Define dementia (>= 2 changes in memory, language function, praxis, visuospatial
abilities, executive functions; often accompanied by disturbance in mood and behavior
Dementia is a global crisis, expected to quadruple in the next 40 years
Definitive diagnosis includes post-mortem identification of "plaques" and "tangles" in
microscopic specimens of brain tissue, together with overall "brain atrophy"
Nearly half of those afflicted are over the age of 85
Explain the importance of identifying mild cognitive impairment, and suggest several
approaches to identifying and predicting mild cognitive impairment (known as MCI):
Using brain imaging techniques and 2., cognitive screening tests based on memory where
MCI individuals are discriminated by their lack of attention to novel images in
preferential looking tasks (that is, they don't remember what they just saw, and therefore
all images seem "novel." )
Can you identify risk factors for neurodegenerative disease ? (age, head trauma,
depression, high blood pressure and high cholesterol, low B12 and folate)
Can you identify protective factors for neurodegenerative disease? (exercise, education,
anti-inflammatory drugs, red wine)
What is known about genetics and Alzheimer's?
There is a rare dominant form that has onset prior to 65 years of age, associated
with proteins known as pressenilins
There is a common, sporadic form of AD associated with the late onset of disease
(>65 years of age); about 40% of these are associated with the protein, Apo E.
The most common hypothesis regarding causation is known as the "Amyloid
Hypothesis" in which the "plaques" visible under the microscope are associated
with aggregated amyloid protein, due to lack of clearance of the amyloid caused
by aberrant function of ApoE
Consider the Barker hypothesis
How does it apply to the evidence for predicting cardiovascular disease?
What is it? Be prepared to give the background, explain the original observations, the
hypotheses, and subsequent observations. How is this viewpoint relevant in today's
world? How does these observations shift the focus in present medical approaches? Give
three examples of organs/systems/disease that could reflect similar prenatal insults.
Describe the insult, give the details of the consequences. Consider interventions that
could be designed and implemented to predict well-being among high-risk populations.
As individuals, what can we do to limit the negative predictive outcomes for our own