Alzheimer’s Disease and Cognition

Question 1

What is the definition of cognition?

Answer 1

The mental action or process of acquiring knowledge and understanding through thought, experience, and the senses.

Question 2

What are the consequences of cognitive impairment?

Answer 2

• increased risk for injury
• complicates disease management
• decreased functional ability
• increased need for assistive services
• financial hardship
• caregiver burden

Question 3

What are the risk factors for cognitive impairment?

Answer 3

• Elderly people are at highest risk for cognitive impairment
• personal behaviors, substance abuse, participation in high-risk activities, accidental injuries
• environmental exposure
• congenital factors
• genetic conditions
• health-related conditions (acute/chronic treatments

Question 4

What does th type and degree of cognitive impairment depend on?

Answer 4

The type of problem and its severity

Question 5

What are the things that are helpful in recognizing cognitive impairment?

Answer 5

• memory
• language
• visuospatial
• calculation
• abstract reasoning
• thought process and content

Question 6

What are some diagnostic tests for cognitive impairment?

Answer 6

• lab tests (to rule out medical problems)
• Neuropsychometric testing
• brain imaging techniques

Question 7

What are some of the brain imaging techniques used to diagnose cognitive impairment?

Answer 7

• neuroimaging

- MRI or PET

Question 8

What can the MRI or PET detect?

Answer 8

• intercranial tumors
• infarcts (vascular dementia)
• frontotemporal lobe atrophy

Question 9

What is Alzheimer’s disease?

Answer 9

A common degenerative neurological disorder.

Question 10

When does AD usually manifest?

Answer 10

After age 65

Question 11

Half the population over ___ have AD.

Answer 11

85

Question 12

When a patient has AD, what else may they die from?

Answer 12

Comorbidities

Question 13

What are the two basic types of AD?

Answer 13

Familial and sporadic

Question 14

What is an example of progressive degenerative changes in AD?

Answer 14

Gross atrophy of cerebral cortex.

Question 15

What is AD caused by?

Answer 15

• neurofibrillary tangles
• Amyloid process
• loss of communication between neurons
• death of neurons results

Question 16

Death of neurons follows a…

Answer 16

Specific pattern

Question 17

What is the limbic system?

Answer 17

Center for emotion, memory

Question 18

What is the hippocampus?

Answer 18

Center for recent memory

Question 19

What type of memory is lost more slowly and why?

Answer 19

Remote memory, because it is spread over more areas of the brain

Question 20

Death of neurons cause what?

Answer 20

Motor changes, loss of ability to think remember, and reason

Question 21

Death of neurons causes changes in behavior that interfere with what?

Answer 21

Life.

Question 22

What can exhibit from death of neurons?

Answer 22

Delusions or hallucinations

Question 23

The summary of the pathophysiology and etiology of AD includes what?

Answer 23

• blood flow to affected areas decreases
• atrophy of cortical area of the brain
• structural, chemical changes

Question 24

What are the risk factors of AD?

Answer 24

• Age over 65
• Family history
• Gender
• Head injury

Question 25

Is there a way to prevent AD?

Answer 25

No

Question 26

What are the actions that can limit risk of AD?

Answer 26

- weight control - regular exercise - consume protective foods - use of drugs and alcohol - being mentally and socially active

Question 27

What things could be associations with AD?

Answer 27

- anoxia - infectious disease (HIV) - Depression - poisoning - substance abuse - Down syndrome - DM - Atherosclerosis - HTN - smoking - inflammation

Question 28

In AD, what accompanies cognitive decline?

Answer 28

Physical decline

Question 29

What do you do with the many manifestations of AD that are similar to those of other conditions?

Answer 29

Rule out other disease processes

Question 30

What does the rate of progression of this disease depend on?

Answer 30

Overall health and type of care after diagnosis

Question 31

Mnemonic: D:

Answer 31

Drug or alcohol

Question 32

Mnemonic: E:

Answer 32

Emotional disorders

Question 33

Mnemonic: M:

Answer 33

Metabolic or endocrine disorders

Question 34

Mnemonic: E (2):

Answer 34

Eye and ear dysfunctions.

Question 35

Mnemonics: N:

Answer 35

Nutritional deficiencies

Question 36

Mnemonics: T

Answer 36

Tumors, trauma, or toxins

Question 37

Mnemonics: I

Answer 37

Infections

Question 38

Mnemonics: A

Answer 38

Atherosclerotic effects on heart, brain

Question 39

How many stages of dementia are there?

Answer 39

Seven

Question 40

How is stage 1 AD characterized?

Answer 40

No impairment

Question 41

How is stage 2 AD characterized?

Answer 41

Normal aged forgetfulness

Question 42

How is stage 3 AD characterized?

Answer 42

Mild cognitive impairment

Question 43

How is stage 4 AD characterized?

Answer 43

Mild or early stage AD (symptoms are more obvious, trouble performing ADL’s)

Question 44

How is stage 5 AD characterized?

Answer 44

Moderate AD (lose ability to live independently)

Question 45

How is stage 6 AD characterized?

Answer 45

Moderately severe AD (can remember own name but not name of spouse)

Question 46

How is stage 7 AD characterized?

Answer 46

Severe AD (complete loss of ability to respond to surroundings, requires total care)

Question 47

For collaboration of a patient with AD, who is involved?

Answer 47

-MD, Nurse, Social Worker, Neurologist, Psychiatrist, PT, OT, Gerentology nurse specialist, MD, Case worker, pharmacists

Question 48

Are there any diagnostic test for AD?

Answer 48

No, except for a brain autopsy

Question 49

What are other diagnostics to discover AD?

Answer 49

H&P, (including psychiatric and neuro), Ongoing interviews, Brain scans, CT and MRI, PET imaging, Lab work ups

Question 50

What is PET imaging?

Answer 50

It’s a type of nuclear medicine imaging.

Question 51

What may slow down progression of of AD

Answer 51

Acetylocholinesterase inhibitors and MNDA receptor antagonists.

Question 52

What if taken before the disease, may slow progression of AD?

Answer 52

NSAID’s

Question 53

True or false. | Research suggests certain antihypertensives may be useful.

Answer 53

True.

Question 54

What type of behaviors management drugs are given for AD?

Answer 54

- antidepressants | - antipsychotics

Question 55

What is the prototype drug for mild to moderate AD?

Answer 55

Donepezil

Question 56

What is Memantine?

Answer 56

A NMDA receptor antagonist

Question 57

What is Memantine used for?

Answer 57

Moderate to Late AD

Question 58

What is the action of Memantine?

Answer 58

It blocks the effects from high levels of glutamate thereby slowing the intracellular calcium accumulation and resultant nerve damage

Question 59

What is contraindicated for Memantine?

Answer 59

Renal or hepatic impairment, seizure history.

Question 60

What are the adverse affects of Memantine?

Answer 60

Heart failure, HTN, fatigue, dizziness, anxiety, confusion, insomnia, arthralgia, incontinence

Question 61

What do you use is combination with Memantine?

Answer 61

Donepezil