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24 Cards in this Set
- Front
- Back
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T/F:
Healthy young-old and old-old persons showed significant difference on the mini-mental exam. |
False: healthy individuals in these groups scored similarly on the exam.
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Name two variables that may confound an older person's score on a mini mental status exam.
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1.Testing under timed conditions does result in lower scores
2.Cognitive skills may flucuate by time of day or other variables 3.Deafness (presbyacusis) may interfere with ability to answer questions |
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Do cognitive skills all decline at a uniform rate, or are some skills preserved longer than others?
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Different skills decline at different rates - e.g. language skills are often preserved the longest.
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What is a general definition for dementia?
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Multiple cognitive deficits that significantly disrupt function.
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What are three aspects of memory loss?
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1.Aphasia
2.Apraxia 3.Executive function 4.Agnosia |
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Does incidence of AD vary by gender?
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Yes, women are more vulnerable than men.
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Which appears more frequently - sporadic or familial AD? How is age of onset related to each type?
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Sporadic AD accounts for 80-90% of all cases and has a later age of onset. Familial accounts for 10-20% and has an earlier age of onset.
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What is a significant difference in normal age-related atrophy of the brain and atrophy caused by AD?
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Normal atrophy is global and uniform, whereas atrophy caused by AD tends to be regional - often with sparing of the pre- and postcentral gyri.
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Besides AD and age-related changes, what conditions should be on the differential of dementia in an older patient?
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*drug-induced dementia
*depression *hypothyroidism *vitamin B-12 deficiency |
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AD is often diagnosed on autopsy or with a brain biopsy, but what non-invasive technique might be used to detect it?
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MRI or PET can sometimes be used to detect the presence of characteristic plaques and atrophy.
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What is the microscopic criteria for diagnosis of AD? Where in the brain are these histological changes seen?
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Amyloid plaques and neurofibrillary tangles seen in the cerebral cortex and limbic system.
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What is a mild cognitive impairment? How is it prognostic for AD?
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Profound loss in recent memory with preservation of other cognitive skills and daily functioning; presence confers a 10-fold increase in likelihood of AD.
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What is the first area of the brain afffected in AD and what symptoms are seen as a result?
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The amygdala and hippocampus are affected first and this is manifested as a decline in short-term memory.
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What is the medial survival time for patients with AD?
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8.5 years
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A vegetative state and loss of general function indicates which area of the brain has been affected in AD?
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Primary motor and somatosensory cortices.
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The early appearance of what symptom is a particularly bad prognostic sign for AD?
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Loss of motor skills early in the disease progression.
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T/F:
Amyloid plaques exert a cytotoxic effect on neurons by choking off the blood supply. |
False: they plaques are not neurotoxic on their own but they do induce inflammmation that is damaging to neurons.
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How are amyloid plaques formed?
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Abnormal cleavage of the amyloid precursor protein (APP) results in the formation of the insoluble A-B fragment which subsequently forms aggregates.
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What role have A-B fragments been proposed to play in the brains of normal individuals?
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It is present in small amounts and thought to play a role in the inhibition of excitatory signals to NMDA receptors.
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What genetic information has been used to explain (in part) the relationship between Down's syndrome and a higher incidence and earlier onset of AD?
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APP genes are located on chromosome 21, thus are overexpressed in Down's syndrome (trisomy 21). Overexpression of APP in mice has lead to increased plaque formation.
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What genetic mutations have been implicated in nearly half of the cases of familial AD?
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Mutations in presenilin 1 and 2 on chromosome 1.
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Describe how isoforms of Apolipoprotein E are associated with AD.
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*E2 and E3 isoforms seem to be protective against AD
*E4 heterozygotes have a 3-4-fold increased risk for AD *E4 homozygotes have a 7-fold increased risk for AD |
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Besides anticholinesterases and NMDA antagonists, what are two classes of drugs that have shown promise in the treatment of AD?
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*COX-2 inhibitors (reduce inflammatory damage caused by plaques)
*statin drugs |
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What is the main structural feature of neurofibrillary tangles?
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Protein tau in abnormal paired helical arrangements.
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