19. ten warning signs of dementia • Memory loss that affects job skills • Diffi culty performing familiar tasks • Problems with language • Disorientation to time and place • Poor or decreased judgment • Problems with abstract thinking • Misplacing things • Changes in mood or behavior • Changes in personality • Loss of initiative
22. Apoptosis, or programmed cell death, is a highly regulated process that allows a cell to self-degrade in order for the body to eliminate unwanted or dysfunctional cells. During apoptosis, the genome of the cell will fracture, the cell will shrink and part of the cell will disintegrate into smaller apoptotic bodies. Unlike necrosis , where the cell dies by swelling and bursting its content in the area, which causes an inflammatory response, apoptosis is a very clean and controlled process where the content of the cell is kept strictly within the cell membrane as it is degraded [1]. The apoptotic cell will be phagocytosed by macrophages before the cell’s contents have a chance to leak into the neighbourhood [1]. Therefore, apoptosis can prevent unnecessary inflammatory response.
74. Multi-infarct dementia , also known as vascular dementia , is the second most common form of dementia after Alzheimer disease (AD) in older adults. The term refers to a group of syndromes caused by different mechanisms all resulting in vascular lesions in the brain. Early detection and accurate diagnosis are important, as vascular dementia is at least partially preventable .
75. This photo / picture shows mum, who suffered from advanced multi-infarct dementia, shortly before she died.
76. The main subtypes of this disease are: mild cognitive impairment multi-infarct dementia, vascular dementia due to a strategic single infarct (affecting the thalamus , the anterior cerebral artery , the parietal lobes or the cingulate gyrus ), vascular dementia due to hemorrhagic lesions, small vessel disease (which includes vascular dementia due to lacunar lesions and Binswanger's disease ), and mixed Alzheimer's and vascular dementia
77. Vascular lesions can be the result of DIFFUSE cerebrovascular disease or FOCAL lesions (or a COMBINATION OF BOTH, which is what is observed in the majority of cases) .
78. Symptoms The onset of multi-infarct dementia often goes unnoticed in the early stages, particularly if the strokes are minor. If the strokes are minor, symptoms caused by each stroke may include mild weakness in the limbs, slurred speech, dizziness and a slight impairment to the short-term memory, though these do not last for long. However, the cumulative effects of these strokes will eventually result in noticeable symptoms being displayed. These symptoms include: problems with recent memory wandering or getting lost in familiar places walking with rapid, shuffling steps disinhibition, including loss of bladder or bowel control emotional lability difficulty following instructions problems handling money
79. In terms of cognitive testing patients have patchy deficits. They tend to have better free recall and fewer recall intrusions compared with patients with Alzheimer's disease. As small vessel disease often affects the frontal lobes, apathy early in the disease is more suggestive of vascular dementia because it usually occurs in the later stages of 'Alzheimer's'. Consequently patients with vascular dementia perform worse than their Alzheimer's disease counterparts in frontal lobe tasks such as verbal fluency. They also tend to exhibit more perseverative behaviour. They may also present with general slowing of processing ability, difficulty shifting sets and impairment in abstract thinking. In the more severe patients or those patients affected by strategic infarcts in the Wernicke or Broca areas; dysarthrias , dysphasias and aphasias may be present.
80. Lateralizing signs such as hemiparesis , bradykinesia , hyperreflexia , extensor plantar reflexes , ataxia , pseudobulbar palsy , and gait and swallowing difficulties may be observed .
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87. The role of the clinical psychologist in the assessment, diagnosis and Management of patients with dementia
88. Guidelines for the Evaluation of Dementia and Age-related Cognitive Decline
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90. III. Procedural Guidelines: Conducting Evaluations of Dementia and Age-Related Cognitive Decline 6. Psychologists conduct a clinical interview as part of the evaluation. 7. Psychologists are aware that standardized psychological and neuropsychological tests are important tools in the assessment of dementia and age-related cognitive decline. 8. When measuring cognitive changes in individuals, psychologists attempt to estimate premorbid abilities. 9. Psychologists are sensitive to the limitations and sources of variability and error in psychometric performance. 10. Psychologists recognize that providing constructive feedback, support, and education, as well as maintaining a therapeutic alliance, can be important parts of the evaluation process.
91. Key points . Psychological assessment can make a useful contribution in the diagnosis of dementia, but like other methods for detecting dementia is not wholly accurate, and so evidence from psychological assessments needs to be considered in the context of other possible indicators. . Within psychological forms of assessment, tests of memory offer the best single indicator of the presence of dementia. . Psychological assessment is not very useful for discriminating between different forms of dementia.
92. There is good evidence that even people with quite marked levels of dementia are sensitive to environmental influences. For example, even such simple things as the arrangement of furniture can have an effect on the amount of verbal interaction between residents in a residential unit.
93. A number of specially designed forms of intervention for use with those suffering from dementia have been devised. The best known and best validated of these is reality orientation , but even here the gains are limited and short-lived after the programme has been discontinued. Special forms of intervention, such as reality orientation and reminiscence therapy, tend to assume that all those suffering from dementia share a single key disability or feature. This assumption may not be entirely true and the use of more specific forms of psychological intervention of the kinds used with other client groups should be considered in order to address the specific problems of individuals.
99. The Cambridge Neuropsychological Test Automated Battery (CANTAB) is a battery of neuropsychological tests, administered to subjects using a touch screen computer. The 22 tests in CANTAB examine various areas of cognitive function , including: general memory and learning, working memory and executive function , visual memory, attention and reaction time (RT), semantic/verbal memory , and decision making and response control.
100. The CANTAB endeavours to import the accuracy and rigour of computerised psychological testing whilst retaining the wide range of ability measures demanded of a neuropsychological battery. It is suitable for young and old subjects, and aims to be culture and language independent through the use of non-verbal stimuli in the majority of the tests
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102. The CANTAB endeavours to import the accuracy and rigour of computerised psychological testing whilst retaining the wide range of ability measures demanded of a neuropsychological battery. It is suitable for young and old subjects, and aims to be culture and language independent through the use of non-verbal stimuli in the majority of the tests
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104. Halstead-Reitan Battery Definition The Halstead-Reitan Neuropsychological Test Battery is a fixed set of eight tests used to evaluate brain and nervous system functioning in individuals aged 15 years and older. Children's versions are the Halstead Neuropsychological Test Battery for Older Children (ages nine to 14) and the Reitan Indiana Neuropsychological Test Battery (ages five to eight).
105. Purpose Neuropsychological functioning refers to the ability of the nervous system and brain to process and interpret information received through the senses. The Halstead-Reitan evaluates a wide range of nervous system and brain functions, including: visual, auditory, and tactual input; verbal communication; spatial and sequential perception; the ability to analyze information, form mental concepts, and make judgments; motor output; and attention, concentration, and memory. The Halstead-Reitan is typically used to evaluate individuals with suspected brain damage. The battery also provides useful information regarding the cause of damage (for example, closed head injury, alcohol abuse, Alzheimer's disorder, stroke ), which part of the brain was damaged, whether the damage occurred during childhood development, and whether the damage is getting worse, staying the same, or getting better. Information regarding the severity of impairment and areas of personal strengths can be used to develop plans for rehabilitation or care.
108. Muriel Deutsch Lezak is an American neuropsychologist best known for her book "Neuropsychological Assessment", widely accepted as the standard in the field. She holds bachelor's and master's degrees from the University of Chicago, and earned a Ph.D. (Clinical Psychology) from the University of Portland in 1960. Her work has centred on research into, assessment and rehabilitation of brain injury. Muriel Lezak
114. WECHSLER DETERIORATION RATIO HOLD TEST – DON’T HOLD TEST HOLD TEST x 100 10 PERCENT - POSSIBLE 20 PERCENT – TRUE DETERIORATION 30 PERCENT – SEVERE DETERIORATION
