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Organic & Neurogenic Comm Disorders > Dementia > Flashcards

Flashcards in Dementia Deck (40)
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1

Dementia

Acquired disorders – progressive cognitive decline

Individual has to have:

Memory impairment + 1 other cognitive domain
Examples: language, visuo-spatial skills, abstract thinking, or judgement

Significant loss in functional abilities
Examples: social, vocational, daily living, etc.

2

Alzheimer's Disease

Cortical Dementia

Clinical presentation:
Slow onset with ~ 10 year progression to death

Global Deterioration Scale (Ferris, de Leon, & Crook, 1982)
7-point rating scale of cognitive and functional capacity

3

AD Stage 4

Early Alzheimer’s Disease Diagnosis

Multiple facets of memory impairment – typically difficulty recalling short-term memories; problems with new learning


4

AD Stages 1 & 2

effects of normal aging (everyday forgetfulness)

5

AD Stage 3

mild cognitive impairment

6

AD Stages 5-7

Advanced Stages of Alzheimer’s

Memory and other cognitive functions progressively decline

Changes in personality and emotional regulation

No longer live independently

Bed ridden- primitive reflexes return

7

AD Neuropathology:

Diffuse brain atrophy (the brain shrinks)
~20% reduction in weight compared to normal controls

Temporal, frontal, & parietal lobes

Ventricles enlarge
Begins in hippocampus & entorhinal cortex

Impacts connections between these areas, the amygdala and neocortex

Vulnerable regions of neocortex
Temporal lobe
Frontal lobe
Parietal lobe
Associations between these lobes

8

AD Neuropathological changes:

Senile plaques:
Round with beta-amyloid core; found outside the neuron
Abnormal amounts or structures of beta-amyloid

Neurofibrillary tangles:
Found inside the neuron
Tangles of abnormally decomposed tau protein

Neuronal and synaptic loss

Reduction in neurotransmitters
Including: acetylcholine & serotonin

9

AD Neuropsychological changes:

Memory – difficulty recalling current or recent information
Difficulty with learning new information
Remote memory is impaired over time
Procedural memory remains intact until late stages

Executive dysfunction- difficulty setting and achieving goals
Reduced attention
Difficulty problem solving
Difficulty with reasoning


10

AD Language Impairments

Naming/word finding problems

Semantic paraphasias

Difficulty comprehending complex sentences
multiple step directions

Eventually problems with simple sentences
Discourse errors
Maintaining topic
Producing a variety of sentences
Difficulty with abstract language
jargon

Difficulty with reading and writing

11

AD Visuo-spatial relationships

May be impaired early
See over time
Difficulty navigating while traveling
May appear disoriented

12

AD Motor abilities

relatively intact until late stages
May see restlessness- early on
Immobile- late stage

13

AD Medical management:

No cure

Drug treatments
Modulating neurotransmitters- to improve cognitive functioning
Neuroleptics- treat behavioral symptoms
Tacrine-to improve memory
Inhibits a chemical that prevents the breakdown acetylcholine

14

Pick's Disease

Restricted brain atrophy
Cortical Dementia

Temporal and frontal lobes
Atrophy may be symmetrical or asymmetrical

Rare disease with onset typically in 40’s

Cause unknown

15

PD Clinical presentation:

Early changes in personality
Poor social skills
Emotional blunting (no emotions)
Disinhibition
Poor insight and judgement
Language disorder
Naming problems and empty speech seen early, then gets worse

16

PD Neuropathology:

Atrophy of the temporal and/or frontal lobe(s)

Pick bodies
Dense structures found inside cortical cells – occurs in ~ ¼ of cases
Do not occur in normal age and not found in other diseases

Pick cells
Inflated or enlarged neurons – occurs in ~ ½ of cases

17

PD Neuropsychological changes:

Memory- deficits occur in later stages of the disease

Language-
Early difficulties include naming and empty speech

Mid-late difficulties include aphasia and mutism

Visuo-spatial – impaired late

Motor abilities- impaired late
Tremor, rigidity, and slow movements
Muscle weakness

18

PD Medical treatment:

No cure

Personality changes managed pharmacologically

Train caregivers to assist with daily living needs

19

Parkinson's

Subcortical Neurodegenerative disorder that affects the extrapyramidal system

Gradual onset of symptoms

Typically seen in older individuals

Symptoms include:
Tremors
Rigidity
Posture and balance problems
Masked-like face
Eventual dementia

20

Parkinson's Clinical presentation:

Deficits in:
Memory
Executive functions
Personality
Motor movements
Balance
Dementia
Depression

21

Parkinson's Neuropathology:

Loss of dopamine in substantia nigra and other brain structures

Lewy body inclusions- found in substantia nigra neurons and other brain structures
Outer region is loosely packed neurofilaments and inner region is tightly packed

22

Parkinson's Neuropsychological changes:

Memory- procedural and spontaneous recall impaired
Language- hypokinetic dysarthria (impaired respiration, phonation, articulation, and resonance)
Harsh vocal quality
Reduced syllabic stress
Monoloudness
Imprecise consonants
Increased rate of speech
Palilalia- stuttering-like repetitions
Also see flat affect

Visuo-spatial- impaired to some degree

23

Parkinson's Hallmark

Motor abilities:
Rigidity
Bradykinesia
Cogwheeling- jerky, ridged movements of limbs
Resting tremors
Intention tremors
Balance and postural changes
Shuffling gait

24

Parkinson's Medical treatment

Drug treatments to either
Decrease excitatory neurotransmitters
Increase dopamine levels (Levodopa)
Drug treatments have side effects

25

Huntington's

Subcortical Inherited progressive disease

A child of a parent with the disease has a 50% of developing it

Onset in adulthood but can be adolescences or elderly

Duration approximately ~14 years

Associated with changes in personality, memory motor and intellectual functioning

Psychological issues include:
Depression
Mania
Delusional thoughts
Paranoia

26

HD

Clinical presentation:
Initial symptoms are chorea and behavioral changes

Movements affect face, trunk, and limb muscles

Neuropathology:
Loss of neurons in the caudate nucleus, projects to the globus pallidus, and substantia nigra
Atrophy of frontal lobe over time
Some reductions in neurotransmitters

27

HD Neuropsychological changes:

Memory- difficulty encoding and retrieving information

Language-
Reduced verbal fluency
Word finding difficulties and paraphasias
Hyperkentic dysarthria
Harsh vocal quality/excessive loudness
Prolonged phonemes or pauses
Monopitch
Hypernasality
Imprecise consonants
Involuntary inspiration/ex

28

HD Deficits

Visuo-spatial- some deficits observed

Motor abilities- problems with voluntary and involuntary muscle movements

Involuntary- chorea, dystonia, athetosis, motor restlessness, and myoclonus

Medical treatments:
No cure
Pharmacological treatments

29

AIDS

Subcortical Neurological disorder associated with the AIDS virus

The AIDS virus is complex and has a variable course
Lots of things can go wrong

Clinical presentation:
“Probable dementia” if 2 or more issues are present
Attention, processing speed, reasoning skills, visuo-spatial, memory, learning, speech and language

Must also have:
Motor impairment, change in social or emotional behavior, alterations in consciousness, or psychiatric disorder

30

AIDS Neuropathology:

Cerebral atrophy
Frontal
Parietal
Temporal

Enlarge ventricles

Inflamed brain tissue

Multinucleated giant cells

Small inflammatory noodles found in white matter and subcortical nuclei