Podcast
Questions and Answers
What distinguishes amnestic MCI from nonamnestic MCI?
What distinguishes amnestic MCI from nonamnestic MCI?
What is true about DSM-5's classification of mild neurocognitive disorder?
What is true about DSM-5's classification of mild neurocognitive disorder?
Which population segment has the highest prevalence of dementia?
Which population segment has the highest prevalence of dementia?
What cognitive decline is most commonly associated with Alzheimer’s disease?
What cognitive decline is most commonly associated with Alzheimer’s disease?
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Which condition is NOT commonly associated with mild neurocognitive disorder?
Which condition is NOT commonly associated with mild neurocognitive disorder?
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What is the projected number of people with dementia by 2030?
What is the projected number of people with dementia by 2030?
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What factor contributes to the decline in dementia prevalence rates despite the increasing number of cases?
What factor contributes to the decline in dementia prevalence rates despite the increasing number of cases?
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Which cognitive impairment is commonly linked to Parkinson's disease?
Which cognitive impairment is commonly linked to Parkinson's disease?
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Which symptom is typically an early sign of Parkinson's disease?
Which symptom is typically an early sign of Parkinson's disease?
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What is a common consequence of vascular disease affecting the brain?
What is a common consequence of vascular disease affecting the brain?
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Which condition arises when cognitive impairment occurs after the establishment of Parkinson's disease?
Which condition arises when cognitive impairment occurs after the establishment of Parkinson's disease?
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What does frontotemporal dementia primarily affect?
What does frontotemporal dementia primarily affect?
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What process is referred to when a stroke causes sudden death of brain tissue?
What process is referred to when a stroke causes sudden death of brain tissue?
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What is often the first symptom observed in Alzheimer's disease?
What is often the first symptom observed in Alzheimer's disease?
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Which of the following is not a characteristic symptom of Alzheimer’s disease?
Which of the following is not a characteristic symptom of Alzheimer’s disease?
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Which category of biomarkers is specifically related to neuronal degeneration in Alzheimer's disease?
Which category of biomarkers is specifically related to neuronal degeneration in Alzheimer's disease?
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Which cognitive symptom is commonly compensated for by social functioning in Alzheimer's patients?
Which cognitive symptom is commonly compensated for by social functioning in Alzheimer's patients?
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In Alzheimer’s disease, which diagnostic criterion is primarily assessed through imaging techniques?
In Alzheimer’s disease, which diagnostic criterion is primarily assessed through imaging techniques?
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How do patients with Alzheimer’s often convey ideas when they struggle to recall specific words?
How do patients with Alzheimer’s often convey ideas when they struggle to recall specific words?
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What distinguishes biomarkers of Alzheimer's from those used to assess memory and functional abilities?
What distinguishes biomarkers of Alzheimer's from those used to assess memory and functional abilities?
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What aspect of memory does the hippocampus primarily influence in Alzheimer's disease?
What aspect of memory does the hippocampus primarily influence in Alzheimer's disease?
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Which of the following conditions is characterized by cognitive impairment and is not specifically about Alzheimer’s disease?
Which of the following conditions is characterized by cognitive impairment and is not specifically about Alzheimer’s disease?
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Which region of the brain exhibits disproportionate atrophy in Alzheimer's disease as observed through MRI?
Which region of the brain exhibits disproportionate atrophy in Alzheimer's disease as observed through MRI?
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What is the primary feature associated with cognitive decline in Alzheimer's disease?
What is the primary feature associated with cognitive decline in Alzheimer's disease?
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Which age group has the highest prevalence of traumatic brain injuries (TBIs)?
Which age group has the highest prevalence of traumatic brain injuries (TBIs)?
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What condition involves placques made of amyloid and neurofibrillary tangles made of tau?
What condition involves placques made of amyloid and neurofibrillary tangles made of tau?
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What is the most common cause of TBIs among older adults?
What is the most common cause of TBIs among older adults?
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What skeletal effect is described as damage occurring on the opposite side of the impact in traumatic brain injuries?
What skeletal effect is described as damage occurring on the opposite side of the impact in traumatic brain injuries?
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Which disease is characterized by cognitive impairment, particularly in visual-spatial tasks?
Which disease is characterized by cognitive impairment, particularly in visual-spatial tasks?
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What is a common nontraumatic cause of brain injury?
What is a common nontraumatic cause of brain injury?
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In which condition is cognitive decline noted to be closely linked with neurofibrillary tangles?
In which condition is cognitive decline noted to be closely linked with neurofibrillary tangles?
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What main aspect differentiates Alzheimer’s disease from other neurocognitive disorders?
What main aspect differentiates Alzheimer’s disease from other neurocognitive disorders?
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At what age do rates of traumatic brain injuries notably increase?
At what age do rates of traumatic brain injuries notably increase?
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What is a common initial cognitive decline seen in Mild Cognitive Impairment (MCI)?
What is a common initial cognitive decline seen in Mild Cognitive Impairment (MCI)?
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Which term is now preferred over 'dementia' in the DSM-5?
Which term is now preferred over 'dementia' in the DSM-5?
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What underlying cause can also lead to Mild Cognitive Impairment (MCI) besides Alzheimer's disease?
What underlying cause can also lead to Mild Cognitive Impairment (MCI) besides Alzheimer's disease?
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Which of the following can be a symptom distinguishing delirium from dementia?
Which of the following can be a symptom distinguishing delirium from dementia?
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Which of the following is a potential impact of delirium on older adults?
Which of the following is a potential impact of delirium on older adults?
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What is one of the specifiers used in diagnosing neurocognitive disorders in the DSM-5?
What is one of the specifiers used in diagnosing neurocognitive disorders in the DSM-5?
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Which type of cognitive ability might decline first in patients with conditions other than Alzheimer's disease?
Which type of cognitive ability might decline first in patients with conditions other than Alzheimer's disease?
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Delirium is particularly significant because it increases the risk of what condition in older adults?
Delirium is particularly significant because it increases the risk of what condition in older adults?
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How is dementia defined in relation to cognitive functioning?
How is dementia defined in relation to cognitive functioning?
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What is the relationship between delirium and dementia in elderly patients?
What is the relationship between delirium and dementia in elderly patients?
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Study Notes
Mild Cognitive Impairment (MCI)
- MCI is a syndrome characterized by cognitive decline that is not severe enough to affect daily living.
- Professionals differentiate between amnestic (memory affected) and nonamnestic MCI, depending on the cognitive domain affected.
- Single-domain vs. multi-domain MCI - one can be impaired in more than one cognitive domain but it's not dementia unless everyday living is impacted.
- DSM-5 uses the term "mild neurocognitive disorder" to reflect that conditions other than Alzheimer's disease can cause MCI.
Prevalence of Dementia
- Prevalence of dementia increases significantly with age, affecting 5% of individuals aged 71-79, 24% of those 80-89, and 37% of those 90+.
- Well-known risk factors include low educational levels and vascular risk factors like hypertension and diabetes.
- 35.6 million people worldwide had dementia in 2010, a number projected to double every 20 years.
- By 2050, 115.4 million people are expected to have dementia.
- Despite increasing numbers, dementia prevalence may be declining (Wu et al., 2017).
Alzheimer's Disease Biomarkers
- NIA/AA guidelines categorize biomarkers for Alzheimer's into two groups:
- Biomarkers of Aβ protein deposition: low CSF levels of Aβ and positive PET amyloid imaging.
- Biomarkers of "downstream" neuronal degeneration: elevated CSF tau (including total tau and phosphorylated tau), decreased FDG uptake on PET in temporoparietal cortex, and disproportionate atrophy in the temporal and parietal cortex on structural MRI.
Alzheimer's Disease: Memory Symptoms
- Memory decline is usually the first symptom, with patients better at recalling past events than recent ones.
- As the hippocampus deteriorates, the ability to form new memories declines.
- Memories and knowledge established earlier in life remain unaffected until late in the disease's progression.
- Forgetting recent conversations, routes, or how to operate new appliances are common.
Alzheimer's Disease: Cognitive Symptoms
- Intact social functioning can mask memory loss as patients may use workarounds (e.g., avoid answering a question they don't know the answer to instead of admitting they don't remember).
Alzheimer's Disease: Language Symptoms
- Difficulty finding words in conversation is common.
- Circumlocution (using other words or phrases instead of the desired word) develops.
Causes of Neurocognitive Disorders
- Autopsies often reveal multiple causes for dementia.
- Over 50% of individuals with dementia had multiple etiologies, with only 30% having Alzheimer's disease alone.
Traumatic Brain Injuries (TBIs)
- Older adults (65+ ), children (0-4), and adolescents (15-19) are most susceptible to TBIs.
- The highest rates of TBI-related hospitalizations and deaths are among adults 75 years and older.
- TBI rates increase with age, peaking among those 85 and older.
- Falls are the most common cause of TBIs among older adults (60.7% of TBI in 65+ age group, followed by 7.9% from motor vehicle accidents).
Traumatic Brain Injuries (cont'd)
- Contracoup damage - brain injury opposite the side of the impact. E.g. a blow to the left side can push the right side of the brain against the skull, causing damage to the right side.
- Common nontraumatic causes of brain injury include brain tumors and anoxia (oxygen deprivation).
Alzheimer's Disease
- Involves amyloid plaque formation (from Aβ) and neurofibrillary tangles (from tau).
- Amyloid plaques build up between neurons and interfere with communication.
- Microtubules within cells become twisted and form neurofibrillary tangles.
- Cognitive decline and impairments are more closely linked to neurofibrillary tangles than plaques.
Delirium and Dementia
- While clinicians must differentiate between delirium and dementia, it's important to remember:
- Having dementia increases the risk of delirium.
- Delirium in older adults increases the risk of dementia.
Diagnostic Terminology
- Neurocognitive disorder, dementia, MCI:
- All refer to a syndrome of cognitive and/or behavioral symptoms.
- They have a variety of underlying causes.
- DSM-5 uses "probably due to" or "possibly due to" specifiers to reflect the uncertainty in identifying the underlying cause.
"Dementia"
- Cognitive decline from a prior level of functioning.
- Severe enough to interfere with daily activities, causing a reliance on others for help.
- Alzheimer's disease is one of many causes, but DSM-5 uses the term "major neurocognitive disorder" instead of dementia.
Mild Cognitive Impairment (MCI)
- Other terminology used includes:
- Cognitive Impairment, Not Dementia (CIND)
- Cognitive Impairment Not Otherwise Specified (NOS)
- Mild Neurocognitive Disorder
National Institute on Aging (NIA)/Alzheimer’s Association (AA) Diagnostic Criteria for MCI (Albert et al., 2011)
- These criteria expanded awareness that:
- One can have Alzheimer's disease without symptoms severe enough to be considered "dementia."
- Conditions other than Alzheimer's can cause MCI or dementia.
- While memory is typically the first cognitive decline, patients sometimes show decline in other areas first (e.g., language or visuospatial skills).
REM Sleep Behavior Disorder
- May be related to disruption of brainstem areas involved in REM sleep control (e.g., reticular formation).
- These areas may be affected by Lewy body disease early on.
Parkinson’s Disease
- Initial symptoms include resting tremor, muscular rigidity, and slowed movement.
- Balance issues, falls, and difficulty walking develop later.
- If cognitive impairment arises after establishing Parkinson's disease, it is termed "neurocognitive disorder due to Parkinson's disease."
Vascular Disease
- Involves buildup of atherosclerotic plaques in cerebral arteries, disrupting blood supply.
- Complete blockage of arteries causes ischemia in surrounding brain areas.
- Vascular disease can cause cognitive impairment through gradual buildup of ischemic damage, as well as sudden strokes.
- Infarction - sudden brain tissue death due to oxygen deprivation.
Vascular Disease (cont'd)
- Most strokes are ischemic (blocked blood supply), while approximately 13% result from hemorrhages (artery rupture and bleeding).
- Patient's typically experience some recovery weeks after a stroke, but may have lasting cognitive deficits.
Vascular Disease: Cognitive Presentation
- Gradual buildup of vascular disease often leads to initial decline in processing speed and executive functioning.
- Sudden strokes can cause impairments in language, visual perception, attention, executive functioning, and/or processing speed depending on the stroke's location.
Frontotemporal Dementia
- Caused by various pathologies in the frontal or temporal lobes.
- Most cases are caused by:
- Microtubule-associated protein tau (MAPT)
- TAR DNA-binding protein with molecular weight 43 kDa (TDP-43)
- Fused-in sarcoma (FUS) protein.
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Description
This quiz explores Mild Cognitive Impairment (MCI), detailing its characteristics and classifications, as well as the prevalence and risk factors associated with dementia. It also addresses the differences between MCI and dementia, providing insights into cognitive health in aging populations.