SCD
- Subjectieve complaints over waarneming verslechtering cogn cap
- In werkelijkheid valt het onder de normale NP of andere klinische
measures
- Geen interferen IADL (instrumentele activiteiten in dagelijks leven;
continentie, hygiene, eten, etc)
- Niet te wijten aan andere (psych) condities
- Prev +/- 25% 60+
risk factors for dementia: worry/concern iso complaint, cogn complaints
other than memory, pos biomarkers (APOE), lower MMSE score (mini
mental state examination), higher age
MCI
- Decline greater than expected for age
Revised criteria:
1. Concern about change condition; change larger than expected
2. Evidence impairment 1/more cogn domains: not only memory, 1-2
SD below
3. Preservation independence daily life (or mild difficulties)
4. Not demented = IADL not severe enough to interfere
overlap DSM-5 minor neurodegen disorder: + not due to delirium or axis
1 dis
overlap cognitive imp no dementia (CIND): any cogn dis (not only
memory) for various possible causes, incl. drug use, alcohol abuse,
psychiatric/degen illnesses
Alzheimer NL: 44% gaat over naar dementia binnen 5 jaar, Annual
conversion rate (ACR)
Reversion rate: 20-50% terug naar oude staat: aMCI & MD MCI meest kans
op dementie
AD meds little effect on MCI
Alzheimers Dementia (AD) – cortical dementia
Most prevelant type dementia: 70%, most prevelant in women (APOE 4)
Oorzaak:
- Amyloid plaques (between nerve cells; extra cellular) &
neurofibrillary tangles (within, = dual proteinopathy, misfolding
proteins) Aβ42 formed when protein (amyloid precursor protein)
folds incorrectly.
- Fibres consist of protein, tau, that normally occurs in neurons (in the
microtubules) Protein processed incorrectly, tau molecules clump
together, form tangles, microtubules disintegrate Tangles
interfere with normal cell function
- Insidious onset gradual development symptoms
, Criteria AD:
- Insidious onset
- Worsening cogn functions based on report/observation
- Cong imp in amnestic or nonamnestic presentation (only 1!)
Criteria for major neurocognitive disorders (DSM V)
1. Significant cognitive decline from previous level of performance
based on
report patient or informant AND clear objective deficits (>2 SD
below
appropriate norm population)
1. Cognitive deficits sufficient to interfere with independence
2. Cognitive deficits do not exclusively occur in context of delirium
3. Cognitive deficits can not be attributed to Axis 1 disorder (e.g.
depression
or schizophrenia)
Key impairment = episodic memory (early sign); delayed recall &
recognition
also: semantic mem, EF, lang production, visuospat only later stages
bhvr: apathy, depression, aggression, agitation, sleep disturbances,
irritability
VAD / VCI / CVD- subcortical dementia (deep)
- Prev: 2nd most common! About 16% dementia cases in NL
- Memory is niet altijd het meest aangetast
- Niet altijd in medial temporal areas (verschil AD)
- Stepwise detoriation abrupte verslechtering en daarna stabiel
large vessel
- With white matter/small vessel stroke: more likely insidious onset
Diagnosis VCI/VaD – 2 factors
1. Aanwezigheid cogn imp op neuropsych testen (NINDS; episodic mem
imp)
2. Aanwezigheid CVD op neuroimaging (ongeacht oorzaak)
Relatie tussen cogn imp en CVD = spatial (locatie stroke en functie imp)
& temporal
Criteria major vascular neurocognitive disorder (DSM V)
1. Evidence significant cognitive decline in at least 1 domain
2. Cognitive deficits sufficient to interfere with independence
3. Evidence cerebrovascular disease
4. Onset cognitive deficits temporally related to cerebrovascular event
Large vessel strokes: 30% krijgt VAD binnen 12 maanden
Bijna 50% early stage VCI krijgt dementie binnen 5 jaar
Leeftijd grootste risico factor
- Subjectieve complaints over waarneming verslechtering cogn cap
- In werkelijkheid valt het onder de normale NP of andere klinische
measures
- Geen interferen IADL (instrumentele activiteiten in dagelijks leven;
continentie, hygiene, eten, etc)
- Niet te wijten aan andere (psych) condities
- Prev +/- 25% 60+
risk factors for dementia: worry/concern iso complaint, cogn complaints
other than memory, pos biomarkers (APOE), lower MMSE score (mini
mental state examination), higher age
MCI
- Decline greater than expected for age
Revised criteria:
1. Concern about change condition; change larger than expected
2. Evidence impairment 1/more cogn domains: not only memory, 1-2
SD below
3. Preservation independence daily life (or mild difficulties)
4. Not demented = IADL not severe enough to interfere
overlap DSM-5 minor neurodegen disorder: + not due to delirium or axis
1 dis
overlap cognitive imp no dementia (CIND): any cogn dis (not only
memory) for various possible causes, incl. drug use, alcohol abuse,
psychiatric/degen illnesses
Alzheimer NL: 44% gaat over naar dementia binnen 5 jaar, Annual
conversion rate (ACR)
Reversion rate: 20-50% terug naar oude staat: aMCI & MD MCI meest kans
op dementie
AD meds little effect on MCI
Alzheimers Dementia (AD) – cortical dementia
Most prevelant type dementia: 70%, most prevelant in women (APOE 4)
Oorzaak:
- Amyloid plaques (between nerve cells; extra cellular) &
neurofibrillary tangles (within, = dual proteinopathy, misfolding
proteins) Aβ42 formed when protein (amyloid precursor protein)
folds incorrectly.
- Fibres consist of protein, tau, that normally occurs in neurons (in the
microtubules) Protein processed incorrectly, tau molecules clump
together, form tangles, microtubules disintegrate Tangles
interfere with normal cell function
- Insidious onset gradual development symptoms
, Criteria AD:
- Insidious onset
- Worsening cogn functions based on report/observation
- Cong imp in amnestic or nonamnestic presentation (only 1!)
Criteria for major neurocognitive disorders (DSM V)
1. Significant cognitive decline from previous level of performance
based on
report patient or informant AND clear objective deficits (>2 SD
below
appropriate norm population)
1. Cognitive deficits sufficient to interfere with independence
2. Cognitive deficits do not exclusively occur in context of delirium
3. Cognitive deficits can not be attributed to Axis 1 disorder (e.g.
depression
or schizophrenia)
Key impairment = episodic memory (early sign); delayed recall &
recognition
also: semantic mem, EF, lang production, visuospat only later stages
bhvr: apathy, depression, aggression, agitation, sleep disturbances,
irritability
VAD / VCI / CVD- subcortical dementia (deep)
- Prev: 2nd most common! About 16% dementia cases in NL
- Memory is niet altijd het meest aangetast
- Niet altijd in medial temporal areas (verschil AD)
- Stepwise detoriation abrupte verslechtering en daarna stabiel
large vessel
- With white matter/small vessel stroke: more likely insidious onset
Diagnosis VCI/VaD – 2 factors
1. Aanwezigheid cogn imp op neuropsych testen (NINDS; episodic mem
imp)
2. Aanwezigheid CVD op neuroimaging (ongeacht oorzaak)
Relatie tussen cogn imp en CVD = spatial (locatie stroke en functie imp)
& temporal
Criteria major vascular neurocognitive disorder (DSM V)
1. Evidence significant cognitive decline in at least 1 domain
2. Cognitive deficits sufficient to interfere with independence
3. Evidence cerebrovascular disease
4. Onset cognitive deficits temporally related to cerebrovascular event
Large vessel strokes: 30% krijgt VAD binnen 12 maanden
Bijna 50% early stage VCI krijgt dementie binnen 5 jaar
Leeftijd grootste risico factor
