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Early Detection of Cognitive Disorders
Early Detection of Cognitive Disorders

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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?

By: marina-yarberry
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Early Detection of Cognitive Disorders - Description


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 Download Presentation

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