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20 Cards in this Set
- Front
- Back
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Alzheimers disease |
Most common dementing illness approx 50% of all dementias are AD 2% of 65-70yo 20% of 80+ * problem of aging population (baby boomers) - need support |
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Diagnoses of AD |
Definite diagnosis can only be made on pathology (dead) in Life - can only diagnose Dementia of the Alzheimer Type (DAT) |
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Pathology |
Examination of tissues (diseased body parts) or bodily fluids Biopsy vs Autopsy (dead) |
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Aetiology of AD (causation) |
- no genetic link - rare early onset - Down syndrome - prone to developing AD earlier (40s) - no other factors known -Can have sudden decompensation * Pathology will not suddenly start developing, but head injury may reveal existing AD |
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Clinical features of DAT |
Onset: 1-2 years before diagnosis
Course: slow deterioration, can plateau Death= average 8.5 years after onset
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3 main phases of DAT |
Phase 1: 2-3 years - failing memory (amnestic) - muddled inefficiency in ADLs (Activity of daily livings) -Spatial disorientation (get lost) -Mood - agitation, apathetic (don't care) Phase 2: Rapid deterioration - intellect, personality deteriorate - Focal symptoms appear: -- can't sequence motor movements --cannot recognise visual objects --forget words --can't solve math problems - muscles constantly tense, posture, gait (walk) - delusions/hallucinations can occur Phase 3 (terminal stage) - lack of emotion (apathy) - bed riden -lose brain function -bodily wasting occurs * typically die from pneumonia |
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McKhann et al Criteria |
Criteria for diagnoses of AD - Probable - Possible - Definite |
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Probable AD |
Progressive worsening of memory and or other cognitive functions - Deficits in 2+ areas of cognition (usually Amnestic) |
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Possible AD |
made on basis of dementia syndrome if onset/presentation/clinical course is not typical - can be made in presence of another disorder |
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Definite AD |
- Histopathological evidence of AD from biopsy/autopsy |
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Pathology of definite AD |
- atrophied brain (shrink, loss of neurons in frontal/TL) -increase of glial(support cells) *extensive amounts of senile plaques, neurofibrillary tangles in Hippocampi/amygdala |
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Amnestic presentation - changes in brain (AD) |
- starts in hippocampus/MTL -spreads posteriorly/outwards to parietal cortex -spreads to involve frontal cortex (eventually whole neocortex/outer brain) |
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Clinical pattern of DAT - memory impairment |
1. MTL memory impairment - Retrograde okay, Anterograde impaired. 2. Posterior TL = Wernicke-type aphasia - difficulties finding words, fluency of speech 3. Frontal lobes = Apathy *For diagnoses of AD, ADL must be affected (activities of daily life) |
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General course of change? |
middle, up, forward Affecting: memory, words, apathy |
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Treatment and prevention of AD |
- pharm: rebalance of Acetylcholine, but no affect on pathology - halts deterioration (plateau) - No clear evidence for preventing AD |
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AD vs normal aging |
cognitive deterioration evident in normal aging, but not as extreme as AD |
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Case study MK |
76, woman last 2-3 years became more forgetful - repetitive in general conversation - needs memory aides? no other memory difficulties - had diabetes, hypertension, depression - on anti-depressant medication - still depressed Daughter said her mother didn't have daily memory difficulties, memory improved on antidepressant medication |
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MK assessment |
low IQ, anxious intact cognitive functioning except memory Learning unrelated word pairs was impaired. Severely impaired recall after delay - no clear evidence of progressive deterioration -no clear evidence on impact on daily life CONCLUSION: Mild cognitive impairment |
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MK review assessment |
- memory deteriorating - functional impact: forgot to give herself insulin injection - no visuospatial/langauge deficits -anxiety about her diagnoses continues - new learning deteriorated MTL damage - impaired recall unchanged * deterioration in language *subtle visuospatial deficit |
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Implications (brain) |
- memory impairment = deteriorating MTL function - language deficit = affecting posterior TL - visuospspatial changes = spread to parietal lobes Diagnoses = DAT dementia of the Alzheimer Type |
