NP: Lecture 9 Dementia I

Question 1

2 ways to look at normal cognitive aging

Answer 1

biological perspective & multidimensional perspective

Question 2

crystallized intelligence

Answer 2

skills, abilities and knowledge that are overlearned, well practiced and familiar.
vocab and grammar
remains stable or improves with age

Question 3

fluid intelligence

Answer 3

abilities involving problem-solving and reasoning.
processing speed and executive functioning
declines with normal aging

Question 4

dus welke vorm van iq declines with age

Answer 4

fluid intelligence (problem solving)

Question 5

welke vorm van iq remains stable of wordt beter over time

Answer 5

crystallized intelligence

Question 6

kijken naar model crystallized iq en fluid

Answer 6

oke

Question 7

wannner is fluid op het beste

Answer 7

rond 20 jaar

Question 8

processing speed: crystallized or fluid, and decline?

Answer 8

fluid, yes

Question 9

attention: crystallized or fluid, and decline?

Answer 9

fluid, simple tasks do not decline, complex tasks do decline

Question 10

memory: crystallized or fluid, and decline?

Answer 10

fluid, mixed

Question 11

language: crystallized or fluid, and decline?

Answer 11

meer crystallized dan fluid

in general no, visual confrontation naming, cerbal fluency does decline

Question 12

visuospatial: crystallized or fluid, and decline?

Answer 12

mixed crystallized and fluid
simple tasks: no, complex tasks: yes

Question 13

executive function: crystallized or fluid, and decline?

Answer 13

fluid, mixed

Question 14

wat aspects of memory decline with age

Answer 14

delayed free recall (spontanous retrieval of info without a cue)
source memory (knowing the source of information)
prospective memory (remembering to perform actions in the future)

Question 15

what aspects of memory remain stable with age

Answer 15

recognition memory (dus ability to retrieve info with a cue)
temporal order memory: memory for the correct time or sequence of past events
procedural memory: memory of how to do things

Question 16

normal cognitive aging: structural changes

Answer 16

cortical thinning and gray matter shrinks
decreased white matter density (vooral frontal & occipital)
loss of dopaminergic receptors

Question 17

waar leidt loss of dopaminergic receptors toe

Answer 17

attentional dysregulation
executive dysfunction
difficulty with contextual processing

Question 18

scaffoling theory of cognitive aging model bekijken + wat is scaffolding?

Answer 18

“Scaffolding,” which is essentially a form of neuroplasticity, enables people to compensate for age-related cognitive decline through the recruitment of alternative brain regions or the generation of new brain cells.

Question 19

protective factors for healthy aging

Answer 19

Active and healthy lifestyle
Cognitive and social stimulation
Limit cardiovascular risk

Question 20

dementia =

Answer 20

Condition characterized with loss of cognitive functioning and
behavioral abilities which interferes with a person’s daily life
and activities

Question 21

hoe heet dementia in dsm 5

Answer 21

major neurocognitive disorder

Question 22

major neurocognitive disorder dsm 5

Answer 22

significant cognitive decline from previous level, in one or more cognitive domains.

1. concern of person or surrounding, 2. decline needs to be documented and quantified.

interfere with independence
do not occur exclusively in context of a delirium

Question 23

age > 65 years dementia prevalences

Answer 23

ad 54%
vad 16%
dlb 5%
ftd 2%
other 23%

Question 24

age < 65 years

Answer 24

ad 34%
vad 18%
ftd 12%
alcohol related 10%
dlb 7%
hd 5%
other 14%

Question 25

general risk factors dementia

Answer 25

age female gender low education lazy lifestyle cardiovascular risk factors brain injury

Question 26

alzheimers disease

Answer 26

neurodegenerative, progressive brain disorder most common type most distinctive symptom; memory impairment 1/9 individuals > 65 year incidence increases with advancing age

Question 27

prevalence alzheimers in europe

Answer 27

5%

Question 28

gender alzheimers

Answer 28

women more than men

Question 29

one new case of dementia every ...

Answer 29

3 seconds

Question 30

wat wordt geconsidered als early-onset ad

Answer 30

<65 jaar

Question 31

inherited forms of ad =

Answer 31

rare, caused by mutation. usually onset before 50 years

Question 32

welke genen kunnen tot inherited ad leiden

Answer 32

mutations in APP, PS-1 and PS-2

Question 33

ad onset bij downs syndrome

Answer 33

onset 10-20 years earlier than in the general population

Question 34

3 changes of ad in the brain

Answer 34

shrinkage of cortex enlarged ventricles shrinkage of hippocampus

Question 35

amyloid plaques =

Answer 35

insoluble threads of misfolded amyloid protein in the spaces between nerve cells

Question 36

neurofibrillary tangles =

Answer 36

twisted strands of mutated tau proteins inside nerve cells

Question 37

hoe ga je van app naar amyloid

Answer 37

abnormal APP cleavage - AB depositon - senile plaques - neurodegeneration - ad

Question 38

criticsm of amyloid cascade hypothesis

Answer 38

- lack of evidence - not clear if plaques and tangles are a cause or consequence of AD - no effective treatment with this

Question 39

vascular hypothesis evidence

Answer 39

- typical ad pathology is observed with cerebrovascular damage - inadequate blood flow to brain (= brain hypoperfusion) is likely involved in the pathogenesis

Question 40

wat is de vascular hypothesis

Answer 40

advanged ageing and vascular risk factors - brain hypoperfusion - neuroglial energy crisis - mild cognitive impairment - neurodegeneration - ad

Question 41

criticism vascular hypothesis

Answer 41

- unclear wether the vascular component of ad is cause or effect - unclear if typical ad pathology and vascular pathology are unrelated or related

Question 42

3 stages of diagnostic criteria of AD

Answer 42

syndrome diagnosis specific diagnosis definite diagnosis

Question 43

syndrome diagnosis=

Answer 43

dementia present or not

Question 44

specific diagnosis =

Answer 44

probable ad or not

Question 45

definite diagnosis

Answer 45

neuropathological characteristics of ad -> post mortem

Question 46

specific diagnosis stages

Answer 46

- probable ad dementia - probable ad dementia with increased level of certainty - possible ad dementia - probable or possible ad dementia with evidence of ad pathophysiological process

Question 47

probable ad

Answer 47

neurocognitive presentation, gradual onset and worsening of cognitive deficits and functioning

Question 48

probable ad dementia with increased level of certainty

Answer 48

- documented progressive cognitive decline - genetic mutation (APP, PS-1, PS-2)

Question 49

possible ad dementia

Answer 49

atypical course mixed presention

Question 50

probable or possible AD dementia with evidence of AD pathophysiological process

Answer 50

Evidence from biomarkers

Question 51

biomarkers=

Answer 51

A (medical) sign that can be used as an objective indication of medical state observed from outside the patient, which can be measured accurately and reproducibly. medical signs =/= medical symptoms

Question 52

definite diagnosis =

Answer 52

A definite diagnosis can only be made post-mortem when neuropathological characteristics of AD have been demonstrated during an autopsy.

Question 53

agreement between clinical and autopsy diagnosis =

Answer 53

80%

Question 54

hoe diagnosticeren ze nu ad

Answer 54

Currently, the clinical diagnosis (specific diagnosis) is based on the (medical) history of patient, clinical examination, neuroimaging (CT, MRI or PET) and neuropsychological testing.

Question 55

neuropsychiatric symptoms of AD

Answer 55

- Depression - Anxiety - Apathy, social disengagement and/or irritability - Psychosis (including hallucination and/or delusions) - Agitation, aggression and/or wandering - Motor unrest - Sleeping problems - Eating problems

Question 56

other symptoms of AD

Answer 56

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

Question 57

wat is de prognosis bij older age of onset

Answer 57

older age of onset is slower late of decline. dus latere onset is beter! jongere onset is slechter.

Question 58

what about prognosis and neuropsychiatric symptoms

Answer 58

neuropsychiatric symptoms = faster rate of decline

Question 59

high level of education prognosis

Answer 59

later onset, but faster rate of decline

Question 60

life expectancy after AD diagnosis =

Answer 60

8-10 jaar

Question 61

medication to inhibit cognitive symptoms bij AD

Answer 61

- Cholinesterase inhibitors (for patients with mild to moderate AD) - N-Methyl D-aspartate (NMDA) antagonist (for patients with moderate to severe AD)

Question 62

psycho treatment bij ad

Answer 62

psychoeducation cognitive training manage behavioural symptoms

Question 63

criteria for mci

Answer 63

cognitive concern objective evidence nog steeds independence not demented

Question 64

prevalence of MCI > 60 years

Answer 64

rond de 20%

Question 65

protective factors for mci

Answer 65

zelfde als ad: active and healthy lifestyle ,cognitive and social stimulation, limit cardiovascular risk

Question 66

subtypes of mci

Answer 66

memory loss -> amnestic MCI -> single domain or multiple domain absence of memory impairment -> non amnestic MCI -> single domain or multiple domain

Question 67

mci progression

Answer 67

20% reversion to normal cognition 30-55% remains stable 20-40% progression to dementia (first year: 10-15% per year)

Question 68

reversion to normal cognition bij wie?

Answer 68

Younger age, male sex, single domain MCI, absence of medical conditions, lower level of education

Question 69

progression to dementia bij wie

Answer 69

Severity of underlying pathology and cerebral dysfunction (e.g., degree of functional impairment at time of diagnosis) + neuroimaging abnormalities (e.g., hippocampal atrophy)