Medicine Notes Psychology Notes
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Cognitive disorders of old age
Domains of age related decline
Working memory
Processing speed
Long term memory
Reasoning
But not all cognitive domains are affected by ageing
Crystallised intelligence
Semantic memory- fact store
Skill learning- mirror drawing but it takes longer
Old age diseases
Amnesia
Dementia
Delerium
Old age + Brain atrophy
Hippocampal atrophy – this results in normal learning but impaired transfer
Required for binding/compressing irrelevant information, allowing the subject to focus on relevant features
Individuals with hippocampal atrophy can’t use the previously learned info and so treat the new problem as if it’s completely new
Changes in brain activity with ageing
Overactivity in older relative to younger subjects- this could be due to additional recruitment of neural activity to maintain performance
Hemispheric asymmetry reduction in older adults- due to de-differentiation where there is loss of regional specificity
Posterior-anterior shift in aging (more activitiy) in the frontal regions of the brain)- dynamic ongoing process of plasticity
Dementia
Definition: Set of symptoms including memory loss, mood changes and problems with communicating and reasoning
Diagnosis
Multiple cognitive deficits- e.g memory and executive function
Functional impairment- no longer able to carry out activities of daily living
Clear consciousness
Change from previous level
Long duration >6 months
Types of dementia
Alzheimer’s disease:
60%
caused by amyloid plaques, tau tangles
medial temporal lobe, parietal lobes, sometimes frontal; hippocampal memory deficits
Primary episodic deficit
Fronto-temporal dementia
5-20%
tau, TDP-43, FUS
frontal variant (behaviour)- drastic personality changes, temporal variant (semantic/aphasia)-language difficulties
Vasular dementia
5-15%
vascular pathology
Step wise preogression
Dementia with lewy bodies
2-8%
Lewy bodies
motor symptoms similar to Parkinosim (tremor, rigid muscles, no facial expression), sleep disturbance, visual hallucinations, fluctuating deficits (good and bad days)
Comparisons
AD vs FTD : AD worse on epidosodic memory; FTD fluency tasks worse
Pyramids and palm trees test
FTD due loss of semantic memory- fail to associate palm trees with pyramids
AD fail to remember what they came across before
AD vs VaD
Difficult as VaD can be anywhere
Memory deficit in both cases although worse in AD
Some suggestion that perception-emotion recognition is differentially impaired in VaD
AD vs DLB
DLB-memory is intact but more visual deficit
However all types of dementia reveal that the standard neuropsych tests have a lot of overlap. Diagnostic boundaries not clear
Tests for dementia
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