Neurocognitive Disorders - Dementia Flashcards
(31 cards)
dementia
cognitive DECLINE (AQUIRED deficit, not developmental)
- more than one cognitive domain affected
- social/occupational functioning impairment
- static or progressive
All patients w/ Alzheimer’s have _____
All patients w/ Alzheimer’s have DEMENTIA
but NOT all pts w/ dementia have Alzheimer’s.
Neurocognitive Disorders (NCDs), major and minor
include delirium, conditions involving substantial decline in a single cognitive domain, conditions affecting younger individuals (e.g. TBI, HIV) as well as previously described dementias
6 cognitive domains
- complex attention
- executive function
- learning and memory
- language
- perceptual - motor
- social cognition
Major Neurocognitive Disorder due to Alzheimer’s disease (DSM-V)`
- evidence of INSIDIOUS onset, GRADUAL progression of impairment, and significant cognitive DECLINE from a previous level of performance in 2 or more of the 6 cognitive domains, based upon:
- -> Concern of decline expressed by the individual/others
- -> Substantial impairment in cognitive performance (standardized testing, etc) - either evidence of gene mutation OR memory/learning affected domains
- cognitive deficits interfere w/ daily independence
- cognitive deficits do NOT occur exclusively in context of delirium
Mild Neurocognitive Disorder due to Alzheimer’s disease (DSM-V)
The cognitive deficits do NOT interfere with capacity for independence in everyday activities
NCD due to Alzheimer’s is the most common cause of _____ in the elderly.
NCD due to Alzheimer’s is the most common cause of PSYCHOSIS in the elderly.
MCD due to Alzheimer’s prominent behavioral sx
- depression
- apathy
- irritability
- paranoid
- visual hallucinations
- agitation
- sleep disturbance
- wandering
- combativeness
- misidentification sx (thinks husband is imposter)
Amyloid cascade hypothesis
Amyloid Precursor Protein (APP)
1. cleaved by alpha-secretase to a benign breakdown product in the non-amyloidogenic pathway
OR
2. cleaved by beta-secretase and then gamma-secretase to form beta amyloid/amyloid-beta/A-beta/Αβ –> AGGREGATION and NEUROTOXICITY
Strategies to reduce beta-amyloid
- reduce production, vaccinate, facilitate clearance, prevent aggregation of beta amyloid
recent: use of monoclonal Abs directed against beta amyloid very early in the course of the illness
MCD due to Alzheimer’s unmodifiable risk fx
- Advancing age
- Family history and genetics
- first degree relative affected
- Apolipoprotein E (APOE) genotype (4*)
- Rare autosomal dominant “deterministic” genes - Down’s syndrome –> highly increased risk
- Female gender (some disagreement)
- head trauma
- low educational levels
- vascular risk fx (sedentary/obesity/smoking/HTN etc.)
Apolipoprotein E (APOE) genotypes (which increases risk? neutral? protective?)
APOE-4 allele, esp. homozygous –> inc risk (earlier onset, possibly via impaired Beta amyloid clearance)
APOE-3 allele, neutral
APOE-2 allele, may be PROTECTIVE
MCD due to Alzheimer’s biomarkers
- Measures of brain beta-amyloid deposition
- diminished CSF beta-amyloid (not getting cleared)
- positive amyloid in PET imaging - Measures of neurodegeneration
- inc CSF tau (tangles)
- dec glucose uptake in parietal/temporal cortex (FDG PET)
- structural imaging (MRI)
- PET tau imaging
MCD due to Alzheimer’s:
FDA approved meds
Cholinesterase Inhibitors
N-methyl-D-aspartate (NMDA) Partial Receptor Antagonists
- blocks xs glutamate (excitatory)
In elderly pts w/ dementia, how are Behavioral and Psychological Symptoms of Dementia (BPSD) and caregiver burden reduced?
Anticholinergic burden reduction (by reducing or eliminating medications with CNS anticholinergic side effect)
Does beta-amyloid increase or decrease in CSF?
Decrease. Less clearance.
Major Frontotemporal Neurocognitive Disorder
previously Frontotemporal Dementia
- Symptomatology often dominated by PERSONALITY change:
- social inappropriateness
- behavioral disinhibition
- apathy
- impaired judgment and insight
- perseverative, compulsive behavior
- hyperorality, such as overeating - Onset before 65 y/o
- Decline often faster than Alzheimer’s
Major Neurocognitive Disorder with Lewy Bodies
formerly Lewy Body Dementia
- FLUCTUATING cognition, variations in attn/alertness
- VISUAL hallucinations early on
- Parkinson sx, marked sensitivity to antipsychotic medication side effects
- REM sleep disorder (dreams acted out)
- autonomic dysfunction (falls, syncope, orthostatic hypotension)
- Lewy bodoes (alpha-synuclein) cerebral cortex
differential dx of Major Neurocognitive Disorder with Lewy bodies
vs. Parkinson’s
in Parkinson’s, motor sx clearly PRE-date cognitive decline
Major Vascular Neurocognitive Disorder
formerly Vascular Dementia
- cognitive deficits may be related to one or more cerebrovascular events
- course sometimes uneven w/ decline followed by periods of stability and maybe some improvement
- Pathophys of NCD due to Alzheimer’s and Vascular disease may overlap
- Patients over 85 often have NCD due to Alzheimer’s and cerebrovascular disease
Other Major/Minor Neurocognitive Disorders can be due to…
traumatic brain injury, substance/medication use, HIV infection, Prion disease, Parkinson’s Disease, Huntington’s Disease, another medical condition, or multiple etiologies
The most common cause or form of dementia
Alzheimer’s disease
T/F
Pts w/ dementia-related apathy are also likely to be depressed and will respond well to antidepressants
FALSE
Which dementia often initially presents w/ vivid visual hallucinations?
Major Neurocognitive Disorder with Lewy Bodies
