. R____ to seek medical a____ 3. Poor a____ to medical help
1. identification of symptoms (Dementia often only becomes apparent to others in crisis) 2. Resistance, advice 3. access
55
Sabbargh (2017) - accuracy of dementia diagnosis __% in primary care and __% by specialist services when verified at autopsy
50%, 75%
56
Current drugs on NHS treat s____, but do NOT c____, r____, or s____ n____
symptoms, cure, reverse, slow neurodegeneration
57
The 1st UK-approved disease-modifying treatment works by promoting the clearance of a____ p____
amyloid plaques
58
IDEMCare Study (Roche et al., 2018) developed a leaflet tailored to overcome barriers to help‐seeking specific to black African and Caribbean groups. This lead to an increased i____ to s____ h____ in minority ethnic e____
intention, seek help, elders
59
Dementia rate is __-__x higher in minority ethnic groups in the UK, but d____ rates are much lower
5-7x, diagnosis

YR2 - Clinical Psychology and Mental Health (11 decks)

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