early detection of cognitive disorders
DESCRIPTION
Early Detection of Cognitive Disorders. Robin J. Heinrichs, Ph.D ., LP Neuropsychologist & Assistant Professor Director of Neuropsychology Laboratory. What is cognition ?. Thinking All the things our brain does to help us do things, learn things, and verbalize and understand others. - PowerPoint PPT PresentationTRANSCRIPT
Early Detection of Cognitive Disorders
Robin J. Heinrichs, Ph.D., LP Neuropsychologist & Assistant
Professor Director of Neuropsychology Laboratory
Thinking All the things our brain does to help us do
things, learn things, and verbalize and understand others.
What is cognition?
Comprehension Verbal fluency Solving problems Switching
between tasks Abstract thinking Sequencing
activities
To name a few …
Learning Memory Attention Speed of
processing Visuospatial
abilities Planning
Processing speed … influences … Attention Word-finding Memory Cognitive flexibility
Less efficient at learning new information Therefore poorer recall 30 years and after …
Does cognition change with age?
Not impairment Noticeable Annoying Function fine
Normal/typical aging
Decline is worsening Interferes with functioning Others around us concerned
What could this be? Dementia
When to be concerned?
Dementia is an enduring decline in cognition that interferes with functioning in everyday living.
American Psychological Association
What is dementia?
Dementia is an enduring decline in cognition that interferes with functioning in everyday living.
American Psychological Association
Changes are worsening, often gradually over time Different types of dementia follow different
patterns of decline
Dementia is an enduring decline in cognition that interferes with functioning in everyday living.
American Psychological Association
Some portion of cognitive abilities have declined Pattern of decline varies depending on the cause Decline is in more than one area of cognition
Dementia is an enduring decline in cognition that interferes with functioning in everyday living.
American Psychological Association
The change in cognitive functioning must be severe enough to make it harder for the individual to carry out activities of daily living Managing finances Managing medication Maintaining a calendar and going to appointments on
time Preparing meals
If decline in cognitive abilities and difficulty functioning are severe enough = Dementia
Cognitive decline that is 2 standard deviations below previous
Decline in more than one cognitive domain
A diagnosis of Dementia does not tell you what is causing the decline.
Dementia is a general diagnosis
Dementia can be caused by many diseases and pathologies that have affected the brain.
Knowing the cause tells us what to expect in the future.
Allow the individual to plan and make decisions for themselves before they are unable to do so
Allow the patient and family to ensure safety and well-being over time
Future – hope is that treatments will be found to intervene early in the disease (pre-clinical)
Early detection benefits
Alzheimer’s disease Frontotemporal disease Vascular disease Parkinson’s disease Lewy body Other
Types of dementia
The best method of early detection of Alzheimer’s disease and other dementing processes is Neuropsychological assessment.
4 years before diagnosis Poorer memory for new information than
others same age = Alzheimer’s diagnosis later
Alzheimer’s disease (AD)
Best Predictors of AD – Preclinical Stage Naming & fluency Verbal memory Abstract reasoning
Gradual decline in memory for new = Best preclinical predictor
Clinical AD cognitive impairments: Learning and memory Trouble naming and verbal fluency Visuospatial abilities Carrying out tasks (apraxia) Executive functioning (problem-solving,
sequencing, set-shifting, concept formation, abstract thinking)
Lack of awareness of impairment (agnosia)
AD is a disease in which nerve cells in the brain degenerate and die
Historically the disease was identified by amyloid plaques and neurofibrillary tangles in the brain upon autopsy
Today we think this is late in the disease and these are found in brains without AD
Research continues with promise
First notice trouble remembering things - May repeat the same questions or stories
Damage to the temporal lobe of brain
Temporal lobe
The frontal lobe experiences damage next.
This causes problems with executive functioning. Focusing Multi-tasking Problem solving Staying on track with a task Switching between tasks Abstract thinking Comprehension of complex
information
Frontal lobe
Course of AD: Gradual decline in abilities Increasing need for assistance
First with independent tasks - finances and medication management
Then daily tasks like dressing and bathing Course of disease varies and can range from
six to fifteen years.
Caused by degeneration and death of nerve cells within the frontal lobes and the temporal lobes. In general caused by loss of neurons and
abnormal amounts or forms of tau proteins in the brain.
FTD is relatively difficult to diagnose as a decline in memory is not associated.
Instead, executive functioning abilities decline.
Frontotemporal disease (FTD)
Executive functioning changes: Focusing without distraction Planning and sequencing Solving problems Comprehending complex information Multitasking Focus on unimportant details and missing the big
picturePersonality changes Often looks like a psychiatric disorder
FTD looks different
Of all changes, changes in personality are often the most upsetting to families Failure to inhibit inappropriate behaviors, e.g.
loud, rude comments in front of others that do not bother the patient
Inappropriate sexual comments to others Flattened reaction to emotional events, e.g.
when spouse is upset they do not react OR … more easily irritated or upset, more often
tearful
Primary progressive aphasia Form of FTD Trouble coming up with what you want to say. Difficulty finding the right word. Pronunciation problems. Paraphasia; saying words that sound like the one
you want. Trouble reading. Difficulty writing.
Course of FTD: Gradual decline in cognitive and functional
abilities Gradually increasing need for assistance
with tasks Because trouble carrying out tasks is primary
difficulty, assistance is often needed earlier in the disease
Course varies from several years to ten years.
Vascular dementia is caused by cerebrovascular disease through any insult to the brain by blocked blood flow or a bleed within the brain. Terms used include: stroke, transient ischemic attack
(TIA), hemorrhage, ischemia, embolism, thrombosis, infarct
These events cause brain cells to die in the affected areas.
This causes cognitive deficits that coincide with the area of insult.
Vascular dementia
For example, if a blockage or bleed occurs in certain areas of the left hemisphere, patient will have difficulty speaking or understanding what is said.
The bigger the area of insult the more cognitive damage.
The longer the anoxic insult or the bleed, the greater the cognitive decline.
Important! Cognitive decline in vascular dementia is more sudden than
AD or FTD. Insult … then cognitive decline … then some recovery … left
with enduring deficit Step-wise decline
If no more vascular insults occur cognitive abilities will not decline more.
BUT … past CV disease makes future CV disease more likely.
Parkinson’s disease – not all incur cognitive decline
Huntington’s disease Multiple sclerosis Lewy body disease Anoxic insult
Other causes of dementia
Patient or family mention … 1. Personality change
More irritable More laid back Tearful Disinhibited Lack of motivation, interest in things Lack of awareness of any deficits
2. Difficulty getting along with others3. Work is harder now4. Poor review or criticism from boss at work
Signs to look for
5. Takes longer to figure things out6. Patient stopped fixing things around house, quit
using computer, etc.7. Patient stopped reading or other activities they
used to do8. Financial problems, late bills or trouble with bank9. Car accidents or tickets; doesn’t like to drive
now10.Repeating themselves or asking others the same
questions; forgetting
Schedule a neuropsychological evaluation KUSM Memory and Cognition Clinic
293-3850 7829 E. Rockhill, Wichita KS 67206
Then what?