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Lecture 10

PSYB32 - Lecture 10 Notes.docx

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University of Toronto Scarborough
Konstantine Zakzanis

PSYB32 – Lecture 10 (Final lecture) WebOption – Summer 2013 Chapter 16: Aging and Psychological Disorders Slide 3 – Old Age and Brain Disorders Dementia  Steady course of cognitive deterioration that does not improve  Two types of Dementia: slowly progressive and step wise:  Slowly progressive: the deterioration is gradual, happens over a long period of time. There are no sudden drastic drops in capacity that happens over night  Step wise: the person has some cognitive decline and stays at that level, and then some sort of event will happen and they’ll get worse, then they’ll function at that level for a little while, and then something will happen which makes it worse, and so on  To be clinically diagnosed with dementia, it has to affect your social and occupational functioning (activities of daily living)  Each form of Dementia has its own unique neuropsychological signature o In other words, they each tend to present with a unique constellation of cognitive deficits o As the dementias evolve however, it becomes a more global dementia (a broader decline rather than just in specific areas) which makes it hard to tell one dementia from another Slide 5 – The Canadian Study of Health & Aging  Cognitive Reserve hypothesis: The more connections you form in your brain (be it via education, or other ways to keep your brain in shape) then the greater your cognitive reserve is. This means that you’re much less likely to succumb to brain deteriorating diseases like dementia or alzheimers because you have a much stronger brain with many connections to lose. If you have a weak reserve then it doesn’t take much for signs of decline to start showing. o Basically keeping your brain active keeps these declines at bay Slide 6 – Alzheimer’s Disease  Text says about 50% of those with Dementia suffer from Alzheimer’s Disease  The cognitive deterioration in Alzheimers is slowly progressive, rather than step wise Slide 7 – Neuropathology of Alzheimer’s Disease  Picture of a brain the prof autopsied  Temporal lobes look especially atrophied (wasted away)  Key to diagnosing someone with Alzheimer’s are the number of Plaques and Tangles found in certain areas of the brain o We all have plaques and tangles in our brains right now but the number and placement of these differ in patients with Alzheimer’s  They typically accumulate in regions of the brain that are most oxygen demanding. The structure that is the most oxygen demanding of all is the Hippocampus (in charge of memory consolidation; learning) o So this is typically how alzheimer’s begins. With difficulties in consolidating new information  As the disease progresses, these plaques and tangles begin to accumulate in the temporal lobes and then the parietal and frontal lobes at the same time o When they encroach on the parietal lobes, some impairments would be: spatial impairments which is why they get lost so frequently o When they encroach on the temporal lobes, impairments would be: difficulties finding words/understanding others Slide 10 – DAT Post Mortem  The reasons why the ventricles in an Alzheimer’s patient’s brain looks so huge is because the rest of the brain begins to shrink o At some point, it’ll shrink so much that you won’t have this neurological signature unique to Alzheimer’s, but rather, profound cognitive impairment that’s all encompassing Slide 11 & 12 – Neuroimaging of patient with Alzheimer’s  A SPECT imaging showing decreased blood flow throughout the brain  This doesn’t tell us the person has Alzheimer’s but it can help in trying to understand whether there is something neurobiologically wrong  The problem with neuroimaging is that these images don’t show distinct markers for Alzheimers o In other words, not every patient with Alzheimer’s will look dramatically different from the brains of healthy controls  This is why the diagnosis can only be made via autopsy Slide 14  Because it’s cognitive impairment that disables the person, neuropsychological evaluations have been shown to be the most sensitive to the disorder o If you wanna know that someone has alzheimer’s your best bet is via a neuropsychological evaluation rather than neuroimaging techniques or a neurological examination  Neuropsychological evaluations do show signatures of Alzheimer’s disease: o When the person shows declines in Memory, Naming, and visuospatial impairments Slide 16  When we can’t find the word for something we tend to try to describe what it is instead. Patients with Alzheimer’s disease do this a lot  For example, when they try to name an item they’ll go “it’s a…a – a – a umm the thing you drink out of”  this is called circumloclution  If you provided a memory test which involved showing the patient 16 items and then asking them to name those 16 items right after showing them, would they be able to? Yes – this is because their working memory is still intact  If they’re asked to repeat the words that are on the list after 10 minutes however, they wouldn’t be able to. In fact they’ll probably say “what list?”  This is because their hippocampus isn’t consolidating the names on that list so as soon as the task is over, it’s as if it never happened  Two kinds of paraphrasing errors they tend to make o Semantic Paraphasias: when they’re trying to say a word, they’ll give you another word that’s semantically related to what they were trying to say  ie if showed a harmonica they may instead call it a flute (another instrument you blow into in order to produce sound)  These types of errors are indicative of temporal lobe deterioration o Phonemic Paraphasias: not common until later stages of the disease. It’s when they change or misuse the first few phonemes (letters) of the word that they’re trying to say  ie if they’re asked to name the picture of the harmonica, they may instead call it a harp (both start with h-a-r)  these errors are indicative of frontal lobe deterioration Slide 17 – Visualspatial abilities  Again, Alzheimer’s patients get lost in familiar environments which demonstrates a decline in visual spatial abilities  On the slide is an example of the block design sub-test  It asks of the patient to create the same pattern as the test booklet above shows  A patient with Alzheimer’s will have great difficulty completing even the simplest designs  When we see those 3 types of deficits in a Neurological examination (circumlocution, paraphrasing errors and visual spatial deficitis) then we can diagnose the patient with Probable Alzheimer’s disease Slide 18 – The Dementias: Cortical dementias  There is a typology we should be familiar with and it’s the way in which we categorize the different Dementias  Alzheimer’s disease is a type of Cortical dementia o The word Cortical is used because the impairment, or neuropathology, is specific to the cortical structures of the brain o This is also to distinguish it from Sub-cortical dementias  Another example of a Cortical dementia is Primary Progressive Aphasia Primary Progressive Aphasia  A slowly progressive dementia that starts off as nothing more than naming difficulties o The person will start to use Circumlocutions, they’ll make paraphrasic errors, but their memory and visuospatial skills are still intac
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