Week 14: Cognitive Disorders- Dementia & Alzheimers

dementia def

decline in intellectual function severe enough to interfere with a persons relationships and ability to carry out daily activites

dementia includes

cognitive impairments as well as 1+ of other issues

what other problems may those with dementia have

abstract thinking, judgement, problem solving, reduction in frequency of communication, personality

Alzheimers dementia

most common form amongst older adults

vascular dementia "mini strokes, multi infarct"

insidious, subtly progressive worsening of memory and cognitiion

what causes vascular dementia

chronic reduced blood flow in brain as result of vascular changes

dementia with lewy bodies (DLB) commonness

third most common

lewy bodies are also present in

alzheimers disease dementia and PD dementia

overlap in symptoms of DLB and PD dementia is likely due to

how brain processing protein alpha-synuclein

causes of irreversible dementia

alzheimers disease, vascular dementia, DLB, PD, huntington's disease, HIV

reversible dementia like symptoms

depression, meds side effects, drug interactions, hypothyroidism, chronic alcoholism, vitamin b12 deficiency, benign brain tumor, brain infection

CDC def of alzheimer's disease

most common form of dementia, involves part of brain that control thought, memory, adn language and can seriously affect their ADLs

NIH def of alzheimers

irreversible progressive brain disorder that slowly destroys memory and thinking skills and eventually ability to carry out simplest tasks of daily living

how many is US have alzheimers

5 million

mortality of alzhemiers

7th leading cause

what causes death of alzheimers

secondary to dehydration and infection

nearly ___ of those over 85 may have AD

50%

where is AD found

throughout cortex

beta amyloid plaques

abnormal clusters of amyloid precursor proteins (APP)

neurofibrillary tangles

strands for tua protein inside dead and dying nerve cells

where are neurofibrillary tangles most common

temporal lobe structures like hippocampus and amygdala

what happens to cortex in AD

shrinks

the areas that are damaged through shrinking are involved in what functions

thinking, planning, and remembering (executive functions)

executive functions def

higher level cognitive abilities that enable an individual to successful engage in independent goal directed behavior

executive function cortexes

frontal and pre frontal

Organization executive functions

attention, decision making, planning, sequencing, problem solving

regulation executive function

initiation of action, self control and regulation, self monitoring of judgements and impulses

where is shrinkage severe

hippocampus

what is hippocampus important for

formation of new memories

damage to hippocampus results in

memory loss and inability to learn new things

what happens to ventricles in ad

become larger

how do plaques and tangles spread

spread throughout cortex in predictable pattern through progression

how long do they live

7-8 years after dx, some survive up to 20

course of disease depends on

age at dx, other concurrent health conditions

early AD

may not be detected yet but have small changes in thinking/planning and learning/memory

mild to moderate ad lasts for

2-10 years ( have dx now)

mild to mod ad have issues with

serious memory/thinking issues that impacts social life, get confused with money, expression, and organizing thoughts, changes in personality and difficulty recognizing people, speaking/comprehension, sensory integration, perception issues, visiospatial issues, cant read/watch tv

examples of visuospatial issues

knowing where body is in regards to environment, reading, judging distances, determining colors or contrast

how long does severe ad last

1-5 years

severe ad

seriosuly damaged, brain shrinks

severe ad symptoms

no ability to communicate, recognize self, family and loved ones, and care for self

how do they dx AD

MRI, look at rate of cognitive change, cognitive screening, neuropsychological testing

mini mental state exam (MMSE

tests orientation to time, place, immediate recall (3 words), attention (100-7s, spell WORLD backward), delayed verbal recall, naming, repetition, 3 stage commands, reading, writing, copying

what score on MMSE indicates cognitive immpairment

less than 20/30

normal clock drawing test

if all numbers are present in correct sequence and position and if hands readably display requested time

is AD cureable?

no

AD intervention

anti-chilinesterase, antioxidants, NSAIDS, hormone replacmenet, immunotherapy

anticholinesterase is used to

improve memory

vitamin E (antioxidant) is used to

control free radical damage

estrogen is used to

decrease risk of ad by 50%

PT as a treatment

fall prevention, general exercises to decrease wandering, educate caregivers, ADs, teach gait, teach motor skills