Dementia (week 10)

Question 1

Dementia (definition)

Answer 1

progressive failure of many cerebral functions that is not caused by an impaired level of consciousness

Question 2

characteristics of dementia

Answer 2

• reduced cognitive function
• impaired mental abilities
• decreased ability to orient
• decreased STM, followed by LTM
• decreased language ability
• impaired judgement
• alterations of behavior

Question 3

what occurs with dementia

Answer 3

memory impairments
disorientation
hallucinations
illusions
delusions
confusion

Question 4

what is the commonality of dementias

Answer 4

degeneration of neurons

atrophy of cerebral cortex and basal ganglia

Question 5

classifications of dementia

Answer 5

cortical
subcortical
combination

Question 6

types of cortical dementias

Answer 6

Alzheimer’s

Pick’s

Question 7

types of subcortical dementias

Answer 7

Parkinson's
Huntington's
Hydrocephalus
Endocrinopathies
Drug Intoxication
Heavy Metal Poisoning
Depression-Dementia Syndrome

Question 8

Combination Dementias

Answer 8

Multiinfarct dementia
AIDS
Creutzfeldt-Jacob

Question 9

factors that play a role in development of dementia

Answer 9

genetic predisposition
environment
behavior

Question 10

testing for dementia

Answer 10

lab testing (to r/o other causes)
neuropsychological exam

Question 11

How is dementia treated

Answer 11

no cure, tx aims to slow the progression & maximize fxn

Question 12

most common disease that interferes with cognitive ability in people over age 65

Answer 12

Alzheimer’s

Question 13

Alzheimer’s accounts for __-__% of cases of late life dementia

Answer 13

50-60

Question 14

what accounts for the other 40-50% of cases of late life dementia

Answer 14

anoxic and infarct

Question 15

primary risk factor for Alzheimer’s

Answer 15

age; increases with each decade of age

Question 16

What other diseases are associated with Alzheimer’s

Answer 16

Parkinson’s

Down’s Syndrome

Question 17

What is found in post mortem Alzheimer’s brains

Answer 17

• aggregation and precipitation of amyloid

- neurofibrillary tangles

Question 18

what makes up the neurofibrillary tangles

Answer 18

microtubules in nerve cells

Question 19

what are amyloid plaques composed of

Answer 19

A-beta peptides

Question 20

Amyloid cascade hypothesis for Alzheimer’s

Answer 20

there is an imbalance in production and removal of A-beta peptides in the brain that leads to accumulation and aggregation

Question 21

what is Amyloid

Answer 21

a lipoprotein

Question 22

where are neurofibrillary tangles primarily found in Alzheimer’s

Answer 22

hippocampus & cerebral cortex

Question 23

what are neurofibrillary tangles composed of

Answer 23

hyperphosphorlyated Tau protein that are unable to bind to microtubules allowing them to collapse

Question 24

how is the inflammatory response triggered in Alzheimer’s

Answer 24

accumulation of A-beta peptides is attacked by microglia, which sets up inflammatory process

Question 25

what is released during inflammatory response that is neurotoxic

Answer 25

cytokines nitric acid free radicals

Question 26

what drug class may serve protective function against Alzheimer's

Answer 26

NSAIDs

Question 27

cholinergic hypothesis

Answer 27

significant loss of cholinergic neurons and nicotinic receptors in hippocampus and cortex thought to be secondary to the primary process of Alzheimer's

Question 28

have attempts to increase ACh levels in the brain been successful?

Answer 28

no; ACh may not have been getting to the right part of the brain to help

Question 29

Other neurotransmitters that may contribute to Alzheimer's

Answer 29

- excitatory amino acids - increased activity of MAO-B - loss of serotonergic neurons

Question 30

how is LDL related to Alzheimer's Disease

Answer 30

- some LDLs are associated with increased deposition of A-beta peptides - AD is positively correlated with hypertension, increased LDL, and diabetes

Question 31

What vitamins may reduce risk of AD

Answer 31

E & C

Question 32

is vitamin E fat or water soluble?

Answer 32

fat (can be toxic)

Question 33

is vitamin C fat or water soluble

Answer 33

water (can cause kidney stones)

Question 34

How is estrogen associated to AD

Answer 34

estrogen may protect from AD

Question 35

what particular behavior changes are likely to be seen in AD

Answer 35

irritability agitation restlessness

Question 36

what types of imaging are used to diagnose AD

Answer 36

CAT MRI to check for shrinkage of sulci in cortex

Question 37

What serologic tests are performed to r/o other causes of AD

Answer 37

``` blood cell counts electrolytes hepatic function thyroid function B12 levels ```

Question 38

what pharmaceuticals can induce symptoms of AD?

Answer 38

``` sedatives and hypnotics anticholinergics opiates antipsychotics anticonvulsants histamine receptor blockers ```

Question 39

what medications are used to treat AD

Answer 39

- cholinesterase inhibitors for mild-moderate (improve cholinergic transmission) - glutamate receptor antagonist (Namenda) for moderate-severe

Question 40

what has been shown to decrease the likelihood of AD

Answer 40

exercise lifestyle | quality of brain (education, brain teasers, etc)

Question 41

what AD treatment is currently under investigation

Answer 41

immunotherapy to increase removal of A-beta peptides