PSYB32H3 Lecture Notes - Lecture 10: Mild Cognitive Impairment, Dementia With Lewy Bodies, Vascular Dementia

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Published on 4 Jul 2012
School
UTSC
Department
Psychology
Course
PSYB32H3
PSYB32- Lecture 10
Aging and Psychological Disorders
Dementia- progressive; gradual deterioration of intellectual and cognitive functions, as well as
behavioural functions; does not get better, gets worse over time; have to demonstrate that
there is an impairment over time and not just one examination
o Slowly progressive- when the cognitive, intellectual, and behavioural impairments
slowly get worse over time; continuous deterioration; 8-10 years from first diagnosis to
ultimately death
o Step wise deterioration- when the person will be functioning at a certain level, and
dramatically drop literally within an hour or days because something might have
happened; then they will function at that level until something happens, and they will
drop, and this continues (step wise)
o In order to meet diagnostic criteria, the impairment must result in some sort of social or
occupational disability; as the dementia goes on, this will become incredibly obvious and
will have an impairment even when it comes to self-care; mild cognitive impairment
(MCI)- when an elderly individual will not only exhibit the cognitive compromise that
comes with aging but a single cognitive impairment that is mild in nature, typically
memory but it does not impair them in terms of their social and occupational
functioning
o Each dementia syndrome has a unique neuropsychological signature; a dementia
syndrome cannot be diagnosed definitively while the person is alive, so we never know
for sure what the person has; neuropsychological testing is the most sensitive to
differentiating between dementia syndromes; in other words, the type of pattern of
deficits they display and in what order they deteriorate in are unique to the different
dementias we will discuss; in frontal lobe dementia one of the first signs are executive
deficits or behavioural problems
o A diagnosis of dementia is clinical; not until autopsy that we can definitively diagnose
someone with one of the dementia syndromes
o Dementia is a diagnosis made by ruling out things
Alzheimer’s Disease
o Accounts for about half the patients that are diagnosed with dementia
o At the present time there are 26.6 million persons worldwide diagnosed with dementia
which is probably a gross underestimate; by 2050, this number is expected to go to 106
million people (tsunami of persons that are going to require care in their elder years)
o Some other early signs are people who will ask the same question over and over again,
naming problems (stutter a bit), usually begins at the age of 65; the older you get the
more likely it is that you will get Alzheimer’s Disease; women tend to live longer with
the disease, women are also more likely to die from Alzheimer’s Disease; men are more
likely to have comorbid conditions that can kill them, often a vascular component to
their disease (stroke, heart attack); disease is slowly progressive, and not step wise
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o When a person is diagnosed with Alzheimer’s Disease, they are labelled as possible
Alzheimer’s Disease when their signs and symptoms look like it is AD; then their
diagnosis is changed to probable AD when the doctor has seen the patient a couple
times over time; confirmed AD does not happen until autopsy
o Alzheimer’s Disease also has an early onset form, and when typically diagnosed it is far
more progressive (go from early stages to late stages in about half of the time); error in
the textbook is about the genetic risk factors of AD and a specific gene called the E4
allele and that being a risk factor for late onset AD which is untrue, it is actually a risk
factor for early onset of AD; if you carry one of those genes, your chances of getting AD
is increased by 40%, and if you have two of those genes it is almost certain at 90%
prevalence; not a biomarker because not everybody who has an E4 gene will get AD,
and not every patient with AD does not have E4 gene in their genetic makeup
o Not the disease itself that kills a person but usually a complication of being bed ridden,
unable to care for oneself, and all of the illnesses that can strike an individual when they
are stuck and tied to a bed (pneumonia, heart disease)
o The fact that Alzheimer’s Disease is the most common form of dementia could change
over time; hallucinations are typically not part of the illness, but medicinal side effect if
they are on something; if hallucinations are present, then they will typically be
diagnosed with Lewy body Dementia that has only been known for the past decade or
so
o Neuropathology
Atrophy is when the brain basically wastes away
In Alzheimer’s Disease, the sulci become enlarged particularly in the temporal
lobes causing problems with memory (hippocampus); atrophy moves to the
medial temporal lobes, parietal lobes (disorientation), and then the posterior
part of the frontal lobes (speaking); described by Aloid Alzheimer in 1906; at
autopsy
You count the number of tangles and plaques in a particular part of the brain
because it is not a matter of whether or not they present but how many are
present
Risk factors associated with the development of AD are head injuries and
depression, and the third is cognitive reserve which is the notion that high
education levels delay the clinical expression of dementia because the brain
develops backup or reserve neural structures as a form of neuroplasticity
Also means that there is more interconnectivity with respect to your neural
communication/ you have more gas in your tank/ use it or lose it; based on the
facts that someone who is cognitively active it helps preserve their cognitive
functioning, and cognitive activity aids with our crystalized intelligence
(vocabulary, semantic knowledge) but not so much with our fluid intelligence
(novel problem solving)
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Document Summary

Atrophy is when the brain basically wastes away. You count the number of tangles and plaques in a particular part of the brain because it is not a matter of whether or not they present but how many are present. Persons with head injury and depression may lack the motivation to learn; physical activity works in the same way as cognitive activity to preserve the reserve: neuroimaging dat. Sensitive to the early stages of dementia; neuropsychological signature of somebody with an early stages of ad are memory, naming, visualspatial impairments. Explicit memory impaired because of inability to consolidate (hippocampus) Procedural memory relatively intact- when we don"t have to consciously retrieve something, things we have done throughout our lives. Retrieval impaired- can"t consolidate, so they are unable to retrieve something. The way in which the professor likes to categorize dementias is to divide them into cortical and.

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