Alzhimer 6/6

Major and Mild Neurocognitive Disorders

• Mild neurocognitive disorder
– Early stages of cognitive decline
– Begins to interfere with ADLs
• Major neurocognitive disorder (also known as dementia)
– Broad deterioration of brain functioning
– Significant impairment in daily functiong

Mild vs Major = level of impairment in daily functioning
– Significant impairment in daily function

DSM 5 CRITERIA for neurocognitive disorders

Cognitive Decline in:

• Attention

• Executive function

• Memory & learning

• Language:

  • Aphasia → language difficulty

  • Anomia → issues with naming things

• Perceptual-motor:

  • Apraxia → trouble sequencing movements

• Recognition:

  • Agnosia → can’t recognize objects/faces

• Social cognition

Causes for neurocognitive disorder

• Alzheimer’s (60–80%)

• Vascular disease

• Parkinson’s

• Lewy body disease

• Brain injury

• Substance use

• Huntington’s, HIV, etc.

Neurocognitive Disorder due to Alzheimer’s
DSM-5-TR Criteria

• Criteria is met for Major Neurocognitive Disorder

• Follows Alzheimer’s pattern:
– Decline in memory/learning AND at least one other cognitive
domain (e.g., language, perceptual-motor, social cognition)
– Symptoms develop “insidiously” (gradually and steadily)

• Evidence of genetic mutation or family history

• No evidence of mixed etiology (eg., TBI, substance use,
vascular disease, etc)
– Otherwise, labelled as due to “possible” Alzheimer’s
21

Neurocognitive Testing

MMSE (Mini Mental State Exam)

• Tests memory & language

• Example questions:

  • Date?

  • Location?

  • Name?

MoCA (Montreal Cognitive Assessment)

• Detects early impairment

• Tests:

  • Memory

  • Attention

  • Executive function

  • Language

  • Orientation

Clock Drawing Test

• Predicts decline

• Alzheimer’s signs:

  • Missing numbers

  • Misplaced numbers

Biological reasons for alzhimers

Brain Changes

• Neurofibrillary tangles: damage indicated by tangled,
  strand-like filaments in brain neurons

• Amyloid plaques: gummy protein deposits
  → disrupt neurons → cell death

Genetics

• Chromosomes 21 & 14

• High-risk genes:

  • APP

  • PSEN1

  • PSEN

Psychosocial causes

• Low education/cognitive stimulation
• Chronic stress - increased cortisol, neural damage
• Social isolation/loneliness - less stimulation, increased
stress
• Physical inactivity - reduced blood flow , reduced O2 and
nutrients to the brain
• Poor sleep - impaired amyloid clearance

Biological treatment

• Medication to remove amyloid plaques was
approved in Canada last year (Lecanemab)
– First disease modifying medication for Alzheimer’s

• Medications to improve cognitive symptoms:
– e.g., Cholinesterase inhibitors increase acetylcholine (a
memory-related neurotransmitter)

• Vitamin E, exercise, nutrient-rich food, socializing
delay progression