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56 Cards in this Set
- Front
- Back
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What plays the most significant role in causing dementia-related disorders? |
Non-neuro degenerative, modifiable risk factors |
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Is amyloid-beta diagnostic of Alzheimer’s? |
No! It may not even be present in the disease Required to diagnose AD, however *A number of other pathologies mimic Alzheimer’s by presenting with amyloid-beta |
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Does normal aging lead to significant memory loss? |
No Only experience significant memory loss if another pathology is present I.e. neuro degeneration or amyloid aggregation |
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Key pieces of history that indicate Lewy body disease |
1. Loss of smell 2. Constipation 3. Parasomnias Also: -Parkinsonism -Mental blocks -Inattention *Visual hallucinations -REM sleep disorder |
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Do dementias affect level of consciousness? |
No |
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What psychiatric illness is most likely to mimic dementia? |
Depression |
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What drugs are most likely to cause treatable dementia? What is the clinical significance of this? |
Anticholinergics: Ex’s. Amitryptaline (TCAs) Trihexyphenidyl Benadryl
*NEVER use these is a patient who is 65+ *NEVER diagnose Alzheimer’s in a patient taking these medications (may be mimics) |
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Multi-infarct Dementia is gradually progressive and requires multiple CNS hits: -Multiple micro-strokes |
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Most common cause of infection-related dementia in older people |
Neurosyphilis |
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How fast do Alzheimer’s disease and Creutzfeldt-Jakob progress? |
Alzheimer’s: years (2-10) CJD: months (much faster) |
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Dementia + startle myoclonus |
CJD |
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What transplant may cause CJD? |
Corneal transplant |
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Periodic triphasic sharp wave complexes |
CJD |
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Is REM increased or decreased in depression? |
INCREASED *Also increased in PTSD **Increases the retention of emotional memory (negative emotions, in these cases) |
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Distinguish the following: episodic, semantic, and procedural memory |
Episodic- real experiences Semantic- concepts, facts, and definitions Procedural- Concrete, executable programs; can be combined into larger programs by “chunking” |
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Is memory loss required to diagnose dementia? |
NO |
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Know what, know when, and know how |
Know what: Impaired in Alzheimer’s disease *Default network Episodic memory and semantic knowledge Know when: Impaired in frontotemporal dementia *Salience network Do the right thing at the right time -Impulse control issues -Apathy/loss of empathy -Socially-inappropriate behavior Know how: Impaired in Lewy body disease *Executive network Working memory impaired Goal-directed behavior impaired Motor and visual-spatial impaired |
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Compare the progress of Neurodegeneration in Alzheimer’s and frontotemporal dementia |
Alzheimer’s: *Begins in temporal lobe and angular gyrus -Connected to a “default network” *Spreads throughout this network in the dementia stage FTD: *Begins in right frontal insula and the anterior cingulate cortex -Connected to “salience network” *Spreads throughout this network |
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What is the #1 determining factor of Alzheimer’s disease onset and risk? |
-Clearance rate of beta amyloid Lower clearance = early age of onset |
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Describe the following for Alzheimer’s disease: clinical course, key clinical features |
Clinical course: -Insidious onset *Slowly progressive (8-10 years; Amboss) Key clinical features: 1. Amnestic- impaired learning AND recall 2. Language- word retrieval impaired 3. Visual- object agnosia, simultanagnosia, alexia, face recognition 4. Executive- impaired reasoning, judgment, and problem solving |
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Biomarkers for Alzheimer’s disease |
CSF: *LOW a-beta amyloid -High tau PET (FDG): Hypoperfusion of bitemporal lobes and parietal lobe MRI Posterior temporal atrophy (MRI) |
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What drugs raise dementia risk? |
1. Antihistamines 2. TCAs 3. Anti-muscarinics |
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What are the untreatable dementias? |
1. Alzheimer’s disease 2. Prion disease 3. Any dementia-related neurodegenerative disease (ex. Parkinson’s and Huntington’s) |
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What is the least significant cause of dementia? |
Cerebral infarction |
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Biomarkers required to be in the Alzheimer's continuum |
A-beta amyloid |
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Decreased glucose uptake in occipital lobe on FDG-PET |
Lewy body disease (executive network) |
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Cingulate island sign |
Dementia with Lewy bodies spares the posterior cingulate cortex (shown on FDG-PET) *Distinguishes DLB from AD! |
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What type of dementia has no amyloid beta present onPIB-PET? |
Frontotemporal dementia (salience network) |
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“I went to the front door and range the bell” vs. “I went tothe place and did the thing” |
Phonemic paraphasia *Alzheimer’s disease |
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“John hit Mary” vs. “Mary hit John” |
Semantic paraphasia *Frontotemporal dementia (salience network) |
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Sleep apnea |
Alzheimer’s disease (default mode network) |
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REM sleep disorder |
Parkinson’s (Dementia with Lewy bodies) *Executive network |
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Biomarkers required for Alzheimer’s |
Amyloid and phosphorylated tau *Don’t need to see Neurodegeneration (t-tau) |
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Three networks and their associations |
Frontal executive Default (Alzheimer’s disease) Salience (fronto-temporal degeneration) |
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Clinical staging of dementia: |
Cognitively unimpaired Subjective cognitive impairment Mild cognitive impairment Dementia (mild, moderate, or severe) |
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All dementias are considered as a continuum |
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Alzheimer’s disease is a syndrome, NOT an etiology *It is a clinical consequence of one or more diseases |
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What neurodegenerative and non-neurodegenerative pathologiesaffect the different brain networks? |
Default Neurodegenerative: -Alzheimer’s
Non-ND: Epilepsy HSV
Salience ND: -Behavioral variant FTD -PSP -CBS
Non-ND: -TBI -Frontal stroke or tumors
Executive ND: alpha-synuclein-opathies -Lewy body dementia -Multiple system atrophy -Parkinson’s disease
Non-ND: -External factors (alcohol, sleep disturbance, anticholinergic drugs, diabetes) |
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Is it possible for neurodegenerative pathologies to coexist? |
YES *Most autopsied brains show mixed pathologies |
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What disease pathologies cause the fastest and slowestchange in Neurodegeneration? |
Most- Alzheimer’s disease Least- vascular pathology |
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Does age cause neurodegeneration? |
NO *Only the pathologies associated with aging cause neurodegeneration |
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Key principal: amyloid burden -> increasedneurodegeneration *Aging alone does not lead to cognitive impairment |
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What biomarkers are indicative of the Alzheimer’s continuum? |
Amyloid *Anything without amyloid (even tau and neurodegeneration) is a non-Alzheimer’s pathology |
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What categories are assessed to determine dementia severity? |
CHOMP J Community affairs Home and Hobbies Orientation Memory Personal care Judgment and problem solving |
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What are the five fingers of dementia diagnosis? |
1. History 2. Motor/Neuro exam 3. Cognition 4. Mood and behavior 5. Objective tests |
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Vertical and horizontal gaze disorder pathologies |
Vertical- progressive supranuclear palsy Horizontal- corticobasal syndrome *Both effect the salience network |
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What pathologies affect episodic and working memory? |
Episodic- Alzheimer’s disease Working- Lewy body diseases and non-neurodegenerative dementias Ex. blocks in the middle of thoughts -Inconsistent task execution -Forgetting the purpose of a task while performing it |
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What dementias are sleep apnea and REM sleep disorderassociated with? |
Alzheimer’s disease- sleep apnea *Reduced ability to clear amyloid through the glymphatic system Parkinsonian disorders- REM sleep disorder |
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Memory deficit progression of Alzheimer’s |
First- repetition *Unable to form new memories (will often repeat themselves) Second- reminiscence *Start to forget most recent memories (will often reminisce about memories from long ago) Third- reference -Lose connections and associations? (ex. may see their children and their siblings) |
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Describe the language deficits for the different types ofdementias |
Default mode network: logopenia -Semantics -Sounds (phonemes) -Nouns -Phonemic paraphasias (words become jumbled; substitute words that don’t make sense) -Nonspecific referents, circumlocutions Salience network: semantic -Semantics -Loss of word knowledge -Nouns -Semantic paraphasias (lost the meaning of words) -Social use of language--discourse Executive- nonfluent -Affects grammar and articulation *Difficulty linking words into a sentence -Can produce only short words and very short phrases *Basically: Broca’s aphasia |
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Mild dementia- difficulty with instrumental ADLs Moderate dementia- difficulty with personal ADLs |
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What senses are usually lost first in dementia? |
Smell/taste *Auditory, visual, and somatosensory are lost later |
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Describe the mood and behavior abnormalities with differenttypes of dementia |
Alzheimer’s (default network) -Irritable; anxious; depressed -Apathy (present in ALL dementias) -Restless pacing Frontotemporal dementia (salience network) -Euphoria -SEVERE Apathy -Rituals, obsessions, compulsions -Impulsive Dementia with Lewy bodies (executive network) -High anxiety -Depression -Apathy (present in ALL dementias) -Delusions -Visual hallucinations |
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Can hippocampal volume used to predict Alzheimer’s? |
NO *LEAST SPECIFIC MARKER for AD (lots of overlap with other pathologies) |
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What is the most specific diagnostic procedure for Alzheimer’s? |
Lumbar puncture 1. Decreased amyloid-beta 2. Increased phosphorylated tau (p-tau) 3. Increased total tau (t-tau; indicative of neuronal injury) |
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Greatest genetic risk factors for early onset and late onset Alzheimer’s disease |
Late onset- Apolipoprotein E4 (chromosome 19) Early onset: APP gene (chromosome 21) Presenilin 1 (chromosome 14) Presenilin 2 (chromosome 1) *All of these are autosomal dominant (not sure about Apo-E4) |
