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Etiology of Dementia
Progressive cognitive decline resulting in new…
Etiology of Dementia
Progressive cognitive decline resulting in new functional dependence
Departure from previous mental functioning
Cognition
=mental activity
Acquisition, storage, transformation and use of knowledge
Margaret W. Matlin 6th edition
Cognitive Processes
Perception
use of previous knowledge to gather and interpret stimuli registered by the senses
- visual recognition
- auditory recognition
- attention - concentration of mental activity
- consciousness - awareness people have of the outside world and of their perceptiosn, images, thoughts, memories, and feelings
Memory
- Working/short-term Memory - brief, immediate memory for material that you are currently processing and coordination of mental activity
- Long-Term Memory - memory for expreiences anf information acccumulated over a lifetime
- episodic memory - personal events
- semantic memory - organized knowledge about the world - factual information
- procedural memory - knowledge on how to do something
- encoding/acquisition
- consolidation
- retrieval
Retrograde Amnesia
Memory loss of events prior to brain damage
Anterograde Amnesia
Memory loss of events after brain damage
Language
- comprehension - Wernicke's Area
- production - Broca's Area
Aphasia - difficulty in communication
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Deductive Reasoning
From premises, you draw a conclusion
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Bottom-up Processing
Importance of stimulus in object recognition
Top-down Processing
How a person's concepts and higher level mental processes influence object recognition
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Diagnostichttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488926/Cunningham, E., McGuinness, B., Herron, B., & Passmore, A. (2015). Dementia. The Ulster Medical Journal, 84(2), 79–87.https://www.alz.org/
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<65 Early Onset incidence of FTLD and ADD almost equal
- ADD: aberrant production of amyloid
> 65 Late Onset - FTLD considerably lower than ADD
95%
- ADD: faulty clearance of amyloid
3% Huntington's Disease, Creutzfeldt-Jakob Disease, HIV/AIDS, Multiple Sclerosis, Normal Pressure Hydrocephalus
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Cognitive Impairments
- Memory
- Visuospatial abilities
- Personality
- Behaviour
WM, inhibitory control, cognitive flexibility
Assessment
History
- Change from baseline
- Functional Decline
- Past medical history
- Drug History
- Home circumstances
- Alcohol and smoking
- Family history
Physical Examination
- Pulse
- Chest auscultation
- Ability to follow instructions
- Focal neurological deficits
Cognitive Examination
- Formal testing (MMSE)
- Geriatric Depression Scale
- Daily Activities
- Neuropsychiatric Inventory
Investigation
To rule out tumours, subdural haematomes, stroke and normal pressure hydrocephalus
- Blood Tests
- CT scan (or MRI)
- ECG
- FDG-PET and SPECT - differentiate between subtypes
Mild Cognitive Impairment (MCI)
objective cognitive symptoms that fall short of the requirements of dementia and that do not interfere with daily life or independent function
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Risk Factors
Unchageable
Genetics
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Apoliprotein E allele
TREM-2 allele
- implicated in amyloid processing and neuroinflammation
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Biomarkers
A characteristic that is objectively measured and evaluated as an indicator of normal biological processes to a therapeutic intervention
ADD
- CSF: - amyloid beta; + tau
- Intracerebral PET: + amyloid
- Hippicampal atrophy in MRI
- Decreased uptake of labelled glucose tracer in FDG-PET
LECTURE.
brassicasterol? -
derived from diet (cannot be synthesized) - difficulty entering CSF
- including risk factors
something is going wrong with transport
DLB:
- dopamine transporter scannning
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Management
Non-phamacological
If possible, encouragement for physical exercise
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Transition into residential care
(social circumstances, severity, symptoms)
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Pharmacological
Acetylcholinesterase inhibitor:s (AChEi)
For ADD
- Donepezil
- Galantamine
- Rivastigmine
Raise levels of ACh
Memantine (NMDA receptor agonist)
For ADD, if AChEi not tolerated or contraindicated
Both - not for use in VaD!
No evidence in efficacy fo FTLD - usually makes it worse
Provide only symptomatic benefit
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