Aging & dementia Flashcards Preview

ABPP > Aging & dementia > Flashcards

Flashcards in Aging & dementia Deck (79):
1

Aging depends on the interaction of which 3 variables

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

2

Correlates of successful aging

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

3

Brain changes associated with aging

Loss of synapses, neurons, neurochemical input, neuronal networks

4

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

Most - hippocampus & anterior dorsal frontal lobe
Least - occipital lobes

5

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

Greatest - prefrontal & inferior temporal cortex
Least - occipital areas

6

Memory changes associated with normal aging

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

7

Language changes associated with normal aging

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

8

Visuospatial changes associated with normal aging

Small changes in simple perception, slowed visual processing
Complex visual tasks produce large age effects (visual closure, integration, construction)

9

Executive functioning changes associated with normal aging

Decline in cognitive flexibility, application of abstract concepts

10

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

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

11

DSM-IV definition of dementia

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

12

Probable AD (NINCDS-ADRDA criteria)

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

13

Pathological progression of Alzheimer's

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

14

Anatomical changes associated with Alzheimer's disease

Cerebral atrophy
Neuronal loss
Amyloid plaques
Neurofibrillary tangles

15

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

Parietal, inferior temporal, limbic cortex

Widespread cause of atrophy appears to be loss of dendritic arborization

16

Neuronal loss in Alzheimer's disease is most prominent in

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

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

17

Amyloid plaques

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

18

Neurofibrillary tangles

Intracellular accumulations of tau proteins

19

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

40

20

Declines in advanced IADLs predict

Frequency of hospital contact, nursing home placement, mortality

21

Basic ADLs rely on

Procedural memory skills & basic motor programming

22

Instrumental ADLs require

Controlled processing & executive function

23

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

Over 85

24

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

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

25

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

10-30x

26

Baseline tests that predict later cognitive decline in AD

Verbal tests of naming, verbal memory, fluency, abstraction

27

Baseline tests that predict later functional decline in AD

Nonverbal measures of visuospatial functioning & visual memory

28

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

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

29

Diagnostic criteria for probable vascular dementia (NINDS-AIREN)

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

30

Neary et al. diagnostic criteria for frontotemporal dementia

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

31

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

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

32

Lund & Manchester groups diagnostic criteria for frontotemporal dementia

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

33

Histopathological subtypes of frontotemporal dementia

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

34

Primary progressive aphasia

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

35

Semantic dementia

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

36

Pick's disease

Atrophy of frontal & temporal lobes

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

37

Diagnostic criteria for dementia with Lewy Bodies

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

Neuropathology of dementia with Lewy bodies

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

39

Creutzfeldt-Jakob's disease

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

40

Clinical triad of Creutzfeldt-Jakob

Dementia, involuntary movements, periodic EEG sharp wave activity

41

Name 3 other prion related dementias

Kuru, fatal familial insomnia, bovine spongioform encephalopathy

42

Criteria for MCI

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

43

Predictors of progression from MCI to dementia

Hippocampal atrophy, genetic susceptibility (ApoE-4)

44

7 conditions that are potentially reversible causes of dementia

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

45

Depression vs. AD

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

Risk factors for Alzheimer's disease

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

47

Neuropathology of progressive nonfluent aphasia

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

48

Neuropathology of semantic dementia

Polar & inferolateral temporal cortex

49

Neuropsychological profile of NPH

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

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

50

What are the cardinal features of Alzheimer's disease?

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

51

What are the cardinal features of frontotemporal dementia

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

52

What are the cardinal features of dementia with Lewy bodies?

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

53

What are the cardinal features of vascular dementia?

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

54

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

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

55

What are the cardinal features of progressive supranuclear palsy

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

56

What are the cardinal features of corticobasal dengeneration?

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

57

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

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

58

Alcoholic dementia

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

Dementia pugilistica

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

Flattened affect & parkinsonian extrapyramidal features also common

60

Mattis Dementia Rating Scale (DRS)

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

61

Mayo Older Age Normative Study (MOANS)

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

62

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

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

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

AD

64

Clinical features that suggest something other than AD

Sudden onset
Focal neurological findings
Seizures & gait disturbance @ onset

65

DLB vs AD on neuropsych testing

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

66

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

7% per year

67

Neuropsychological profile of HIV dementia

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

68

Carphologia

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

69

Approximately what percent of dementias are reversible?

5% (others say 10-15%)

70

Functional neuroimaging in late-life depression

Bilateral frontal lobe hypometabolism

71

Prevalence of dementia across lifespan

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

72

Neuropsychological profile of early Lewy Body dementia

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

73

Behavioral deficits in Lewy Body dementia (compared to AD)

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

74

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

Crystallized, fluid

75

Areas of cognitive that are relatively preserved with aging

Simple attention, primary & tertiary memory, everyday language communication

76

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

Entorhinal cortex

77

Differences between Pick's disease & AD

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

78

Clinical triad of Creutzfeldt-Jakob

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

79

Atrophy associated with normal aging generally reflects a loss of

Myelin