Maladaptieve aging Flashcards
(27 cards)
Comorbiditeit met leeftijd
0.5-5%: migraine, epilepsie, hipbreuk, Parkinson, arthritis en kanker
6-10%: COPD, depressie, thyroid disease, hartritmestoornis
11-15%: anemia, diabetes, oogdisease, angina pectoris, ischemische hartziekte
16-20%: heart failure
21-30%: hoge bloed druk en dementie
Why do we need a definition and diagnosis of dementia
Advances of knowledge: cognitive neuroscience, brain imaging, genetics en epidemiologie
Revision of definition en diagnostic criteria
–> identification of diseased people
Tretament recommendation, incidence/prevalence rates, mortality en planning of health care and social services, costs
Dementie
Acquired syndrome characterized by multiple cognitive deficits, severe enough to interfere with daily life/functioning, including social and professional functioning
- cognitive impairment
- behavioral problems
- functional disability
Dementia DSM-IV
A1. memory impairment
A2. at least one of the following cognitive disturbaces
- aphasia (taal)
- apraxia (motor functie)
- agnosia (object identificatie)
- executive function
B. the cognitive deficits cause significant impairment in social or occupational functioing and represent a decline from the previous level
C. The cognitive deficits do not exclusively occur during delirium
Neurocognitieve disorders
- Alzheimer
- Vasculaire ziekten
- HIV
- Lewy body disease
- Traumatische brein injury
- Substance/medication use
- Parkinson
- Huntington
Verschil DSM-IV en DSM-V
- nieuwe, bredere term
- memory deficit not required
- 1 domein genoeg en meer specifieke/complexe cognitieve vaardigheden
- emphasis on cognitive continuum
Minor neurocognitive disorders
- DSM-V
a. modest cognitive decline from a previous level of performance in one or more cognitive domains: complex attention, executive function, learning and memory, language, perceptual-motor or social cognition
b. cognitive deficits do not interfere with independence in everyday activities, but greater effort, compensatory strategies, or accommodation might be required
c. cognitive deficits do not occur exclusivly in the context of a delirium
d. cognitive deficits are not better explained by another mental disorder
Mild cognitive impairment - MCI
- self- or informant-reported cognitive complaint
- objective cognitive impairment (taking into account age and education)
- perserved independence in functional abilities ADL
- does not fulfil the criteria for dementia
–> high risk for developing dementia and early intervention
Activiteis of Daily living ADL
Instrumental ADL
Basic ADL
Major neurocognitive disorder
- DSM-V
a. significant cognitive decline from a previous level of performance in one or more cognitive domains: complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition
b. cognitive deficits interfere with independence in everyday activities
c. cognitive deficits do not occur exclusively in the context of a delirium
d. cognitive deficits are not better explained by another mental disorder
Neurodegenerative/vascular disease
- 50-75% alzheimer
- 20-30% vasculaire dementie
- 10-25% Lewy body dementie
- 10-15% frontotemporale dementie
Dementia due to treatable illness
- toxic disorders (alcohol en drugs)
- sytemisch en metabolische stoornissen
- infectie stoornissen
- brain tumor
- depression
- sensory deprivation
Vasculaire dementia VaD
- Large vessel VaD: multi-infarct dementie en strategische infarct dementie
- Small vessel VaD: subcortical dementia
Klinische features VaD
- abrupt onset
- stepwise progression
- focal neurological signs or symptoms
- history of cerebrovascular disease and risk factors
- cognitive: impaired executive functions
Criteria:
1. dementia
2. crebrovascular disease
3. a relationship between the above two disorders
Alzheimer
- memory deficit
- gradual development
- progressive deterioration
- no other specific causes
Biomarkers: neuroimaging, cerebrospinal fluid, final confirmation at autopsy (plaque or tangles)
Brain changes with Alzheimer
- atrophy (loss of neurons and synapses)
- amyloid-rich neurotic plaques (icomplete degradation of proteins)
- neurofibrillary tangles (protein clumps lad to cell death)
–> these changes begin years before the onset of clincial symptoms
Risk factors and genetics Alzheimer
Autosomal dominant mutations: 21 amyloid precursor protein, 14 presenilin1 en 1 Presenilin2
Genetics: familial aggregation, APOE e4 and others
Clinical featurs Alzheimer
Early: memory, learning and executive functions and depression and apathy
Mild: perceptual-motor and language and psychotic features, agitation and wandering
Severe: social cognition and gait problems and incontinence
Seven stages of Alzheimer
- AD not detectable
- Decline not distinguishable from normal age related memory loss
- Detectable cogntive problems
- Clear cut symptoms
- Need help
- Need for constant supervision and care
- Lose ability to communicate or respond to environment
Diagnosis Alzheimer
- personal history
- physical examination
- neuropsychological testing
- functional status
- blood tests
- neuroimaging
- cerebrospina fluid
MMSE mini mental state examination
- rough indication
- 20 items
- low score (<24) indication of dementia
- take eduactional level into account
Clock test
Draw clock that says 10 past 11, with 5 points:
- 1 for circle
- 1 for right order of numbers
- 1 for right place of numbers
- 1 for 2 clock-hands
- 1 for correct time
MoCa test Montreal Cognitive Assessment
- brief 30-question test
- takes 10-20 minutes
Alzheimer treatment
- symptomatic drugs: restoring imbalanced neurotransmission (acetylcholisterase inhibitors en memantine)
- disease modifying drugs: in progress
- more than 200 drug development failures
