Dementia Flashcards
(40 cards)
Dementia
Acquired disorders – progressive cognitive decline
Individual has to have:
Memory impairment + 1 other cognitive domain
Examples: language, visuo-spatial skills, abstract thinking, or judgement
Significant loss in functional abilities
Examples: social, vocational, daily living, etc.
Alzheimer’s Disease
Cortical Dementia
Clinical presentation:
Slow onset with ~ 10 year progression to death
Global Deterioration Scale (Ferris, de Leon, & Crook, 1982)
7-point rating scale of cognitive and functional capacity
AD Stage 4
Early Alzheimer’s Disease Diagnosis
Multiple facets of memory impairment – typically difficulty recalling short-term memories; problems with new learning
AD Stages 1 & 2
effects of normal aging (everyday forgetfulness)
AD Stage 3
mild cognitive impairment
AD Stages 5-7
Advanced Stages of Alzheimer’s
Memory and other cognitive functions progressively decline
Changes in personality and emotional regulation
No longer live independently
Bed ridden- primitive reflexes return
AD Neuropathology:
Diffuse brain atrophy (the brain shrinks)
~20% reduction in weight compared to normal controls
Temporal, frontal, & parietal lobes
Ventricles enlarge
Begins in hippocampus & entorhinal cortex
Impacts connections between these areas, the amygdala and neocortex
Vulnerable regions of neocortex Temporal lobe Frontal lobe Parietal lobe Associations between these lobes
AD Neuropathological changes:
Senile plaques:
Round with beta-amyloid core; found outside the neuron
Abnormal amounts or structures of beta-amyloid
Neurofibrillary tangles:
Found inside the neuron
Tangles of abnormally decomposed tau protein
Neuronal and synaptic loss
Reduction in neurotransmitters
Including: acetylcholine & serotonin
AD Neuropsychological changes:
Memory – difficulty recalling current or recent information
Difficulty with learning new information
Remote memory is impaired over time
Procedural memory remains intact until late stages
Executive dysfunction- difficulty setting and achieving goals
Reduced attention
Difficulty problem solving
Difficulty with reasoning
AD Language Impairments
Naming/word finding problems
Semantic paraphasias
Difficulty comprehending complex sentences
multiple step directions
Eventually problems with simple sentences Discourse errors Maintaining topic Producing a variety of sentences Difficulty with abstract language jargon
Difficulty with reading and writing
AD Visuo-spatial relationships
May be impaired early
See over time
Difficulty navigating while traveling
May appear disoriented
AD Motor abilities
relatively intact until late stages
May see restlessness- early on
Immobile- late stage
AD Medical management:
No cure
Drug treatments
Modulating neurotransmitters- to improve cognitive functioning
Neuroleptics- treat behavioral symptoms
Tacrine-to improve memory
Inhibits a chemical that prevents the breakdown acetylcholine
Pick’s Disease
Restricted brain atrophy
Cortical Dementia
Temporal and frontal lobes
Atrophy may be symmetrical or asymmetrical
Rare disease with onset typically in 40’s
Cause unknown
PD Clinical presentation:
Early changes in personality Poor social skills Emotional blunting (no emotions) Disinhibition Poor insight and judgement Language disorder Naming problems and empty speech seen early, then gets worse
PD Neuropathology:
Atrophy of the temporal and/or frontal lobe(s)
Pick bodies
Dense structures found inside cortical cells – occurs in ~ ¼ of cases
Do not occur in normal age and not found in other diseases
Pick cells
Inflated or enlarged neurons – occurs in ~ ½ of cases
PD Neuropsychological changes:
Memory- deficits occur in later stages of the disease
Language-
Early difficulties include naming and empty speech
Mid-late difficulties include aphasia and mutism
Visuo-spatial – impaired late
Motor abilities- impaired late
Tremor, rigidity, and slow movements
Muscle weakness
PD Medical treatment:
No cure
Personality changes managed pharmacologically
Train caregivers to assist with daily living needs
Parkinson’s
Subcortical Neurodegenerative disorder that affects the extrapyramidal system
Gradual onset of symptoms
Typically seen in older individuals
Symptoms include: Tremors Rigidity Posture and balance problems Masked-like face Eventual dementia
Parkinson’s Clinical presentation:
Deficits in: Memory Executive functions Personality Motor movements Balance Dementia Depression
Parkinson’s Neuropathology:
Loss of dopamine in substantia nigra and other brain structures
Lewy body inclusions- found in substantia nigra neurons and other brain structures
Outer region is loosely packed neurofilaments and inner region is tightly packed
Parkinson’s Neuropsychological changes:
Memory- procedural and spontaneous recall impaired Language- hypokinetic dysarthria (impaired respiration, phonation, articulation, and resonance) Harsh vocal quality Reduced syllabic stress Monoloudness Imprecise consonants Increased rate of speech Palilalia- stuttering-like repetitions Also see flat affect
Visuo-spatial- impaired to some degree
Parkinson’s Hallmark
Motor abilities: Rigidity Bradykinesia Cogwheeling- jerky, ridged movements of limbs Resting tremors Intention tremors Balance and postural changes Shuffling gait
Parkinson’s Medical treatment
Drug treatments to either
Decrease excitatory neurotransmitters
Increase dopamine levels (Levodopa)
Drug treatments have side effects
