HDE 100C - midterm 3/final

what is Alzheimer's disease known as in the DSM-5?

Major neurocognitive disorder (dementia)

what is the fifth leading cause of death for people age 65+?

Alzheimer's disease

what disease afflicts 1 out of 10 people in the US 65 and older?

Alzheimer's disease

what disease is the most prevalent type of dementia?

Alzheimer's disease

what are senile plaques in Alzheimer's disease?

small, circular deposits of a dense protein, beta-amyloid

what are neurofibrillary tangles in Alzheimer's disease?

webs of degenerating neurons

what do a build up of neurofibrillary tangles cause?

- destroy cell transport system made of proteins

- nutrients and other supplies can't move through cells

- cells eventually die

what are some risk factors associated with Alzheimer's disease?

-age 50+

-head injury

-family history of Alzheimer's disease

-high cholesterol levels

-high blood pressure

-sedentary lifestyle

-tobacco use

-obesity

what is the pre-Alzheimer's stage known as?

mild cognitive impairment (MCI)

Alzheimer's disease is a type of what?

dementia

Alzheimer's disease is a cause of what?

dementia

Alzheimer's is a specific brain disease that accounts for how many dementia cases?

60-80%

what are the diagnostic criteria from the DSM-5 for dementia?

B. cognitive deficits interfere w/ independence in everyday activities

C. cognitive deficits do not occur exclusively in the context of delirium

D. cognitive deficits are not better explained by another disorder

how many Americans are living with Alzheimer's dementia?

6.9 million

how many Americans with Alzheimer's are women?

2/3

when compared with older Caucasians, how likely are African Americans to have Alzheimer's disease and other dementias?

2x as likely`

when compared with older Caucasians, how likely are Hispanic Americans to have Alzheimer's disease and other dementias?

1.5x as likely

what are some of the racial and ethnic disparities in Alzheimer's disease and other dementias?

- red lining

how many people ages 65-74 are currently diagnosed with Alzheimer's disease?

1.83 million

how many people ages 74-84 are currently diagnosed with Alzheimer's disease?

2.67 million

how many people ages 85+ are currently diagnosed with Alzheimer's disease?

2.42 million

what is the prevalence of Alzheimer's disease in people 65+?

10%

what percentage of people aged 65-74 have Alzheimer's dementia?

5%

what percentage of people aged 75-84 have Alzheimer's dementia?

14%

what percentage of people aged 85+ have Alzheimer's dementia?

33%

how many seniors dies with Alzheimer's or another dementia?

1 in 3

what is excess mortality?

observed # of deaths - expected # of deaths

how many Americans provide unpaid care for a family member or friend with dementia?

11 million+

what proportion of caregivers are women?

2/3

what proportion of caregivers are daughters?

less than 1/3

what proportion of caregivers are in the sandwich generation?

1/4

what is the first stage of Alzheimer's disease?

1. No impairment

what is the second stage of Alzheimer's disease?

2. Very mild cognitive decline

what is the third stage Alzheimer's disease

3. Mild cognitive decline

what is the fourth stage of Alzheimer's disease?

4. Moderate cognitive decline

what is the fifth stage of Alzheimer's disease?

5. Moderately severe cognitive decline

what is the sixth stage of Alzheimer's disease?

6. Severe cognitive decline

what is the seventh stage of Alzheimer's disease?

7. Very severe cognitive decline

what are symptoms of stage 1 of Alzheimer's disease?

- no memory problems

- interview does not show evidence of dementia

what are symptoms of stage 2 of Alzheimer's disease?

- memory lapses

- not detected by medical exam or surrounding people

what are symptoms of stage 3 of Alzheimer's disease?

- close people notice difficulties

- medical exam may detect memory/concentration problems

what are symptoms of stage 4 of Alzheimer's disease?

- medical exam should show definitive problems

what are symptoms of stage 5 of Alzheimer's disease?

- noticeable gaps in memory and thinking

- need help with daily activities

what are symptoms of stage 6 of Alzheimer's disease?

- lack of awareness of recent experiences and surroundings

- difficulty remembering personal history

- distinguish familiar and unfamiliar faces, have trouble remembering names of family

- need help dressing

- major sleep and continence disruption

- personality and behavioral changes

- wandering

what are symptoms of stage 7 of Alzheimer's disease?

- lose ability to respond to environment

- lose ability to have a conversation

- lose ability to control movement

- may still say words or phrases

- abnormal reflexes

- rigid muscles

- impaired swallowing

what are the 10 signs of Alzheimer's disease?

1. memory loss that disrupts daily life

2. challenges in planning or problem solving

3. difficulty completing familiar tasks

4. confusion with time or place

5. trouble understanding visual images and spatial relationships

6. new problems with words in speaking or writing

7. misplacing things and losing the ability to retrace steps

8. decreased/poor judgement

9. withdrawal from work and social activities

10. changes in mood or personality

what changes to the brain occur in Alzheimer's disease?

- shriveling cortex --> damages to thinking, planning, and remembering areas

- decreased volume; especially severe in hippocampus

- ventricles enlarge

- sulci become wider

early-stage Alzheimer's disease (mild) affects what areas of the brain?

hippocampus: learning and memory

frontal lobe: decision making, problem solving, and purposeful behavior

deficit in short-term episodic memory

middle-stage Alzheimer's disease (moderate) affects what areas of the brain?

frontal lobe: decision making, problem solving, and purposeful behavior; more damage

trouble speaking or understanding speech

trouble knowing where body is in relation to surrounding objects

late-stage Alzheimer's disease (severe) affects what areas of the brain?

widespread shrinkage due to cell death

lose ability to communicate, recognize loved ones, and care for themselves

what type of Alzheimer's dementia affects people ages 65+?

late-onset Alzheimer's dementia

what type of Alzheimer's dementia is more common in people ages 65+?

late-onset Alzheimer's dementia

when does death occur for individuals with late-onset Alzheimer's dementia?

8-10 years after diagnosis; sometimes 20 years

what type of Alzheimer's dementia affects people under age 65?

early-onset Alzheimer's dementia;

often genetically inherited;

rare;

very severe

what percentage of patients have early-onset Alzheimer's dementia?

5%

what is etiology?

set of causes of a disease

how many different variants of the APOE gene are there?

3: APOE e2, APOE e3, and APOE e4

what function does the APOE e2 gene have towards Alzheimer's dementia?

may provide some form of protection against disease;

Alzheimer's dementia usually occurs later in life;

this allele occurs in 5-10% of people

what function does the APOE e3 gene have towards Alzheimer's dementia?

seems to have a neutral effect;

most common of the APOE alleles

what function does the APOE e4 gene have towards Alzheimer's dementia?

increases risk of developing Alzheimer's dementia;

typically develops earlier onset in certain populations;

1 copy of allele occurs in 15-25% of people;

2 copies are higher risk for Alzheimer's dementia;

2-5% of the population have 2 copies of the allele

what percentage of people diagnosed with Alzheimer's dementia in the US have at least one copy of the APOE e4 allele?

40-65%

how many Alzheimer's dementia cases are early onset?

<10%

of the <10% cases with early onset Alzheimer's dementia, how many have a mutation in APP, PSEN1, or PSEN2?

10-15%

The risk variants of APP, PSEN1, and PSEN2 are associated with what in relation to Alzheimer's dementia?

late onset Alzheimer's dementia

what is the risk gene that increases the likelihood of developing Alzheimer's dementia?

APOE

what is the deterministic genes that directly cause Alzheimer's dementia almost 100% of the time?

APP, PSEN1, and PSEN2

there is higher prevalence of having Alzheimer's dementia if you also have what?

down syndrome;

almost 6x higher than in people without down syndrome

why is there a higher prevalence in people with down syndrome and Alzheimer's dementia?

3 copies of chromosome 21 which is the gene that codes for APP; extra copy of the APP gene may increase production of beta-amyloid

at least what percentage of people with down syndrome develop Alzheimer's dementia during their 50's and 60's?

50%

what percentage of those over 65 with down syndrome have Alzheimer's dementia?

75%

what are the risk factors of developing Alzheimer's disease?

- high cholesterol

- high blood pressure

- sedentary lifestyle

- tobacco use

- obesity

- head injury

what does diagnosis of Alzheimer's dementia entail?

careful medical evaluation, looking thoroughly through medical history, mental status testing, a physical and neurological exam, and tests

what is a MRI scan?

- Magnetic resonance imaging

- Uses strong magnetic field to produce an image of the body's interior

- Computer creates a 3D model of the brain

what is a CT scan?

A computed tomography is cross-sectional x-ray images of the brain and spinal cord.

what are potential treatments for Alzheimer's disease?

Cholinesterase inhibitors, Aducanumab (Aduhelm), and Lecanemab (Leqembi)

what does cholinesterase inhibitors do?

- a chemical that inhibits the acetylcholinesterase enzyme from breaking down acetylcholine, thereby increasing both the level and duration of action of the neurotransmitter acetylcholine

what do cholinesterase inhibitors treat?

treat Alzheimer's dementia symptoms

prescribed during early to moderate stages

treat symptoms related to memory, thinking, language, judgment, and other thought processes

what does aducanumab (aduhelm) do?

attach to & remove beta-amyloid plaques

anti-bodies that cross the blood brain barrier

What is positron emission tomography (PET)?

a method of brain imaging that assesses amyloid activity by using a radioactive substance injected into the bloodstream

what does lecanemab (leqembi) treat?

appropriate for early Alzheimer's dementia

what does lacanemab (leqembi) do?

decreases beta-amyloid plaques in the brain

what is elder abuse and neglect?

intentional or neglectful acts by a caregiver or "trusted" individual that lead to, or may lead to, harm of a vulnerable elder

what percentage of people 60+ who live at home have suffered elder abuse, neglect, and exploitation?

10%

how many elders were treated in emergency department for nonfatal assaults from 2002-2016?

643,000 individuals

how many homicides to elders?

over 19,000

researchers think how many cases are reported to adult protective services?

1 in 5 (or fewer)

why is there underreporting of elder abuse, neglect, and exploitation?

- afraid/unable to tell the police, friends, or family

- may be afraid that if they reveal the maltreatment they may lose source of care

- may be maltreated by loved one and afraid of consequences

- may have dementia and be unable to remember details

what are risk factors of elder abuse, neglect, and exploitation?

- isolation

- depression

- medication/substance abuse

- dementia

- mental health problems

what are common characteristics of victims of abuse, neglect, and exploitation?

- female

- median age of 77

- physical and psychological health problems that lead to disability

what are common characteristics of perpetrators of abuse, neglect, and exploitation?

- husbands or sons

- history of substance abuse

- history of mental or physical health problems

- history of problems with police

- history unemployment

- history of financial problems

what are the warning signs of physical abuse?

- slap marks

- unexplained bruises

- most pressure marks

- certain types of burns or blisters

what are the warning signs of neglect?

- pressure ulcers

- filth

- lack of medical care

- malnutrition or dehydration

what are the warning signs of emotional abuse?

- withdrawal from normal activities

- unexplained changes in alertness

- other unusual behavioral changes

what are the warning signs of sexual abuse?

- bruises around breasts or genital area

- unexplained sexually transmitted diseases

- blood in underwear

- changes in behavior

what are the warning signs of financial abuse / exploitation?

- sudden changes in finances and accounts

- altered wills and trusts

- unusual bank withdrawals

- checks written as "loans" or "gifts"

- loss of property

what does death mean to people?

- organizer of time

- punishment

- transition

- loss

what is death anxiety?

fear of death

who have the greatest fear of death?

middle-aged adults; fear of death of parents

who are more likely to think and talk about death?

older adults

how are extrinsic religiosity and death anxiety related?

related to more death anxiety