Case 8 Dementia Flashcards
(44 cards)
1
Q
How do neurons communicate?
A
- Neurotransmitters (chemicals) released so a message can pass from one synapse to another dendrite to another neuron.
- Have twice number of synapses if we are adults.
- Connections changing every day in brain. Ability of brain to adapt = plasticity
2
Q
What is dementia?
A
- Dementia –> decline in cognitive abilities that are significant enough to interfere with daily life activities
- Dementia = syndrome (expressed in every person in different ways, different symptoms, different behaviours, etc)
- progessive condition = symptoms get worse over time.
3
Q
What are the different types of dementia?
A
- Alzheimers
- Vascular dementia
- Lewy body
- Frontotemporal dementia
- Mixed dementia
- Late onset dementia (65+ yrs)
- Early onset dementia (<65 under age)
4
Q
What is alzheimers?
A
brain disorder that slowly destroys memory & thinking skills & ability to carry out simple tasks.
5
Q
What is vascular dementia?
A
caused by brain damage resulting from restricted blood flow in the brain.
6
Q
What biomarkers are involved with dementia?
A
- Neurofibrillary tangles (tau)→ within the cells
- Amyloid plaques (amyloid beta) → sit between cells
7
Q
How does beta amyloid form?
A
- Amyloid beta normally originates from protein APP.
- protein normally split into enzymes & then normally 40 amino acids.
- But in alzheimer’s split into 42 amino acids.
8
Q
How does the amyloid plaque form?
A
Additional 2 amino acids = clumping of beta-amyloid
9
Q
What happens with amyloid in alzheimers?
A
- Communication between cells disrupted due to the accumulation of amyloid beta.
10
Q
What is the hippocampus and why is it important?
A
- Important for consolidation from short term –> long term memory which is why people with dementia have a lot of memory problems because information is not stored in long term memory.
- In advanced alzheimer’s disease brain, hippocampus almost immediately gone = almost no informed is stored in long term memory.
11
Q
What are the early symptoms of dementia?
A
- forgetfulness
- losing track of time
- becoming lost in familiar places, etc.
12
Q
What are the middle stage symptoms of dementia?
A
- becoming forgetful of recent events and people’s names
- becoming lost at home
- communication problems
- needing help with personal care
- behaviour changes, etc.
13
Q
What are the late stage symptoms of dementia?
A
- unaware of time & place
- difficulties recognizing loved ones
- difficulty walking, aggression
- increasing need for assisted self-care, etc.
14
Q
What are non-modifiable risk factors for dementia?
A
- Age
- Sex
- Family history
- Genetics - does not run in families due to genetics but runs in family because age is most important risk factor and we are getting older and older??? - genes of how old you get
15
Q
What are modifiable cardiovascular risk factors for dementia?
A
- Hypertension
- Obesity
- High cholesterol
- Diabetes type 2
16
Q
What are modifiable lifestyle risk factors for dementia?
A
- Excessive alcohol consumption
- Physical inactivity
- Smoking
- Unhealthy diet
- Low mental stimulation
- Sleep problems
17
Q
What are modifiable psychosocial risk factors for dementia?
A
- Loneliness / social network
- Mood / depression
18
Q
What are other modifiable risk factors for dementia?
A
- Air pollution
- Low educational level
- Hearing loss
- Traumatic brain injury
19
Q
*How is dementia a clinical syndrome?
A
- Dementia = clinical syndrome. (see image)
- Subjective complaints → self reported memory complaints (mention everything they forget = nothing wrong)
- Objectified impairment in 1 cognitive domain → e.g. memory or information processing speed but still can daily function - not everyone in this stage will develop dementia
- Dementia - objectified impairments in multiple domains. interference in daily life
20
Q
What is cognitive reserve?
A
mind’s and brain’s resistance to damage of the brain
21
Q
What happens if you have a high brain reserve with dementia?
A
- Develop dementia more slowly than people without this type of BR
- High BR can compensate damage to the brain network
- patients with high CR may be able to process tasks in a way that allows to better cope with brain damage and/or can sustain greater degrees of brain damage before demonstrating functional deficits.
22
Q
What are reserve-enhancing factors?
A
- Exposure to reserve-enhancing factors over lifespan → reduced risk of dementia
- Physical exercise
- Intellectual stimulation (e.g. education)
- Leisure activities
23
Q
When does brain reserve decrease?
A
BR decreases with ageing due to e.g. wear & tear (oxidative stress) and reduced ability to form synapses (coupling unit between neurons) → brain becomes less plastic
24
Q
What is the incidence of alzheimers?
A
- Prevalence is increasing but incidence is decreasing in high income countries → how?
- Theory = incidence (# of new cases) every year is much smaller than years before but still total # is still increasing but number of new cases is little lower. → why?
- Theory that it is due to having higher educational levels than generations before us, more busy with lifestyles, CVD risk factors are better under control than generations before us (e.g. hypotensive medications, CVD risk managements, etc)
25
What is the prevalence of alzheimers?
* Alzheimers most common form of dementia.
26
What is the mortality of alzheimers?
* 7th leading cause.
* Most of the people with dementia don’t die from dementia.
* Alzheimers disease can cause complications such as **pneumonia, infections, and malnutrition,** which can contribute to the death of the individual.
27
What are symptoms of alzheimers?
* decline in cognitive and functional abilities.
* memory loss
* confusion
* difficulty with language
* poor judgement
* changes in mood and personality.
28
What is the treatment for Alzheimers?
* No cure for Alzheimer's disease.
* Non-pharmacological interventions e.g. **cognitive stimulation therapy**, helpful in managing symptoms.
* Caregiver **support & education** important for overall management of Alzheimer's disease.
* Aducanumab has major side effects (approved in US but not in NL)
29
What is a problem for the future regarding dementia?
* not enough nursing homes, problems of staffing
* Increasing number of dementia due to population growth, increasing risk factors, ageing, some countries don’t have access to education (protective factor)
30
What are diagnostics of dementia?
* Clock test
* Mini Mental State Examination (MMSE)
* Montreal cognitive assessment (MoCA)
* Functional assessments of ability to perform daily acitivties
* Medical evaluations
* Intelligence tests
* Spinal fluid test
31
What is the MMSE?
Mini Mental State Examination (MMSE):
* test is a **risk** assessment → lower the score = higher the chance of dementia
* evaluates individual's cognitive functioning, including **orientation, attention, memory, language & visual-spatial skills.**
32
What is MOCA?
Montreal cognitive assessment (MOCA)
- more comprehensive cognitive test
- evaluates various cognitive domains, including: **attention, memory, language, visuospatial abilities, and executive functions.**
33
What are medical evaluations for dementia?
* lab tests
* blood tests
* CT scan
* Neuro-imaging MRI scan
34
What is the problem with spinal fluid extraction for dementia?
not very sensitive so get many false positives.
35
What are cognitive functions?
* Intelligence
* Memory
* Information processing speed
* Executive functions (inhibition, decision-making, problem solving, etc)
* Language
* Visuospatial skills
36
What are executive functions?
* Information processing speed
* Attention (sustained, selective, divided)
* Problem solving
* Planning / strategy / reasoning
* Control
* Initiating
* Mental flexibility
37
How can early diagnosis and treatment benefit the person with dementia and their caregivers?
Early diagnosis and treatment can help manage **symptoms** and improve **quality of life** for both the person with dementia and their caregivers.
38
*What are the lancet commision 12 steps ?
graph in doc of lancet commission
Modifying 12 risk factors might prevent of delay up to 40% of dementias on population level not individual level.
39
What is the treatment of dementia?
* no treatment, but there are medications that can help with the symptoms. You have to give it in an early stage, it has minimal benefit For example: ‘Aducanumab’. It’s not approved in Europe, but it is in the US.
40
What can be done for people who have developed dementia?
* Organization of care
* Psycho-education
* Psychosocial intervention
* Support for caregivers
* Case management
41
What is the difference between normal and pathological ageing?
* Normal: natural changes that occur in the brain as the person ages.
* Pathological: development of neurological conditions and disease that significantly impact brain function and impair daily activities
42
What are changes that are part of normal ageing?
* Gradual decline in brain volume,
* Changes in # and function of neurons
* Changes in structure & function of brains network
* Changes in physical, cognitive, & psychological functioning (normal part of ageing process) such as changes can include gray hair, wrinkles, decreased vision and hearing, slower processing speed, and decreased physical strength.
43
What changes are part of pathological ageing?
* Require ongoing medical treatment and care.
* severe cognitive decline, functional impairment, and other medical and psychiatric conditions that impact the individual's ability to function independently.
44
Should you screen for dementia and how would you screen this?
* The tests are a combination of screening and diagnosis.
* There is no treatment to prevent/cure it (Wilson and Jungner), only lifestyle changes
* Emotional distress
