Gerontology 1 Flashcards
(40 cards)
What is dementia
a syndrome
Deterioration in cognitive function (i.e. the ability to process thought) beyond what might be expected from normal ageing.
What does dementia affect
Memory
Thinking
Orientation
Comprehension
Calculation
Learning capacity
Language
Judgement
what will people with dementia have problems with
Day-to-day memory- difficulty recalling events that happened recently
Concentrating, planning or organising - difficulties making decisions, solving problems or carrying out a sequence of tasks (eg cooking a meal)
Language - difficulties following a conversation or finding the right word for something
Visuospatial skills - problems judging distances (eg on stairs) and seeing objects in three dimensions
- Orientation - losing track of the day or date, or becoming confused about where they are.
what does dementia not affect
Consciousness
The impairment in cognitive function is commonly accompanied, and occasionally preceded, by deterioration in what?
Emotional control
Social behavior
Motivation
What are the different types of dementia
Pathology of Alzheimers
Reduction size of the Cortex, severe in hippocampus
Plaquesare deposits of a protein fragment called beta-amyloid that build up in the spaces between nerve cells.
Tanglesare twisted fibres of tau protein build up inside cells.
Distinctive Features: STML (short term memory loss), Aphasia, Communication Difficulties, Muddled over everyday activities, mood swings, withdrawn, loss of confidence
what are the 2 important features associated with Alzheimers
Plaquesare deposits of a protein fragment called beta-amyloid (toxic to neurons) that build up in the spaces between nerve cells.
Tanglesare twisted fibres of tau protein build up inside cells.
what is pathology of vascular dementia
Vascular dementia is caused by reduced blood flow to the brain, which damages and eventually kills the brain cells.
Features of vascular dementia
- narrowing and blockage ofthe small blood vessels deep inside the brain(known as small vessel disease)
- a single large stroke(where the blood supply to part of the brain is suddenly cut off)
- lots of mini-strokes that cause tiny, but widespread, damage to the brain
- In many cases, these problems are linked to underlying health conditions– such as high blood pressure and diabetes– as well as lifestyle factors, such as smoking and being overweight.
- Distinctive Features: Memory problem of sudden onset, visuospatial difficulties, symptoms of stroke, anxiety, delusions, seizures
pathology of dementia with lewy bodies
Deposits of anabnormal protein called Lewy bodies inside brain cells
These deposits, which are also found in people with Parkinson’s disease, build up in areas of the brain responsible for things such as memory and muscle movement.
Features of dementia with lewy bodies
Distinctive Features: Cognitive ability fluctuates, visuospatial difficulties, attentional difficulties, overlapping motor disorders, speech and swallowing problems, sleep disorders, delusions
Pathology of frontotemporal dementia
The frontal lobes of the brain, found behind the forehead, deal with behaviour, problem-solving, planning and the control of emotions.
Changes in personality and behaviour, and difficulties with language.
Younger age of onset
Ubiqitin associated clumps of protein
TDP-43
Distinctive features of frontotemporal dementia
Distinctive features: STML not always present, uncontrollable repetition of words, mutism, repetition of words of other people, personality change, decline in personal and social conduct
Rarer forms of dementia
HIV – related genitive impairment
Parkinson’s disease
Corticobasal degeneration
Multiple Sclerosis
Niemann-Pick disease
Creutzfeldt-Jakob disease
Behavioural aspects of dementia
Depression
Apathy / Emotional Blunting
Anxiety
Irritability/ Disinhibition
how is depression related to dementia
Affect 40% of all people with Alzheimer’s dementia
Depression may precede a diagnosis of Alzheimer’s by several years
Earliest signs of Alzheimer’s – apathy and social withdrawal
Purpose of neuropsychological testing is to ascertain if memory is disturbed or whether memory is affected as result of depression
Depression may go untreated
Maybe treated with medications generally classified as antidepressants
what is apathy/emotional blunting and how is it related to dementia
Operationally defined as someone who is content to sit in a chair all day
Emotional blunting refers to a lack of a person’s affective response –
(Mood is how one feels himself or herself. Affect is how he or she is perceived by others.)
Someone with emotional blunting may not smile or laugh at appropriate junctures or reciprocate an expression or gesture of love, such as a hug, kiss, or “I love you”.
Treatment of apathy is more challenging as response to medication is not robust.
If medication is indicated, physicians tend to use categories of medication that increase availability of norepinephrine and dopamine in the brain.
Stimulants have a higher side effect profile, so they are used judiciously.
how is anxiety related to dementia
- Anxiety can be either situational or generalized.
- Situational anxiety may be seen in patients early in disease who have heightened awareness of their deficits. May become anxious when they struggle with a task that once came relatively easy to them. Slower or less accurate.
- Increasing anxiety as the complexity of the task increases, such as completing a tax return.
- In later stages we may see patients become anxious whenever they leave their home, such as to go to a doctor’s visit.
- More generalized symptoms are typically described as a general feeling of unease.
- May ruminate on anxiety-laden topics such as their various physical problems or their fear of running out of money.
- It is not uncommon to have a more advanced patient repeatedly ask others what they should be doing.
- Anxiety and/or irritability may also respond to non-stimulating antidepressants.
- When possible prescribing sedatives is avoided for anxiety in geriatric patients due to the increased risk for somnolence, confusion, and falls with these drugs.
how is irritability/disinhibition related to dementia
- Irritability is regularly seen in Alzheimer’s disease
- Families often describe the patient as being snappy, on edge, or having a short fuse.
- The irritability can be triggered by a frustrating event or may be fairly generalized.
- Hateful words may be uttered. Some may even start cursing or making derogatory comments about another’s race, gender, or religion.
- The latter can be quite disturbing to families, particularly when viewed as out of character for their loved one.
- Increased activity for the psychiatric symptoms of dementia are recommended
- Apathy or depression does not improve when spending time alone or being idle.
- The combination of meaningful activity and being around others lifts spirits.
- Anxiety likewise thrives with inactivity.
what may be the first symptom of dementia
- Social withdrawal or mood disturbance may be the first symptom of Alzheimer’s disease.
what is significant forgetfulness caused by
a primary memory disorder
in what ways is psychosis related to dementia
- hallucinations
- delusions
what is a hallucination
A hallucination is an abnormal sensory perception of a stimulus that isn’t really there.
