dementia, delirium and depression

normal neuron loss w/ aging

2-4%

what is most affected by normal brain aging

prefrontal cortex (executive functioning)

what is the hallmark of aging in metabolic changes

mitochondrial impairment

neuroprotective effect on brain aging

- exercise

- continued cognitive challenge

- decreased alcohol

negative impacts on brain aging

- diabetes/insulin resistance

- dyslipidemia

- HTN

- stress

- head trauma

- sedentary

neurocognitive domains

- perceptual/motor function

- language

- learning and memory

- social cognition

- complex attention

- executive function

what is the term dementia replaced w/

major or minor neurocognitive disorder

PT role in neurocognitive disorder diagnosis

screen for cognitive impairment and refer

what else must be ruled out for neurocognitive disorders

- normal pressure hydrocephalus

- hearing loss

- delirium

- depression

normal pressure hydrocephalus

wet, wacky and wobbly

- magnetic gait

- poor balance/falls

- mood/cognition changes

mild neurocognitive disorder definition

noticeable decrease in cognitive functioning that goes beyond normal changes seen in aging

- not severe enough for dementia criteria

- most common deficit is in memory

major neurocognitive disorder definition

development of memory impairment w/ one of the following impaired: aphasia, apraxia, agnosia or disturbance of executive functioning

*presence of memory impairment is NOT required w/ new updates to DSM-5

Alzheimer's pathology

- global atrophy: due to neuronal cell death contributing to inflammation

- inflammation: excessive inflammatory response promoting cell death

- neurofibrillary tangles: (intracellular) tau protein

- amyloid plaques: (extracellular) beta-amyloid protein

Alzheimer's onset

insidious

- apparent to others during an episode of stress

- short term memory and difficulty performing demanding intellectual tasks are early noticeable signs

Alzheimer's progression

short term memory -> cognitive abilities -> IADLs -> long-term memory -> communication -> BADLs

vascular dementia traits

variability and overactive bladder

dementia w/ lewy bodys characterized by

intracellular protein deposits: Lewy bodies

- PET scan to see

dementia w/ Lewy bodies sx and traits

- REM sleep disturbances

- Parkinsonism

- fluctuating cognition

- visual hallucinations

1 year rule of Parkinson's Dementia

movement disorder at least 1 year BEFORE dementia sx = Parkinson's dementia

dementia sx BEFORE or within 1 year of movement disorders = dementia w/ Lewy Bodies

Frontotemporal dementia sx and traits

*dramatic personality changes

- aphasia

- pseudobulbar sx

Mini-Cog criteria

1. 3 word recall - 1 point each word

2. clock draw - 0 pts abnormal, 2 points normal

3. total them: <4 = further screening, 4+ = normal

mini-mental state exam positive screening

score less than 24 pts

indicator of middle stage major neurocognitive disorders

no longer realize they are confused

end-stage indicators of major neurocognitive disorders

- limited vocab

- non-ambulatory

- weight loss

- limited PO

- max assist

- bowel/bladder incontinence

what medication is high risk for those w/ dementia Lewy bodies

antipsychotics

- can create life threatening neuroleptic malignant syndrome

motor learning and dementia

- repetition: blocked/mass practice

- task specificity: familiar tasks in natural environments

- whole task

is delirium reversible?

yes in an acute confusional state

hallmark of delirium

presence of an underlying medical disorder

what should be assessed in conjunction w/ making end of life decisions

depression