Robin J Heinrichs PhD LP Neuropsychologist amp Assistant Professor Director of Neuropsychology Laboratory Thinking All the things our brain does to help us do things learn things ID: 320598
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Slide1
Early Detection of Cognitive Disorders
Robin J. Heinrichs, Ph.D., LP Neuropsychologist & Assistant Professor Director of Neuropsychology LaboratorySlide2
ThinkingAll the things our brain does to help us do things, learn things,
and verbalize and understand others.What is cognition?Slide3
ComprehensionVerbal fluencySolving problems
Switching between tasksAbstract thinkingSequencing activitiesTo name a few …
Learning
Memory
Attention
Speed of processing
Visuospatial abilities
PlanningSlide4
Processing speed … influences …Attention
Word-findingMemory Cognitive flexibilityLess efficient at learning new informationTherefore poorer recall30 years and after …Does cognition change
with
age
?
Slide5
Not impairmentNoticeableAnnoyingFunction fine
Normal/typical agingSlide6
Decline is worseningInterferes with functioningOthers around us concerned
What could this be?DementiaWhen to be concerned?Slide7
Dementia is an enduring decline in cognition that interferes with functioning in everyday living.
American Psychological AssociationWhat is dementia?Slide8
Dementia is an enduring decline in cognition that interferes with functioning in everyday living.
American Psychological AssociationChanges are worsening, often gradually over timeDifferent types of dementia follow different patterns of declineSlide9
Dementia is an enduring decline in cognition that interferes with functioning in everyday living.
American Psychological AssociationSome portion of cognitive abilities have declinedPattern of decline varies depending on the causeDecline is in more than one area of cognitionSlide10
Dementia is an enduring decline in cognition that interferes with functioning
in everyday living. American Psychological AssociationThe change in cognitive functioning must be severe enough to make it harder for the individual to carry out activities of daily livingManaging financesManaging medicationMaintaining a calendar and going to appointments on timePreparing mealsSlide11
If decline in cognitive abilities and difficulty functioning are severe enough = DementiaCognitive decline that is 2 standard deviations below previous
Decline in more than one cognitive domainA diagnosis of Dementia does not tell you what is causing the decline.Dementia is a
general
d
iagnosisSlide12
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.Slide13
Allow the individual to plan and make decisions for themselves before they are unable to do soAllow the patient and family to ensure safety and well-being over timeFuture – hope is that treatments will be found to intervene early in the
disease (pre-clinical)Early detection benefitsSlide14
Alzheimer’s disease
Frontotemporal diseaseVascular diseaseParkinson’s diseaseLewy body
Other
Types of
dementiaSlide15
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 laterAlzheimer’s disease (AD)Slide16
Best Predictors of AD – Preclinical StageNaming & fluencyVerbal memory
Abstract reasoningGradual decline in memory for new = Best preclinical predictor Slide17
Clinical AD cognitive impairments:Learning and memory
Trouble naming and verbal fluencyVisuospatial abilitiesCarrying out tasks (apraxia)Executive functioning (problem-solving, sequencing, set-shifting, concept formation, abstract thinking)Lack of awareness of impairment (agnosia)Slide18
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 promiseSlide19
First notice trouble remembering things - May repeat the same questions or storiesDamage to the temporal lobe of brain
Temporal
lobeSlide20
The frontal lobe experiences damage next.This causes problems with executive functioning.
FocusingMulti-taskingProblem solvingStaying on track with a taskSwitching between tasksAbstract thinkingComprehension of complex information
Frontal
lobeSlide21
Course of AD:Gradual decline in abilitiesIncreasing need for assistance
First with independent tasks - finances and medication managementThen daily tasks like dressing and bathingCourse of disease varies and can range from six to fifteen years. Slide22
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)Slide23
Executive functioning changes:Focusing without distractionPlanning and sequencing
Solving problemsComprehending complex informationMultitasking Focus on unimportant details and missing the big picturePersonality changesOften looks like a psychiatric disorderFTD looks differentSlide24
Of all changes, changes in personality are often the most upsetting to familiesFailure to inhibit inappropriate behaviors, e.g. loud, rude comments in front of others that do not bother the patient
Inappropriate sexual comments to othersFlattened reaction to emotional events, e.g. when spouse is upset they do not reactOR … more easily irritated or upset, more often tearfulSlide25
Primary progressive a
phasiaForm of FTDTrouble 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.Slide26
Course of FTD:Gradual decline in cognitive and functional abilitiesGradually increasing need for assistance with tasks
Because trouble carrying out tasks is primary difficulty, assistance is often needed earlier in the diseaseCourse varies from several years to ten years.Slide27
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
dementiaSlide28
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.Slide29
Important!Cognitive decline in
vascular dementia is more sudden than AD or FTD.Insult … then cognitive decline … then some recovery … left with enduring deficitStep-wise declineIf no more vascular insults occur cognitive abilities will not decline more.
BUT … past
CV disease makes future CV disease more likely.Slide30
Parkinson’s disease – not all incur cognitive declineHuntington’s
diseaseMultiple sclerosisLewy body diseaseAnoxic insult
Other
causes
of
dementia Slide31
Patient or family mention …
Personality change More irritable More laid backTearfulDisinhibitedLack of motivation, interest in thingsLack of awareness of any deficits
Difficulty getting along with others
Work is harder now
Poor review or criticism from boss at work
Signs to
look
f
orSlide32
Takes longer to figure things out
Patient stopped fixing things around house, quit using computer, etc.Patient stopped reading or other activities they used to doFinancial problems, late bills or trouble with bankCar accidents or tickets; doesn’t like to drive now
Repeating themselves or asking others the same questions; forgettingSlide33
Schedule a neuropsychological evaluationKUSM Memory and Cognition Clinic293-3850
7829 E. Rockhill, Wichita KS 67206Then what?