Chapter 6

Question 1

Introduction

Answer 1

• Older ppl less likely to suffer from mental health than any other

Question 2

Mild cognitive impairment

Answer 2

• Mild cognitive impairment (MCI): no dementia, but decline in everyday life
•  cognitive impairment, not dementia (CIND) CNID: all cases of impairment, regardless of whether individual has sought medical attention
• MCI just prodromal dementia?
• Smoking gun symptom: symptom that unambiguously indicates one illness and one illness only

Question 3

Dementia

Answer 3

• Decline in intellectual functioning must include decline in memory plus at least one other cognitive skill
• Early-onset dementia (EOD): before age 60
• Doubling of cases every 5 years
• 50 types of dementia, not only Alzheimers

Question 4

Functional impairment

Answer 4

• Blessed dementia scale (BDS)
• Mental Status Questionnaire (MSQ)
• Mini-Mental State Examination (MMSE)
• FAST (Stages, Reisberg)
• Clinical Dementia Rating (CDR)
• Agitation increases in dementia patients
• Aetiologies  different types of dementia

Question 5

Alzheimer’s Disease

Answer 5

• Senile dementia of the Alzheimers type (SDAT), primary degenerative dementia (PDD), dementia of the Alzheimers type (DAT)
• Short term memory decline
• Apraxia, visual agnosia (inability to recognize by sight)
• Aphasia (Broca/Wernicke)
• Demented dyslexia
• Parkinsonism
• Kluver-Bucy syndrome: hyperorality (put everything in mouth) bulimia, hypermetamorphosis (urge to touch everything), loss of affect
• NINCDS-ADRDA criteria: probable, possible, definite
• Diagnosis by default just ruling out other symptoms
• Senile dementia
• Senile plaques in brain with AD
• Neurofibrillary tangles Axons keep structure thanks to tau, in AD tau becomes distorted, axons form tangles, communication between neurons lost
Cell loss in cortex amygdala, hippocampus, brain stem
• Loss of neurons in cholinergic system
• Cholinergic hypothesis: suppressing cholinergic activity impairs memory, therefore has role in AD
• Cognitive reserve
• Apolipoprotein E (ApoE): gene that increases risk for AD
• Amyloid precursor protein (APP), presenilin-1, presenilin-2
• No genetic cause twin studies
• Threshold model of dementia: persons genetic make-up may predispose them to develop DAT, but requires environmental triggere.g. vascular disease, aluminium
• Kuru

Question 6

Vascular dementia

Answer 6

• Vascular dementia (VaD): umbrella term, caused by damage to blood vessels in brain
• Thrombosis, embolism, haemorrhage infarct
• Single-infarct/multi-infarct dementia multi= majority
• Mixed dementia
• Cortical atherosclerotic dementia, subcortical…
• Lacunar strokes
• Binswangers disease
• Hachinski Ischaemic Score (IS)
• Characteristic of VaD: stepwise: sudden decline, no change or recovery, another sudden decline…

Question 7

Other dementias

Answer 7

• Frontotemporal dementia –> subtype: Pick’s disease (behavioral variant frontotemporal dementia), neurons degenerate into Pick’s bodies
• Confabulating: making up stories to cover up gaps in memory
• Semantic dementia (temporal variant frontotemporal dementia)
• Creutzfeldt-Jakob disease (CJD): first movement, then intellectual deteriorationBSE
• Huntingtons disease
• Parkinsons disease (PD)
• Dementia with Lewy bodies (DLB)
• Normal pressure hydrocephalus

Question 8

Cortical and subcortical dementias

Answer 8

• Cortical: AD, Pick,

Sub: PD, Huntingtons (VaD: both grops)

Question 9

Illnesses that can be confused with dementia

Answer 9

• Reversible dementias: pseudodementia ( depression), Delirium (acute confusional state ACS)  hypoactive/hyperactive/mixed delirium short attention span, illusionsDelirium Rating Scale Delirium also occurs in demented patients

Question 10

Incidence rates for subtypes of dementia

Answer 10

• AD much more common than VaD
• Late onset dementia (LOD)
• AD more commo in women, VaD more common in men

Question 11

Memory changes in dementia

Answer 11

• LTM: deficit in encoding
• Phonological loop unscathed in early stage of disease, later becomes impaired
• Key deficit in central executivefrontal lobe
• Autonoetic consciousness: awareness of oneself in memories and the ability to travel back in time through memories impoverished in dementia patients
• Temporal gradient: memories from one time of life better remembered than others
• Anxiety

Question 12

Linguistic skills

Answer 12

• Anomia: failure to name objectscommon first symptom of AD
• Intrusions (inserting inappropriate words)
• Perseverations (repeating same word)
• Circumlocution (talking around subject)
• Phonology and morphology well preserved

Question 13

Visuo-spatial skills

Answer 13

• Decline in early stage of AD
• Closing-in: drawing something which is supposed to be copied on or close to the target
• Clock-drawing test (CDT)

Question 14

Olfaction

Answer 14

• Worsens

* Poorer memory for smells

Question 15

The effect on caregivers

Answer 15

• Depression, suicide risk, elder abuse

Question 16

A person-centered approach

Answer 16

•	D=P+B+H+NI+SP
D= demented patient as they present themselves
P=personality
B=life experience
H=physical health
NI=neurological impairment
SP=social psychology
•	Malignant social psychology: surrounding is intimidating, no sense of personal identity
•	Dementia care mapping

Question 17

Dementia- a summary

Answer 17

• Progressive loss of memory, intellectual skill and linguistic skills

Question 18

Learning disabilities

Answer 18

• Older with learning disabilities: higher levels of depression and anxiety
• Higher risk of dementia

Question 19

Depression

Answer 19

• Far less common in later life

* Except: institutionalized patients, dementia patients

Question 20

Anxiety

Answer 20

• 10% of elders have anxiety disorder, majority phobia
• Agoraphobia very common
• A little anxiety can be useful

Question 21

Substance abuse

Answer 21

• Risk of gambling
• Heavy consumers of hypnotic and sedative (sleep inducing) drugs
• 11% of old Americans abuse drugs
• Neuroleptic drugs often prescribed wrongly
• Old drug-addicts numbers will increase with baby boomers
• Not as much heavy drinkers in older generations but also cohort effects
• 5% of old Americans living independently have alcohol problemmeasuring problems
• Men more likely to have drinking problem than women
• Alcohol consumption can be beneficial
• Alcohol abuse in old lowest for any age group

Question 22

Personality disorder

Answer 22

• Lower chance of getting diagnosed
• Most common: dependent and avoidant
• Numbers might be higher
• Cofounded with depression and self-harm
• Cultural differences

Question 23

Schizophrenia

Answer 23

• Early onset schizophrenia (EOS)

* Late onset schizophrenia (LOS) ¼ of cases

Question 24

Overview

Answer 24

• Mental illness in older patients lower than for population as a whole