Dementia Flashcards
(31 cards)
Define Mild cognitive impairment (MCI)
Mild cognitive impairment (MCI) is an intermediate stage between the
expected cognitive decline of normal aging and the more-serious decline of
dementia. It can involve problems with memory, language, thinking and
judgment that are greater than normal age-related changes.
Dementia WHO Definition
- Dementia is a syndrome in which there is deterioration in memory, thinking, behavior and the ability to perform everyday activities.
- Although dementia mainly affects older people, it is not a normal part of ageing.
Define Early Stage Dementia
Early stage: the early stage of dementia is often overlooked, because the onset is gradual. Common symptoms include: • forgetfulness • losing track of the time • becoming lost in familiar places.
Define Middle Stage Dementia
Middle stage: as dementia progresses to the middle stage, the signs and symptoms
become clearer and more restricting. These include:
• becoming forgetful of recent events and people’s names
• becoming lost at home
• having increasing difficulty with communication
• needing help with personal care
• experiencing behavior changes, including wandering and repeated questioning.
Define Late Stage Dementia
near total dependence and inactivity. Memory disturbances are serious and the physical signs and symptoms become more obvious. Symptoms include:
• becoming unaware of the time and place
• having difficulty recognizing relatives and friends
• having an increasing need for assisted self-care
• having difficulty walking
• experiencing behavior changes that may escalate and include aggression.
Types of Dementia
- Alzheimer’s
- Vascular
- Lewy Bodies
- Parkinson’s
- Mixed Dementia
- Frontotemporal Dementia
- Creutzfeldt-Jakob disease
- Normal pressure hydrocephalus
- Huntington’s Disease
- Wernicke-Korsakoff Syndrome (Thiamine deficiency)
Where are plaques vs tau protein found?
• b-Amyloid plaques outside neurons (senile plaques) and tau protein inside neurons (neurofibrillary tangles) eventually lead to neuron dysfunction and death.
• Senile Plaques and Neurofibrillary Tangles are the typical histopathological
findings of the AD.
Pathological roles of Amyloid Beta
At high levels:
- neurotoxic properties
- synaptic and memory impair
- Altered metal binding
- pro-oxidant effects
- lipid perioxidation
- inductor of calcium dyshomeostasis
- alters cholinergic response
Physiological roles of Amyloid Beta
At low levels:
- neurotrophic properties
- role in neurogenesis
- modulator of synaptic plasticity and memory formation
- metal ion sequestration
- antioxidant activity
- role in maintaining structural integrity of BBB
- role in calcium homeostasis
What is the role of AD and ApoE?
• Apolipoprotein E (ApoE) is a glycoprotein that plays an important role in lipid
metabolism and cholesterol transport.
• Apolipoproteins are synthesize d primarily in the liver but can be processed and
secreted in the brain by astrocytes and microglia.
• They are involved in neuronal regeneration, an increase in the synthesis of these
proteins has been observed in the central and peripheral nervous system during
neuronal damage.
• The ApoE4 gene is located at chromosome 19q13.2 and has three isoforms: ApoE2,
ApoE3 and ApoE4.
• Allele 4 of apolipoprotein E (ApoE4) has been reported to represent the main
identified risk factor for sporadic AD. This gene has been associated with Early
Onset of AD and Late Onset of AD in multiple ethnic groups, and carriers of APOE4
exhibit an earlier age of onset for AD.
10 signs of Alzheimer’s
- Memory loss that disrupts daily life.
- Challenges in planning or
solving problems. - Difficulty on completing familiar tasks.
- Confusion with time or place.
- Trouble understanding visual
images and spatial
relationships. - New problems with words in
speaking or writing. - Misplace objects and loosing the ability to retrace steps.
- Decreased or poor judgement.
- Withdrawal from work or social activities.
- Change in mood or personality.
Early signs of Vascular Dementia
impaired judgment, planning, and decisionmaking; may have motor function deficiencies, such as slow gait and poor
balance or language impairment, depending on location of vascular injury
• Focal neurologic signs and symptoms as well as brain imaging demonstrating significant cerebrovascular injury are key indicators.
• Location and extent of brain injuries determine specific manifestation of dementia and/or other impairment
Define Cerebral small vessel disease (CSVD)
A group of pathological processes with multifarious etiology and pathogenesis that are involved into the small arteries, arterioles, venules, and capillaries of the brain.
CSVD mainly contains:
• Lacunar infarct or lacunar stroke,
• Leukoaraiosis,
• Binswanger’s disease (subcortical leukoencephalopathy) and
• Cerebral microbleeds.
Define Lewy Bodies Dementia
Lewy bodies are abnormal aggregations (or clumps) of the protein alpha-synuclein.
If they clumps develop in the cerebral cortex then there will bethe development of Lewy Bodies Dementia.
Early Signs of Lewy Bodies Dementia
dream enactment behaviour, visual hallucinations, visuospatial impairment, parkinsonian features, and marked cognitive fluctuations, possibly in the absence of memory deficits.
Process starts from cortex not hippocampus
Cognitive and psychiatric symptoms occur at least 1 year prior to onset of
significant parkinsonism and motor deficits
Parkinson Disease (PD) Dementia
PD is a neurodegenerative disorder, which leads to progressive deterioration of motor function due to loss of dopamine-producing brain
cells in the substantia nigra which interrupts the communication with the
corpus striatum.
Early signs of Parkinson Disease (PD) Dementia
Early symptoms including rigidity, tremor, and gait changes.
Diagnosis of Dementia: Tests to exclude other causes
- Full blood count
- Electrolytes
- Glucose
- Renal function
- Liver function
- Vit B12 and folates
- Thyroid function
- CT Head
Evaluation by a Memory Clinic with tests like: Mini Mental Short Examination (MMSE), Geriatric Depression Scale (GDS), Montreal Cognitive
Assessment (MoCA) etc.
What is the goal of medications in dementia?
Used to delay the symptoms and improve the quality of life
Medications for dementia
Donepezil
Rivastigmine
Galantamine
Memantine
Define Delirium
an acute and fluctuating disturbance of consciousness with reduced ability to focus,
maintain, or shift attention, accompanied by change in cognition and perceptual disturbances secondary to a general medical condition.
Subtypes of delirium
Hypoactive subtype: apathy and quiet confusion are present and easily missed. This type can be confused with depression.
Hyperactive subtype: agitation, delusions and disorientation are prominent and it can be
confused with schizophrenia.
Mixed subtype: patients vary from hypoactive to hyperactive
Peak time of Post-operative delirium (POD)
Post-operative delirium (POD): is a form of delirium
that manifests in patients who have undergone
surgical procedures and anesthesia, usually peaking
between one and three days after their operation.
Important Delirium outcomes
• Increased mortality
• Reduced functional abilities
• Increased length of stay
• Increased admission to long-term care
• Persistence of cognitive function impairment and of the
symptoms of delirium (inattention, disorientation and
impaired memory)
• Traumatic for patients and family members, and can lead to long-term psychological sequelae
