Mild Cognitive Impairment and Dementia Overview
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Mild Cognitive Impairment and Dementia Overview

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What distinguishes amnestic MCI from nonamnestic MCI?

  • Amnestic MCI can occur without any cognitive impairment.
  • Nonamnestic MCI is primarily caused by Parkinson's disease.
  • Nonamnestic MCI always leads to dementia.
  • Amnestic MCI involves memory loss, while nonamnestic MCI does not. (correct)

    • What is true about DSM-5's classification of mild neurocognitive disorder?

  • It considers the impact of cognitive impairment on daily living. (correct)
  • It only applies to Alzheimer's disease.
  • It ignores the cause of cognitive impairment.
  • It includes specific domains of impairment.

    • Which population segment has the highest prevalence of dementia?

  • Individuals aged 71 to 79 years
  • Individuals aged 80 to 89 years
  • Individuals under 70 years
  • Individuals aged 90 years and older (correct)

    • What cognitive decline is most commonly associated with Alzheimer’s disease?

    <p>Visuospatial deficits</p> Signup and view all the answers

    Which condition is NOT commonly associated with mild neurocognitive disorder?

    <p>Autism spectrum disorder</p> Signup and view all the answers

    What is the projected number of people with dementia by 2030?

    <p>65.7 million</p> Signup and view all the answers

    What factor contributes to the decline in dementia prevalence rates despite the increasing number of cases?

    <p>Improved healthcare and awareness</p> Signup and view all the answers

    Which cognitive impairment is commonly linked to Parkinson's disease?

    <p>Executive dysfunction</p> Signup and view all the answers

    Which symptom is typically an early sign of Parkinson's disease?

    <p>Mild tremor while hands are resting</p> Signup and view all the answers

    What is a common consequence of vascular disease affecting the brain?

    <p>Gradual buildup of ischemic damage leading to cognitive decline</p> Signup and view all the answers

    Which condition arises when cognitive impairment occurs after the establishment of Parkinson's disease?

    <p>Neurocognitive disorder due to Parkinson's disease</p> Signup and view all the answers

    What does frontotemporal dementia primarily affect?

    <p>Frontal and/or temporal lobes</p> Signup and view all the answers

    What process is referred to when a stroke causes sudden death of brain tissue?

    <p>Infarction</p> Signup and view all the answers

    What is often the first symptom observed in Alzheimer's disease?

    <p>Decline in memory</p> Signup and view all the answers

    Which of the following is not a characteristic symptom of Alzheimer’s disease?

    <p>Loss of established memories</p> Signup and view all the answers

    Which category of biomarkers is specifically related to neuronal degeneration in Alzheimer's disease?

    <p>Decreased FDG uptake on PET</p> Signup and view all the answers

    Which cognitive symptom is commonly compensated for by social functioning in Alzheimer's patients?

    <p>Severe memory loss</p> Signup and view all the answers

    In Alzheimer’s disease, which diagnostic criterion is primarily assessed through imaging techniques?

    <p>Biomarkers for Aβ protein deposition</p> Signup and view all the answers

    How do patients with Alzheimer’s often convey ideas when they struggle to recall specific words?

    <p>Circumlocution</p> Signup and view all the answers

    What distinguishes biomarkers of Alzheimer's from those used to assess memory and functional abilities?

    <p>They identify the presence of the disease</p> Signup and view all the answers

    What aspect of memory does the hippocampus primarily influence in Alzheimer's disease?

    <p>Forming new memories</p> Signup and view all the answers

    Which of the following conditions is characterized by cognitive impairment and is not specifically about Alzheimer’s disease?

    <p>Lewy body disease</p> Signup and view all the answers

    Which region of the brain exhibits disproportionate atrophy in Alzheimer's disease as observed through MRI?

    <p>Temporal and parietal cortex</p> Signup and view all the answers

    What is the primary feature associated with cognitive decline in Alzheimer's disease?

    <p>Number of neurofibrillary tangles</p> Signup and view all the answers

    Which age group has the highest prevalence of traumatic brain injuries (TBIs)?

    <p>Adults aged 65 and older</p> Signup and view all the answers

    What condition involves placques made of amyloid and neurofibrillary tangles made of tau?

    <p>Alzheimer's Disease</p> Signup and view all the answers

    What is the most common cause of TBIs among older adults?

    <p>Falls</p> Signup and view all the answers

    What skeletal effect is described as damage occurring on the opposite side of the impact in traumatic brain injuries?

    <p>Contrecoup damage</p> Signup and view all the answers

    Which disease is characterized by cognitive impairment, particularly in visual-spatial tasks?

    <p>Lewy Body Disease</p> Signup and view all the answers

    What is a common nontraumatic cause of brain injury?

    <p>Anoxia</p> Signup and view all the answers

    In which condition is cognitive decline noted to be closely linked with neurofibrillary tangles?

    <p>Alzheimer's Disease</p> Signup and view all the answers

    What main aspect differentiates Alzheimer’s disease from other neurocognitive disorders?

    <p>Development of amyloid plaques</p> Signup and view all the answers

    At what age do rates of traumatic brain injuries notably increase?

    <p>Aged 85 and older</p> Signup and view all the answers

    What is a common initial cognitive decline seen in Mild Cognitive Impairment (MCI)?

    <p>Memory</p> Signup and view all the answers

    Which term is now preferred over 'dementia' in the DSM-5?

    <p>Major neurocognitive disorder</p> Signup and view all the answers

    What underlying cause can also lead to Mild Cognitive Impairment (MCI) besides Alzheimer's disease?

    <p>Other neurodegenerative conditions</p> Signup and view all the answers

    Which of the following can be a symptom distinguishing delirium from dementia?

    <p>Rapid onset of confusion</p> Signup and view all the answers

    Which of the following is a potential impact of delirium on older adults?

    <p>Increased risk of falls</p> Signup and view all the answers

    What is one of the specifiers used in diagnosing neurocognitive disorders in the DSM-5?

    <p>Probably due to</p> Signup and view all the answers

    Which type of cognitive ability might decline first in patients with conditions other than Alzheimer's disease?

    <p>Language ability</p> Signup and view all the answers

    Delirium is particularly significant because it increases the risk of what condition in older adults?

    <p>Dementia</p> Signup and view all the answers

    How is dementia defined in relation to cognitive functioning?

    <p>A decline from a prior level of functioning</p> Signup and view all the answers

    What is the relationship between delirium and dementia in elderly patients?

    <p>Both increase the risk of each other</p> Signup and view all the answers

    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.

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