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

2. 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

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

4. 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

5. 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.

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

7. 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

8. 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

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

11. 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

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

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

14. 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

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

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

17. Alzheimer’s Disease: Treatment
Other treatment strategies besides medications
Manage depression, anxiety, sleep, psychosis
Caregiver support!!!