Dementia Overview Flashcards
(76 cards)
1
Q
what is the foundation of memory?
A
attention
2
Q
focalized (focused) attention
A
ability to respond specifically to one stimulus
3
Q
sustained attention
A
usage for tasks that take a long time
4
Q
divided attention
A
multitasking
5
Q
alternating attention
A
most important for cognitive flexibility
6
Q
memory
A
- short term
- long term
- working memory
7
Q
types of memory
A
- declarative memory
- nondeclarative memory
8
Q
types of declarative memory
A
- episodic
- semantic
9
Q
episodic declarative memory
A
our family’s vacation at the Grand Canyon
10
Q
semantic declarative memory
A
what is the capitol of Maine?
11
Q
types of nondeclarative memory
A
- procedural skill
- associative
- nonassociative
- priming
12
Q
procedural skill nondeclarative memory
A
how to swing a golf club
13
Q
associative nondeclarative memory
A
classical conditioning, fear memory
14
Q
nonassociative nondeclarative memory
A
habituation and sensitization
15
Q
priming nondeclarative memory
A
the power of suggestion
16
Q
dementia
A
- acquired neurological syndrome characterized by persistent intellectual decline which is due to neurogenic causes
- progressive deterioration
- must rule out other conditions (they can be treated medically)
- depression
- delirium
- medicine side effects
- thyroid problems
- infections
17
Q
dementia: nature and course depend on etiology
A
- most are progressive
- some are static
- 10%-20% may have “reversible” causes
- therefore, need careful dx
18
Q
dementia: other conditions
A
- arteriosclerosis
- hearing disorders
- epilepsy
- syphilis
- alcohol abuse
19
Q
dementia: signs and symptoms
A
- cognitive changes
- psychiatric symptoms
- personality changes
- problem behaviors
- changes in day-to-day functioning
- trouble driving, getting lost
- impacts independence in performing activities of daily living
20
Q
dementia: cognitive changes
A
forgetfulness and disorientation
21
Q
dementia: psychiatric symptoms
A
withdrawal and apathy
22
Q
dementia: problem behaviors
A
agitation, wandering
23
Q
changes in activities due to dementia
A
- basic communication skills
- transportation
- meal preparation
- shopping
- housework
- managing medications
- managing personal finances
24
Q
dementia: basic communication skills
A
participating on conversation, such as using a regular phone, mobile phone, remote control email, or the internet
25
dementia: transportation
either by driving oneself, arranging rides, or the ability to use public transportation
26
dementia: meal preparation
meal planning, cooking, clean up, storage, and the ability to safely use kitchen equipment and utensils
27
dementia: shopping
the ability to make appropriate food and clothing purchase decisions using a debit card, cash, and apps to pay
28
dementia: housework
doing laundry, washing dishes, dusting, vacuuming, and maintaining a clean place of residence
29
dementia: managing medications
- taking the correct amount of medication at the correct time
- managing re-fills and avoiding conflicts
30
dementia: managing personal finances
operating within a budget, writing checks, paying bills, and avoiding scams
31
areas that may/will be impacted
- intellectual function
- judgment
- thinking
- visuospatial skills
- language
- memory
- emotion and behavior
32
how to help
- routines
- organizing, but make it fun
33
diagnosis
- at least 3 of the functions are impacted
- American Psychiatric Association: requires memory be impaired
34
mild cognitive impairment
- dx used when the problem is mild and limited to a single domain (e.g., memory)
- if you have MCI, you are more likely to develop Alzheimer's and other dementias
- 10%-15% of people with MCI develop dementia
- especially likely if the MCI involves memory loss
35
definition of dementia
the loss of intellectual functions (such as thinking, remembering, and reasoning) of sufficient severity to interfere with a person's daily functioning
36
diagnostic criteria: DSM-V
- neurocognitive disorders (NCD)
- dementia and amnesia disorders are now included under NCD
- can have major NCD or mild NCD is new
- can still use the term dementia
- memory is not essential (added social cognitive disorder due to early signs of frontotemporal dementia)
37
diagnostic: DSM-IV
had individual criteria for Alzheimer's, vascular dementia and substance-induced dementia
38
DSM-V
- major or mild vascular NCD
- major or mild NCD due to Alzheimer's
- new separate criteria for frontotemporal NCD
- lewy bodies
- TBI
- Parkinson's
- HIV
- Huntington's Prion disease
- other medical condition
- multiple etiologies
- substance-medication induced
- unspecified NCD
39
Huntington's Prion disease
- affects nervous system, dementia, ataxia, Creutzfeld-Jakob
- can be genetic or sporadic
40
dementia is an acquired deterioration of at least 2 of the following
- memory (st, lt, semantic, episodic, procedural)
- language (recep. inner. exp.)
- orientation
- perception
- attention
- ability to carry out purposeful tasks
- visuospatial skills
- cognition (judgment, abstraction, calculation)
- social cognition
41
social cognition
- concept is also introduced as one of the core functional domains that can be affected by a neurocognitive disorder
- this concept may be particularly significant in the evaluation of patients with non-Alzheimer's dementias, such as frontotemporal dementia
42
dementia: prevalence
- 1%-6% over age 65 is severe
- 2%-15% over age 65 is mild/mod
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dementia: incidence
1/100 = severe
10/100 = mild/mod
44
dementia overview
- after age 65, prevalence doubles every 5 years
- age 85+ prevalence is 30%
- family history
- people with a parent or sibling with dementia have a higher risk
- may be autosomal dominant trait
45
dementia and down syndrome
- if they live to middle age, have plaques and tangles
- may have a chemical relationship between the 2 through cerebrovascular amyloid protein
46
TBI
- increased risk of Alzheimer's disease and other dementias
- moderate head injuries = twice the risk of a person with no head injury (loss of consciousness lasting more than 30 minutes)
- more than 24 hours, then severe
- mild TBI does not increase risk for dementia
47
repeated head injuries
- increased risk of dementia
- boxers
- football players
- cognitive impairment
- evidence of tau tangles
48
tau
an important protein found in neurons
49
chronic traumatic encephalopathy (CTE)
- "a brain disease not a brain injury"
- Boston CTE Center is the largest research center
50
Huntington's disease
- progressive neurological disorder with dementia
- autosomal dominant, chromosome 4
51
ethnocultural factors
- data is limited
- Shoenberg, Anderson, and Haerer 1985: Whites and African Americans (men and women) had roughly same prevalence rate
- Ritchie and Lovestone 2002: dementia (esp. Alzheimer's) may be more common in whites than African Americans, Asian Americans, or Hispanic Americans
- vascular dementia may be more prevalent in African Americans and in Japan
- Europe/U.S.: Alzheimer's more prevalent than vascular dementia
- also, more non-white elderly may receive care at home and not use health services, therefore may lead to an underestimation of dementia
52
causes of dementia
- Alzheimer's disease: 50%-60% of all patients
- vascular origin: 20%
- dual dx/Alzheimer's + vascular: 15%
- others include Pick's disease, Parkinson's, progressive supranuclear palsy, primary progressive aphasia, Creutzfeldt-Jakob disease
53
reversible causes
- sleeping pills/sedatives
- anti-Parkinson's drugs
- anti-hypertensive/cardiovascular drugs
- infections such as colds, flu, and pneumonia
- disorders of endocrine function
- nutritional disorders such as B12 deficiency, folate/protein deficiencies
- chronic renal failure
- lung and heart failure
- drug toxicity
- strokes, partially reversible
- anemia
- metabolic/electrolytic imbalances
- trauma
- toxicity
54
reversible causes: metabolic/electrolytic imbalances
- calcium, sodium, potassium
- chronic renal failure, long-standing lung or cardiac disease/anemia
55
reversible causes: toxicity
occupational, environmental, household exposures that are harmful, drug-induced
56
cortical dementia
- degeneration in cortical association areas
- subcortical structures usually intact
- most common is Alzheimer's disease
57
cortical dementia: most common is Alzheimer's disease
- confirmed only upon autopsy
- occurs 2-3x more in women
- characterized by pathological changes in the brain, primarily the association areas of the parietal, temporal, frontal lobes, and hippocampus
58
subcortical dementia
- affect deep brain structures
- basal ganglia
- thalamus
- brainstem
- cortical structures are spared
- cognitive slowness
- motor abnormalities
- low F of aphasia and apraxia
- extrapyramidal syndromes
59
extrapyramidal syndromes
- Parkinson's disease
- Huntington's disease
- progressive supranuclear palsy
- Wilson disease
- spinocerebellar degenerations
- idiopathic basal ganglia calcification
60
Alzheimer's disease: early onset
up to age 60 or 65 (6%)
61
Alzheimer's disease: late onset
usually occurs during the 70s and 80s
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Alzheimer's disease: symptoms
- memory impairment
- difficulty with orientation
- learning and retraining new information
- impairment in communication
- difficulty with visual spatial skills
- cognition
- calculation
- motor systems
- personality deterioration
63
Alzheimer's disease: behavioral difficulties
- delusions
- agitation
- dinural disturbances
- motor restlessness
- emotional liability
- suspiciousness
- depression
- paranoia
64
Alzheimer's disease: there is a destruction and death
of nerve cells
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Alzheimer's disease: this destruction causes
- memory failure
- personality changes
- problems in carrying out daily activities
66
there are 3 main stages of dementia
1. early stage
2. middle stage
3. late stage
67
gross brain inspection
- atrophy
- cellular/neuronal loss
68
Alzheimer's disease: microscopic inspection
- neurofibrillary tangles
- senile plaques (amyloid)
- granulovacuolar degeneration
- reduction cholingeric and noradrenergic systems
69
Alzheimer's disease: neuronal loss
- nerve cells are destroyed
- brain is shrunken
- most obvious in cerebral hemispheres
- especially temporal and parietal lobes
70
Alzheimer's disease: neurochemical changes
- depletion of neurotransmitters
- acetylcholine, somatostatin, vasopressin, and corticotropin
71
Alzheimer's disease results in progressive degeneration over time akin to
an acceleration of the mental aging process
72
in patients with early disease
only minor memory problems out of proportion to their age (mild cognitive impairment) might be apparent
73
with mild-to-moderate disease
patients may become lost, take longer handling daily tasks, and repeat questions
74
with increased progression
patients also exhibit changes with mood and personality, language, reasoning, and sensory processions
75
in severe Alzheimer's disease
patients have great difficulty interacting with daily life and require increasing amounts of supportive care
76
