Normal aging changes --> MCI --> Dementia/AD

Not everyone will go through

MCI and Dementia/AD are pathologic changes

Synaptic connections ↓ efficiency --> normal memory impairment

Plaques (space between) and tangles (inside) normal but extent and location dependent

mostly occur in visual and verbal memory, visuospatial abilities, immediate memory, and ability to name objects

Brain can change based on environmental stimuli

Happens regardless of age but may take longer

Lazy brain --> more likely to develop AD

Each hour increase in watching TV in mid-adulthood --> 1.3x risk of developing AD

Generate cognitive sweat - crosswords, social interactions, etc.

Acquired knowledge/expertise (prior experience)

Increases through 9th decade

Problem solving, spatial manipulation, mental speed, short term memory storages

Reaches peak duing adolescence, ↓ rapidly in adulthood

Affected by neuro injury, genetics, aging

When combined need for resources > total amout of attention capacity available...

1. 2' task could suffer in performance, speed or quality while 1' task relatively unaffected

2. 2' task could be unaffected while 1' task suffered

3. Both 1' and 2' suffer together

4. 2' task prevented while 1' task in progress

interval of time that elapses b/t presentation of 1 possible stimulus & beginning of its associated response

shorter when 1 stim, 1 resp

M > F w/ choice RT

Dr. Leach's invention

multidirectional, procedural learning, diveded attention as opposed to dual task

A&O x 4 (person, place, time, situation)

MMSE

MOCA

Naming, mini-cog, describe similarities between 2 items, trail-making test

attention & executive function

MCI/AD cutoff = <26

more variation w/ progression of disease

time frame for memory=5min

Cognitive impairment

None = 24-30

Mild = 18-24

Severe = 0-17

repeat: apple, watch, penny

draw clock: 45 mins past 10 o'clock

ask to repeat words

items recalled: 3=normal, 1-2 normal clock=negative, 1-2 abnormal clock=positive

Dx: memory complaints, normal ADLs, normal general cognitive functioning, abnormal cog measures using age-related education-adjusted norms

Subjective gradual decline in memory for at least 6mo

performance at -1 SD norm

2-31% develop dementia - best predictors=verbal/visuospatial and memory

Acquired and persistent changes in cog function

Memory loss AND at least 1: aphasia, apraxia, agnosia, disturbance of executive functioning

African American

AD

Vascular - multiple mini-strokes

Neurodegenerative/Lewy Body/Frontotemporal - more executive functioning problems, impulsive

Cortical, progressive, primary

Memory, language, visual-spatial, indifference, delusions, agitation

most common type of dementia

usually late onset, only 5% early

age biggest risk factor

most die 8-10yrs after dx, of aspiration pneumonia 2' decline in swallowing

Cortical

Relative preservation of memory and visual-spatial, personality change, executive dysfunction, excessive eating/drinking, loss of language skills

Subcortical, progressive

Visual hallucinations, delusions, extrapyramidal symptoms, fluctuating mental status, sensitivity to antipsychotic meds

Cortical or subcortical

Abrupt onset, stepwise deterioration, executive dysfunction, gait changes

Symptoms: inattention, distractability, drowsiness

Onset/progression: sudden

Memory changes: limited insight into cognitive deficits

Physical function: interferes with daily function depending on severity

Symptoms: initially alert but gradually develops amnesia, aphasia, agnosia, etc. w/ no signs of illnes

Onset/progression: gradual

Memory changes: variable complaints that are general or no awareness

Physical function: interferes with ADLs/IADLs

Symptoms: sadness, ahedonia, crying, cognition normal on testing

Onset/progression: unclear

Memory changes: more likely to complain about memory loss

Physical function: may interfere