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25 Cards in this Set
- Front
- Back
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Define dementia
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decline in mental fxns due to pathology
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Dementia characteristics
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amensia- memory loss (forming & retreiving)
aphasia- cognitive language disturbance (mute) apraxia- congnitive control of motor fxn defect agnosi- cannot identify objects executive fxn- disturbance in planning, organizing |
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The most common dementia is ___________
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Alzheimer's
(10% of ppl over 65 have, 50% of ppl of 90) *genetic form affects younger individuals |
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What are the 3 progressive stages of Alzheimers?
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1. Impaired short term memory (early)
(pt repeats self) 2. Loss learning & understanding (intermediate) (difficulty completing sentence) 3. Impaired mobility, alertness, & arousal (adance) (incontinent & mute) |
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Early stage of Alzheimers begins w/ damage to what brain areas?
Followed by progressive loss of ______ & _______ in intermediate & advanced stage Alzheimers |
early- entorhinal cortex & hippocampus
intermediate/advanced- progressive limbic & frontal lobes *Degeneration of Cholinergic neurons in nucleus basalis Meyner* |
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Common Alzheimer's symptoms (progressive)
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-trouble remembering * 1st (pt repeats things)
-trouble concentrating -trouble completing sentences -mood disturbances -delusions/hallucinations -lack control of movement -loss of abstract thinking/organization/planning -inability to care for self |
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Alzheimer's diagnosis requires persistent decline in 3 of the following cognitive functions-
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language
memory visuaspatial skills Cognition emotion Personality |
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What is the only way to actually confirm Alzheimers?
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brain biopsy-
amyloid plaques & neurofibrillary tangles present* (neuronal loss (esp from nuc of Meynert) & brain atrophy also usually present) |
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Describe the amyloid hypothesis for Alzheimers
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-Amyloid proteins (APP) can be cleaved by alpha-gamma or beta-gamma secretase
-If cleaved by beta-gamma, pathogenic (40 or 42, 42 is worse) Abeta fragments are produced -High amounts of beta-gamma secretase lead to Abeta fragment aggregation -Aggregate deposits outside neuron & forms amyloid (senile) plaques -Amyloid plaque stimulates inflammation & oxydative damage leading to neuron death |
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Describe Neurofibrillary tangle mechanism for Alzheimers
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-tau protein is abnormally phosphorylated
-hyperphosphorylated tau form aggregates= neurofibrillary tangles, inside neuron -hyperphosphorylation interferes w/ microtubule formation -microtubule depolymerization interferes w/ axoplasmic transport -axons & dendrites degenerate, neuron dies |
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(Plaques/tangles) form outside neurons, (plaques/tangles) form w/i.
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plaques- outside
tangles- inside |
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Genetic causes of familial early onset Alzheimers
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autosomal-mutation of-
-Presenilin 1 or 2 or amyloid precursor protein genes --> interferes w/ Amyloid protein, increases Abeta42 |
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Genetic varients of __________ are associated w/ late onset Alzheimer development
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ApoE varients
ApoE4 increases likelihood ApoE2 decreases likelihood |
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Other risk factors for alzheimers
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head trauma (w or w/o lost consciousness)
high cholesterol Down syndrome Mild cognitive impairment (MCI) Diabetes |
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What are the 2 types of treatment for Alzheimers (AD)?
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1. cholinesterase inhibitors- slows Ach breakdown (cholinergic neurons destroyed)
2. NMDA receptor antagonist- mech not known, works for severe AD *neither get rid of, just help manage, slow AD |
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What is another type of irreversible dementia that is associated with irradic behavior (lack of inhibition)?
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Frontotemporal
(includes Picks disease) |
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How is Frontotemporal dementia (FTD) diff from AD?
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-earlier onset (incidence DOESNT change w/ age)
-begins w/ gradual changes in behavior or progressive language dysfunction (NOT memory) -stronger genetic contribution (autosomal dominant) |
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What areas of the brain are affected by FTD?
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frontal lobe- social judgement (inappropriate sexual)
anterior temporal lobe- language & facial recognition dominant left hemisphere- language, anomia |
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What are the neurological causes of FTD brain damage?
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-mutated Tau gene on chromosome 17
-Tau (+) inclusions--> neuronal cell death |
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What are some other irreversible causes of Dementia?
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Huntingtons
Creusfeldt-Jakob (prion formation--> neuron death) Parkinnsons MS Wilsons Disease |
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What are some preventable/treatable causes of dementia?
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*brain damage*
-vascular -toxic/infection -hormonal -nutritional |
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What is the #2 cause of dementia?
(preventable) |
Vascular dementia
(from vascular disease, stroke, TIA) |
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What factors may lead to vascular dementia?
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high BP
cerebrovascular disease Diabetes * dementia can be managed by disease control (more common in men over 65) |
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How does Vascular dementia differ from AD?
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-movement disorders & incontinence appear early
-symptoms occur in stepwise fashion: confusion--> shuffling movement/tremors--> incontenence--> inappropriate laugh/cry--> difficulty following instruction |
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How can Alzheimers, Frontotemporal Dementia, & Vascular dementia be differentiated on MRI?
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Alzheimers- some medial temporal degeneration
Frontotemporal- obvious frtontal lobe degeneration Vascular- presence of lacunar strokes= visible white matter |
