1. What are major signs of dementia
    • - progressive deterioration of cognitive (ie thought) function
    • - most notably memory, but also attention language, and problem solving
    • - neuropsychiatric symptoms- apathy, agitation, depression
    • Women have the higher prevalence and this increases over 78
  2. Why dementia is a burden to our society?
    the cost 5 billion a yr but there are hiddeb costs
  3. How does memory impairment manifests in dementia?
    • - difficulty learning o retaining new information
    • - information retrival deficits
    • - ersonal episodice memory impairement (misplacing items
    • -declarative memory (what) affected more than procedural memory (how)
  4. How language deficit is expressed in dmentia?
    • - list generation deficits
    • -word finding difficulties (naming problems)
    • - less complex sentence structure (but comprehension reasonable intact
  5. How the deficit of executive function is expressed in dementia
    -problems in planning, predicting, correlating, abstracting

    - problems in integrating and processing of information in order to make a decision (often the first sign in highly intelligent people)
  6. Which behavioural and emotional changes occur in dementia?
    • - these changes are very common and are often the main treatment focus as they trigger institutionalisation
    • - apathetic, socially withdrawn, depressed
    • - disinhibition (inappropriate sexual behaviour orlanguage)
    • - self centered behaviours (childishness, selfishness)
    • -agitation, wandering, agresion
    • - sleep disturbances
    • - delusions, perceptual disturbances
  7. What is the cause of dementia?
    • - results from impaired functioning of cortical andsub-cortical brain systems, particularly those associated with memory and other cognitive functions
    • - generally caused by structural damage that is progressive and relatively irreversible
  8. What is the most common cause of dementia is?>
    Alzheimer's disease even under 65 (35%) and this increases to 54% over 65
  9. What is the gross neuropathology of alzheimers?
    • - shrinkage of the brain is easily detected by eye. Evident from opening up of sulci and apparent enlargement of ventricles
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  10. What are microscopic neuropathology of alzheimers
    • - amyloid plaques (aka seni,e plaques, neuritic plaques) extracellular deposists of an abnormal, insoluble protein call amyloid
    • - neurofibrillary tangles- intracellular collections a protein called tau, from disrupted neuronal microtubules
    • - widespread loss of neurons
    • these changes typically first appear in the temporal lobe (entorhinal cortex and hippocampus), but then spread to prefrontal cortex and beyond
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  11. What are neurofibrillary triangles?
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  12. How does alzheimer's spread through the brain?
    • Starts in the prefrontal cortex then develops to the temoral cortex and bottom of midbrain and occitpial lobe then severe AD results in majority of the brain
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  13. The lobes of the cerebral cortex
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  14. Where is the hippocampus is located?
    • - deep into the temporal lobe
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  15. What are the different types of amnesia?
    • retrograde amnesia- loss of memory before the incident
    • anterograde amnesia- loss of memory ofter incident
  16. Memory and learning definitions
    • - learning is the acquition of new knowledge or info
    • - memory- the retention of learned info
    • - declarative memory- memory for facts and events - easy to form and easy to forget, can be recalled for conscious recollection
    • - procedural memory- memory for skills and behaviour - hard to learns, requires repitition, hard to forget, can be recalled without conscious recollection
  17. What is declarative memory?
    • - immediate memory (fractionsof seconds)
    • - limited capacity
    • - requires continuous rehearsal
    • - use and lose
    • Working memory (sec-min) - a more elaborate form of short term memory- perhaps a reflection of multiple short term memory systems
    • Long term memory (days to years)- unlimited capacity, doesnt require continuous rehearsal, use or lose
  18. memory formation and storage
    • - hippocampus is critical to forming declarative memories
    • - the memories are stored ealsewhere- in association cortex

    So in an alzheimers pt they have wasting of the hippocampus
  19. Alzheimers
    • - prefontal lobe wasting- loss of speech/ language, function, behavious and emotional state
    • - wasting of hippocampus- wasting of memory
  20. Where and what does the orbitofrontal cortex?
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  21. Medial prefrontal cortex
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  22. Dorsolateral prefrontal cortex
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