Neurodegeneration Flashcards
(116 cards)
What structures are required for consolidation of declarative memory?
• Hippocampus and entorhinal cortex (medial temporal lobe structures) required for reinforcement (consolidation) of declarative memory
What projects to and from the entorhinal area?
o Projections to and from all over cortex are funnelled through hippocampus, entorhinal area.
o Entorhinal area has massive projection to cortex and receives massive projections from cortex
What are the earliest lesions which can be seen in Alzheimer’s disease?
Earliest lesions we see in Alzheimer’s is entorhinal cortex
What is the basis of declarative memory anatomically?
• Strengthened connections between cortical areas is the basis of declarative memory
What is important in recall of information anatomically?
• Activation of strengthened networks is the basis of recall
What is the function of the dorsolateral prefrontal cortex?
• Areas such as dorsolateral prefrontal cortex is important in network activation (recall) and storage
How is memory distributed in the brain?
• Memory distributed across modality-specific areas and association areas
o It’s really in the connections
Describe what ageing does to the brain
• Do not lose neurons as you age- may be minor loss of neurons
• Mild cortical atrophy
o Mainly white matter shrinkage
o Minor grey matter atrophy
• Get peroxidised lipids in neurons (lipofuscin)- but it is benign
• Most changes that do occur with age in the brain (permanent or temporary) relate to the cerebrovasculature
• Stroke (loss of blood flow) is the most common neurological disorder and a major cause of death
• Most subtle vascular changes may also occur- mild ischaemia, especially with atherosclerosis can cause temporary disability
Do most people get cognitive disorders or experience mild cognitive decline?
• Majority of people do not see cognitive disorders in their lifetime
o Most people will have some Alzheimer-type pathology but not sufficient to affect function
• Mild cognitive decline is common in late age
What are the problems with defining late age and what is the impact of this?
- Late age refers to more advanced years
- Definition of late age has changed in the last 50 years
- Need to be cautious when considering cross-sectional vs longitudinal design of population ageing studies
What is dementia?
• Dementia- a significant decline in at least 2 areas of higher cognition such as memory, language, planning, judgement, abstraction, calculation and personality- category term. A collection of clinical symptoms, not a disease.
What defines a syndrome within dementia?
• A constellation of symptoms define the syndrome
What are examples of specific dementia symptoms
• Specific dementia symptoms include- o Prefrontal areas affect judgement, impulsivity, emotional expression o Memory areas in MTL o Language areas o Modality specific areas o Higher association areas e.g. parietal o Behaviour: amygdala, hypothalamus, prefrontal areas o Striatum: habits, personality
Describe how dementia was referred to starting from 2013
• 2013- DSMV abandoned the term dementia in lieu of:
o Mild cognitive impairment (MCI)
Some cases of mild cognitive impairment may be prodromal dementia that is, person will go on to develop dementia
Major area of research clinically
o Severe cognitive impairment (dementia)
What are the trends of incidence vs prevalence of dementia and why?
• As a consequence of greater numbers of people living to later ages, the prevalence of dementia is increasing: however, the incidence is actually decreasing in many parts of the world
How many cases of dementia would occur in the next 30-35 years?
Estimated 1000000 cases in Australia in the next 30-35 years
What are different types of dementia?
• Types of dementia include: o Alzheimer’s disease o Vascular dementia o Frontotemporal dementias o Lewy body disease o HIV/AIDS related dementia o Korsakoff’s dementia
What percentage of all dementia cases does Alzheimer’s disease account for?
Alzheimer’s disease accounts for 50-70% of all dementia cases
What types of dementias are treatable?
• Some dementias may be treatable o Intracranial masses o Encephalitis o Meningitis o Vitamin deficiency o Depression-related dementia
Describe when Alzheimer’s disease is diagnosed
- Probable diagnosis during life based on cognitive features and progression
- Definitive diagnosis is post mortem, however the clinical assessment is now highly accurate
Describe the onset and progression of Alzheimer’s disease
- Insidious onset
* Slow (rather than abrupt or stepwise) progression
Describe the duration of Alzheimer’s disease
• Duration is 5-12 years, but likely long prodromal (disease has been there before the symptoms) period
o Mostly diagnosed retrospectively
Describe Alzheimer’s disease symptoms
• Memory signs appear early
o Repetition
o Getting lost
o Inability to do calculations and following conservations
o Trouble orienting to space and time
o Losing things
o Hiding things
• Early on, daily activities of living are intact but may need instruction, breaking down tasks
• Other cognitive signs appear later
o Behavioural changes (agitation, paranoia)
o Aphasias
o Apraxias
o Activities of daily living (dressing, eating, bathing)
o Agitation
What is exclusion criteria for Alzheimer’s disease diagnosis
• Exclusion criteria for alzheimer’s disease diagnosis
o Movement disorders
o Abrupt onset
o Delirium, seizures, focal signs