The Malfunctioning Mind: Degenerative Diseases of the Brain Andrea Mejia. Fall 2016

Defining: Normal aging Declining abilities Cognitive processing speed Fluid intelligence Divided attention Learning efficiency Source memory Visuoperceptual functioning Stable (improved?) abilities Crystallized intelligence = learned knowledge and experiences Maybe talk about WAIS IQ

Defining: Dementia Loss of intellectual capacity and/or personality Due to loss and/or damage of neurons Prevalence increases with age

Degenerative Dementia Intrinsic to the nervous system and affect certain neural systems selectively Presumed to have a degree of genetic transmission Alzheimer’s, Parkinson’s, frontotemporal dementia, etc

Nondegenerative Dementia Diverse etiologies, including vascular, endocrine, inflammatory, nutritional deficiency, and toxic conditions Infectious dementia (AIDS dementia), demyelinating dementia (multiple sclerosis), chronic alcohol or drug abuse (Korsakoff’s syndrome), etc.

Alzheimer’s Disease: Diagnostic Criteria and Associated Features DSM-IV-TR: Memory impairment +1 Language, motor, object recognition, executive functioning

Alzheimer’s Disease: Epidemiology Most common dementia Increasing prevalence Higher prevalence With age Developing nations Women African Americans, Hispanics Survival 2-20 years from diagnosis 1/3 seniors dies with Alzheimer or other dementia 2/3 of americans with Alzheimer’s disease are women In the U.S. someone develops Alzheimer’s ever 66 seconds

Alzheimer’s Disease: Genetic Factors Family history = risk factor Esp. with early onset Three identified genes…still many ?s Having a gene doesn’t mean you will acquire Alzheimer’s...or vice versa Down syndrome Neuropathological changes consistent with AD By age 40 in most

Alzheimer’s Disease: Neuropathology Neuronal loss with cortical neuronal shrinkage Correlates with dementia severity Generalized cortical atrophy Sulcal widening, gyral atrophy Increased ventricular size

Alzheimer’s Disease: Neurocognitive Profile Memory Episodic memory impairment Begins with recent memories Language Word-finding difficulties Grammar and syntax less and less complex Visuospatial functioning Disorientation in familiar places Object misplacement

Alzheimer’s Disease: Neurocognitive Profile In later stages: Executive dysfunction Planning, sequencing, abstracting Agnosia Recognizing objects Apraxia Learned motor acts

Alzheimer’s Disease: Other symptoms Depression Apathy and agitation Anxiety and delusions (often paranoid) Later stages Visual hallucinations Very advanced stages

Neuropsychological Testing of Alzheimer’s Patients Digit Symbol Block design Clock drawing Object naming Memory Deficits on tests of both left and right hemisphere function Not marked by sudden onset

Alzheimer’s Disease: Neuroimaging Structural neuroimaging (MRI, CT) Cortical atrophy Esp. temporal structures (e.g., Hippocampus) Problem: Overlap with other dementias, normal aging

Alzheimer’s Disease: Neuroimaging Functional neuroimaging (fMRI, PET, SPECT) Reduced activation of multiple regions Temporal Parietal

Alzheimer’s Disease: Treatment Other treatment strategies besides medications Manage depression, anxiety, sleep, psychosis Caregiver support!!! http://www.youtube.com/watch?v=q1BkfV2h09g