Dementia and the mental well being Flashcards
(41 cards)
is Dementia an actual disease??
Dementia is NOT a disease itself, but a group of symptoms that can accompany certain diseases or conditions.
It’s a broad term that can be defined as a condition involving:
impairments in thinking,
remembering, and reasoning,
which affect a person’s function and safety
so how would you define it??
Dementia is neither a behavioral, a cognitive nor a functional disorder
Dementia is a chronic, progressive brain illness that affect memory, cognition, and daily function. It is often accompanied by psychiatric symptoms
Family and caregivers are critical
Clinicians cannot rely solely on the patient for reports of symptoms
age associated impairment vs. mild congnitive impairment
Age Associated Memory Impairment Subjective memory complaints Poor memory test performance compared to young adults Normal general cognitive function No difficulty with ADL Mild cognitive Impairment Subjective memory complaints Poor memory test performance compared to age- matched peers Normal general cognitive function No difficulty with ADL
MCI vs. Dementia
Memory complaints
Abnormal memory of age/ education
Normal general cognitive function
Still normal function - ADL Memory complaints Abnormal memory for age/ education Abnormal cognitive function in at least one more domain: Language Abstract thinking Perception Judgment Personality change Impaired function - ADL
Neurocognitve disorder! How would you define this??
Decline in one or more cognitive domains based on: (apraxia, aphasia, memory, executive functioning)
Observation
AND
Objective assessment
Deficits interfere with ADL and IADL
Not due to Delirium, Major Depressive Disorder or Schizophrenia
causes of dementia
Neurocognitive disorder: Alzheimer’s disease, Dementia with Lewy bodies, Parkinson disease dementia, Frontotemporal dementia, Huntington’ disease Vascular: Multi-infarct Inflammatory : MS Cancers: primary, metastatic Other physical: hydrocephalus, trauma
what is the primary disease that causes dementia???
Alzheimer’s disease : 60-85% Dementia with Lewy body: 15-30% Vascular Dementia: 5-20% Frontotemporal Dementia: 5-10% Others: 10-15%
what is the third leading cause of death in the elderly and what is retrogenesis???
6th Leading cause of death – (3rd for the elderly)
Retrogenesis – back to birth—unravels the brain in reverse order (reverse developmental theory) Barry Reisberg, MD
1 in 3 people over age of what have dementia??
1 in 3 people over the age of 85 have AD
4% of people under the age of 65 have AD
The rate of AD doubles every 5 yrs after age 65 reaching 30-50% in those 85 and older
10,000 baby boomers will be turning 65 every day for the next 15 yrs (77million)
The G-8 and the US congress have made finding treatment by 2025 a top priority
Who is the most likely race to get alzheimers
African Americans : are about 2x more likely to have Alzheimer’s and other dementias than Whites
Hispanics are about 1 ½ times more likely to have AD and other dementias than whites
There are NO Known genetic factors that can explain the greater prevalence of AD in African American and Hispanics (obesity , smoking..)
warning signs of dementia
Challenges in planning or solving problems
Difficulty completing familiar tasks at home, work, leisure
Confusion with time or place
Trouble understanding images, spatial relationships
New problems with words in speaking or writing
Misplacing things and losing the ability to retrace steps
Decrease or poor judgment, changes in mood
Withdrawal from work or social activities
Signs of dementia
Memory: difficulty recalling names, phone numbers, misplacing objects, remote recall mildly impaired
Visuospatial: topographic disorientation, poor complex constructions, becoming disoriented
Language: mild word find difficulties, difficulty communicating ideas
Personality: indifference, occasional irritability, anxiety, suspiciousness and depression, lose insight
Psychiatric: sadness or delusions in some patients
Motor: normal
CT/MRI: essentially normal
severe AD how would you describe it??
8-12 year Duration
Intellectual functions: inability to recall children’s or spouse’s name, disorientation to place and eventually person
Function: unable to function independently
Personality: socially inappropriate behavior, flat or restricted affect, agitated
Motor system: limb rigidity and flexion postureSphincter control: urinary and fecal incontinence
EEG: diffusely slow
CT/MRI: ventricular dilatation and sulcal widening
last stages of sevre AD
Seizures Urinary and fecal incontinence Loss of ability to walk Contractures Bedridden Mute
stage 1 and 2 of dementia describe them!!
Stage 1: No disability noted
Stage 2: (very mild cognitive decline)
Clinically labeled the forgetfulness phase.
C/O forgetting where one has placed familiar objects
Forgetting names of persons one formally knew well.
No objective evidence of memory deficit on clinical interview
No objective deficits in employment or social situation
stage 3 of Dementia
Stage 3:(mild cognitive decline)
Clinically labeled as early confusional
Earliest clear cut deficits noted
Word and name finding deficits become evident
Ability to retain material from a reading passage in a book is lost
Objects of value lost by patient
Patients begin to deny there is a problem
Patient gets lost when traveling to unfamiliar places
Mild to moderate anxiety accompanies symptoms
Objective evidence of memory deficit obtained only w/ intensive interview
stage 4 dementia
Known clinically as late confusional phase
Decreased knowledge of current and recent events
Decreased ability to handle finance and travel
May be able to travel to familiar places, recognize familiar persons and be oriented to time and person
Can no longer perform complex tasks
Denial is dominant defense mechanism
Withdraws from challenging situations
Flattening of affect noted
stage 5
Difficulty choosing clothing to wear
Disorientation to time and place frequently exhibited
Often knows his/her name and those of spouse and children
Difficulty recalling major relevant aspects of one’s current life
Needs assistance in order to survive
stage 6
Clinically labeled as middle dementia
Unaware of all recent experiences and events in ones life
Entirely dependent on others for survival
Occasionally forgets name of spouse
Unaware of surroundings
Require assistance with adl’s
Can usually recall ones own name
Pronounced personality changes can occur, including agitation, violent behavior, anxiety
stage 7
Clinically described as late dementia All verbal abilities and psychomotor skills are lost Requires assistance for adl’s Incontinent of urine Patient can no longer command the body Clinically described as late dementia All verbal abilities and psychomotor skills are lost Requires assistance for adl’s Incontinent of urine Patient can no longer command the body
pathogenesis of AD
Amyloid plagues:
Neurofibrillary tangles
Chololinergic hypothesis: Genetic factors
Chronic inflammation
Neurotransmitter deficits: Acetylcholine, Glutamate-induced calcium dysregulation
Oxidative stress (toxins, free radicals)
Amyloid rich plaques: toxic, disrupts potassium and calcium channels
Neurofibrillary tangles: tangles insoluable
Cholinergic hypothesis: Acetylcholine (Ach) is los
drugs believed to help with um mild to moderate AD
Acetylcholinersterase inhibitors: act by inhibiting actetylcholinersterase activity; resulting in an increase in Ach in the synaptic cleft
Drugs: Tacrine, Aricepts, Exellon, Galantamine
Only in Mild – Mod AD
Glutamate believed to cause neuronal toxicity and drug menantine does what??
Glutamate: excessive and erratic glutamate stimulation cause neuronal toxicity and impair learning: Theory: normalize glutamatergic neuro-transmission to maintain or improve cognition
Drug Memantine: less decline in cognition, function, reduction in caregiver time
possible good factors for not getting AD
Dementia free family history
High education or SES
Dietary vitamin E
Apolipoprotein e2 genotype
