Lecture 10: Dementia 1

Question 1

Crystallized intelligence

Answer 1

Skills, abilities and knowledge that are overlearned, well-practiced and familiar.
Vocabulary and general knowledge

Question 2

Fluid intelligence

Answer 2

Abilities involving problem-solving and reasoning
Processing speed and executive functions

Question 3

Cognitive changes in normal cognitive aging

Answer 3

Declined fluid intelligence and intact or improved crystallized intelligence

Question 4

Types of memory that decline with age

Answer 4

1. Spontaneous retrieval: without cues
2. Source memory: where is the information from
3. Prospective memory: rmb to do smth in future

Question 5

Types of memory remains stable with age

Answer 5

1. Recognition memory: rmb events when given cues
2. Temporal order memory: sequence of past events
3. Procedural memory: rmb how to do thing

Question 6

Structural and functional changes in normal cognitive aging

Answer 6

1. thinner cortical and decreased gray matter
2. decreased white matter density (especially frontal and occipital)
3. loss of dopamine receptors

Question 7

protective factors for successful cognitive aging

Answer 7

1. Life style
   - active and healthy lifestyle
   - cognitive and social stimulation
   - limit cardiovascular risk
2. Cognitive reserve
   - plasticity
   - level of education
3. Cognitive retraining
   - teaching strategies to improve memory, reasoning and speed of processing

Question 8

dementia

Answer 8

the umbrella term for a number of neurological conditions, of which the major symptom is the decline in cognitive function due to physical changes in the brain

Question 9

main difference between minor (mild cognitive impairment) and major (dementia) neurocognitive disorders

Answer 9

ability to function independently
1-2 standard deviations below mean in cognitive assessment

Question 10

minor neurocognitive disorders

Answer 10

mild cognitive impairment

Question 11

MCI = precursor (tien than) of

Answer 11

all forms of neurodegenerative diseases
However, A proportion of people with MCI do not have
an underlying neurodegenerative disease

Question 12

The chance to develop dementia within 5 to
10 years after MCI diagnosis is on average
about

Answer 12

50%

Question 13

Treatment for MCI

Answer 13

no intervention
-> reassessment, psychoedu and cognitive training

Question 14

major neurocognitive disorders

Answer 14

• significant decline
• > 2 standard deviations below mean
• disrupting daily function independence

Question 15

The clinical diagnosis of
dementia (or Major neurocognitive disorder) does
NOT say anything about its cause:

Answer 15

The etiological subtype is defined by the underlying brain pathology (Alzheimer, Vasculair, Frontotemporal)

Question 16

Alzheimer’s disease (and variants)

Answer 16

a neurodegenerative disease that causes dementia

Question 17

the most common cause of dementia accounting for
about 70% of all dementia cases

Answer 17

Alzheimer’s disease (and variants)

Question 18

First and most prominant symptom is

Answer 18

gradually progressive memory loss

Question 19

Prognosis

Answer 19

• As AD progresses, multiple cognitive domains become affected
• Neuropsychiatric symptoms such as depression, apathy and anxiety are also common
• Final stage, there is overall cognitive loss, and the person is completely dependent on their environment

Question 20

Diagnosis criteria 1

Answer 20

1. major neurocognitive disorder
2. Vague onset and gradually progressive course (months to years)
3. Cognitive impairment involves a minimum of two of the following domains: executive function, memory, language, visuospatial functions.
4. No evidence of a substantial concomitant cerebrovascular, neurological or psychiatric disease that could explain the cognitive symptoms

Question 21

additional evidence

Answer 21

1, brain imaging
2. formal neuropsychological evaluation
3, Evidence of a causative Alzheimer’s disease genetic mutation (very rare)

Question 22

cause of AD

Answer 22

1. amyloid cascade hypothesis
2. vascular hypothesis
3. both hypotheses combined

Question 23

amyloid cascade hypothesis

Answer 23

the abnormally accumulation (tich tu) of amyloid-beta-protein -> amyloid plaques -> disrupts the connection of neuron -> clearing amyloid plaques = therapy( remains inconclusive)

Question 24

Criticism of amyloid cascade hypothesis

Answer 24

• Lack of coherent evidence
• It is not yet clear whether plaques and tangles are a cause of Alzheimer’s disease or just a consequence.
• Failure to provide an effective treatment

Question 25

Vascular hypothesis

Answer 25

vascular risk factors -> lack of blood and oxygen to the brain -> metabolic reaction -> overproduction of amyloid-beta-protein

Question 26

non-modifiable risk factors in AD

Answer 26

1. gender: female 2. older age 3. genetic predisposition

Question 27

modifiable risk factor in AD

Answer 27

life style,...

Question 28

Clinical course of AD can be divided into the following stages

Answer 28

1. MCI 2. Mild dementia 3. Moderate dementia 4. Severe dementia

Question 29

Most reported cognitive complaints that patients initially present with are:

Answer 29

- Difficulty remembering recent events - Forgetting appointments - Word-finding problems

Question 30

assess the clinical stage of AD

Answer 30

Clinical Dementia Rating (CDR) – semi structured interview

Question 31

Mild dementia (CDR1)

Answer 31

Ø problems in other cognitive functions start to emerge: language production, orientation in time and place, planning and performing activities. Ø Leading to clear limitations in daily life

Question 32

Moderate Dementia

Answer 32

- More extensive cognitive impairments occur - Person becomes increasingly dependent on others in daily life - Basic activities of daily living such as dressing, become more difficult

Question 32

Severe Dementia (CDR3)

Answer 32

Ø Final stage Ø Completely dependent Ø Confused Ø Incontinent (involuntary mat kiem soat)

Question 33

Brain in EEG

Answer 33

slowing of alpha activity

Question 33

Brain changes in AD (CT & MRI)

Answer 33

- extremely reduced cerebral cortex - severely enlarged ventricles - extremely reduced hippocampus

Question 34

PET scan

Answer 34

reduced glucose absorption (metabolized)

Question 35

Clinical diagnosis for AD

Answer 35

Diagnostic cycle 4 stages

Question 36

1.Complaints analysis

Answer 36

Both with patient and close relative: * Reduced insight into deficits (anosognosia) * Patients with dementia/AD commonly deny or trivialise their complaints * Ask questions about: * Subjective complaints of cognitive dysfunctions (e.g., memory, concentration etc.) * Onset and progression of the cognitive problems * Psychiatric symptoms (e.g., mood and anxiety) * Level of independence (activities of daily functioning) * Assessment of global cognitive functioning with screening test (e.g., MMSE) * Family and medical history * Medication use

Question 37

anosognosia

Answer 37

Reduced insight into deficits

Question 38

2.Problem analysis

Answer 38

Neuropsychological assessment

Question 39

Memory (declarative episodic memory)

Answer 39

Early stages: typically anterograde long-term memory impairment * Later stages: also retrograde memory impairment and semantic memory problems

Question 40

Executive function and problem solving

Answer 40

Cognitive flexibility and planning problems

Question 41

Attention

Answer 41

Mental flexibility and divided attention problems (switch task and multitasking)

Question 42

Other symptoms

Answer 42

* Olfactory dysfunction * Seizures (10-20% of cases, usually in later stages of disease) * Motor signs (typically in later stages of disease)

Question 43

Treatment options

Answer 43

Alzheimer's disease cannot be cured Medication to inhibit cognitive symptoms to a certain extent: - Cholinesterase inhibitors for patients with mild to moderate AD) - Memantine (N-Methyl D-aspartate antagonist) for patients with moderate to severe AD * Psychoeducation * Cognitive training (early stages) * Manage behavioral symptoms

Question 44

Prevalence and incidence of AD are

Answer 44

prevalence -> increasing (aging population) incidence -> decreasing (better cardiovascular care)

Question 45

Amyloid plaques can appear

Answer 45

20–30 years before symptoms

Question 46

40% of dementias may be preventable

Answer 46

via lifestyle changes