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Task 7. Diagnosis of dementia (Risk and protective factors of dementia:,…

- - - - Semantic knowledge: deficits that manifiests as a loss of general knowledge and impairment of language abilities (e.g. aphasia). They often impaired tests of naming, berbal fluency, and semantic categorization. They also have a reduced ability to recall overlearned facts.
      - Executive functioning : EF deficits responsible for (especially) concurrent mentla infomation, concept formation, problem solving, and cue-directed behavior occur early in AD.
      - Amnesia: episodic memory impairment is usually the earliest and most salient aspect of AD dementia syndrome. A number of characteristics that are quite effective in differentiating between mildly demented AD patients an normal older adults: (1) impaired on measures of delayed recall, (2) recognition testing do not make more accesible the to-be-remembered information (3) AD patients exhibit and abnormal serial position effect (attenuation of primacy effect (4) semantic encoding is less effective in improving episodic memory performance (5) enhance tendency to produce intrusion errors on both verbal and nonverbal memory tests- -decreased inhibitory processing-
      - Attention ; (less salient in early stages): deficits are usually evident on dual-processing tasks, tasks that require the disengagement and shifting of attention, and WM tasks that are dependent upon the control of attentional resources.
      - Visuospatial abilities (less salient in early stages): deficits usually affect visuoconstructional abilities assessed by the Block Design Test, the Clock Drawing Test, and complex figure copying (e.g. apraxia), and visuoperceptual abilities tapped by tests such as Judgment of Line Orientation or the Money Road Map Test.
      - Functional disturbances: patients progress from the loss of higher-level activities of daily living (e.g. check writing, use of public transportation) through abnormalities of basic activities of daily living (e.g. eating, grooming) as the disease enters advanced phases.
      - Behavioral disturbances:: progress over the course of the illness. Mood change and apathy commonly develop early and continue for the duration of the disease. Psychosis and agitation are characteristic of the middle and later phases of the disease.
    - - Early: Episodic memory, EF (set-shifting), semantic knowledge with a gradual onset. - Mood, apathy (continue throughout the disease) - Loss of higher-level activities of daily living
      - Later: Attention, visuospatial abilities - Psychosis, agitation, basic daily life problems - Abnormalities of basic activities of daily living
      - Very late Motor and sensory deficit
  - - - Semantic dementia: there is a breakdown in the conceptual database that underlies language production and comprehension (progressive fluent aphasia). They have asymmetric anterolateral temporal atrophy with relative sparing of hippocampal formations, typically worse on the left side.
      - Progressive nonfluent aphasia: the phonologic and syntactic components of language are affected in association with left perisylvian atrophy.
      - Frontal variant FTD: changes in social behaviour and personality predominate, reflects orbitobasal frontal lobe focus of the pathology.
- - - - Sensitivity = number of positives correctly identified as such
      - Specificity = number of negatives correctly identified as such
  - - - a general pattern of greater visuospatial, attention, and EF impairment in DLB than AD, and greater memory impairment in AD than DLB is seen. Consideration of these patters of deficits (particularly those of visuospatial abilities) may have important clinical utility in distinguishing between AD and DLB in mildly demented patients. (hallucinations?)
      - AD and DLB can also coexist, which is hard (impossible) to diagnose with high specificity. More tangle pathology (higher Braak stage) led to less visual hallucinations, DLB diagnostic accuracy was higher for lower tangle pathology. (chequar lo ultimo)
      - DLB: motor features of Parkinsonism, visual hallucinations and fluctuating cognition
    - - (a) Severe deficits in episodic memory (AD) versus mild-to-moderate memory impairment that appears to result form a general deficit in the ability to initiate and carry out systematic retrieval of successfully stored information (HD). => equivalent memory deficits when asses during free recall, but in recognition is less impaired in HD.
      - AD faster forgettin over delay interval and decline in structure and organization of semantic knowledge.
      - HD more pronnounced attentional deficits, decline in shifting/ allocating attention -when its must be internally regulated
      - Initial mild WM deficits and pronounced WM deficits later on (AD) versus early affected WM (HD).
      - Impaired visuoconstructional ability that requires extrapersonal orientation (e.g. copying) (AD) versus impaired on visuospatial tasks that require personal orientation (HD).
    - - 71% of AD patients exhibited a profile with memory impairment more prominent than executive dysfunction, whereas only 45% of patients with subcortical VaD exhibited a profile with
        more prominent executive dysfunction than memory impairment
      - Pure VaD or pure AD is rare. Integrative approach is proposed, which would take into account the neuropsychological profile, neuroimaging, and vascular risk factors.