PSYC361: Delirium, alzheimers, and other dementias

What is delirium?

• acute condition including disturbances of consciousness, changes in cognition, and sever confusion which develop over time

• can often be stopped or cured

• caused by stroke, CVD, dehydration, etc.

What is dementia?

• cluster of conditions: cognitive and behavior deficits involving permanent brain damage

• progressive, getting worse with time

• degenerative, associated with loss of brain tissue

Frontotemporal dementia

• damage to nerve cells in frontal and temporal lobe

• both familial and sporadic variants

• earlier onset and shorter survival than AD

• changes in personality and emotion

Lewey body dementia

• Lewy bodies are clumps of the protein alpha-synuclein in cortex

• Common symptoms with AD

• Sleep disturbance, hallucinations, muscle rigidity, changes in mood/behavior

• motor degenerative disorder

Cerebrovascular dementia

• Causes: small cerebral vessel diseases and white matter dysfunction

• Risk factors

  • CVD, high blood pressure

  • Arteriosclerosis and atherosclerosis

• cleaning process is impaired so plaques cant be cleared

Creutzfeldt-Jakob dementia

• vary rare

• brain disorder

How do vital functions change with age?

• accumulation of fat deposits

• stiffening of heart muscles and valves and arteries

• blood flow and tissue perfusion in the brain decreases with aging

• white matter hyperintensities

Two types of early classification of dementia?

• Alzheimer’s disease/pre-senile dementia

  • rare

  • early onset

  • hereditary

  • amyloid plaques and neurofibrillary tangles

• Senile dementia

  • common

  • late onset

  • age related wear and tear

  • closely linked to arteriosclerosis

Early-onset vs late-onset AD

• Early onset:

  • rare

  • associated with autosomal dominant genetic mutations

  • presenulin protein forms plaques

• Late onset:

  • common

  • associated with a number of genetic and other contributing risk factors, including lifestyle choices

Neural changes to brain from AD (4)?

• beta-amyloid deposition: not cleared away efficiently which is toxic to neurons/synapses

• neurofibrillary tangles: tau protein is modified

• cell death: hippocampus, cortex, and forebrain

• Decreases in certain neurochemicals: ACh

What are genetic influences that INCREASE your risk of AD (4)?

• APOE4: protein that packs cholesterol and other lipids and carrying them through the bloodstream

• Cholesterol cycle

• imbalance between production and clearance of amyloid beta

• Brain inflammation

What is the link between AD and diabetes?

• certain diets over-exert the insulin system

• starved cells —> leads to diabetes

• impairs immune response, small vessel disease, nerve damage

How does AD affect immune system and inflammation?

• chronic stress can lead to persistent blood pressure increase

• Damage to inner part of artery walls

• local inflammation

• shortening of telomeres

• Damage to BBBs

Link between cerebrovascular function and health

• white matter hyperintensities and brain microbleeds which may lead to vascular disease

AD warning signs and symptoms

• memory loss that affects highly practiced skills

• changes in personality

• disorientation of time and place

• Sundowning: symptoms of AD are generally worse in the PM than the AM

What are intervention/prevention strategies for AD?

• anti-inflammatory drugs

• drugs attacking plaques

• vaccine for shingles

• drugs reducing cholesterol

What does assessment for AD look like?

• interview with patient and family members

• MMSE

• Health assessment and lab tests

• MRI

• Neurological assessment