Neuropsychology of Memory: Alzheimer's and Dementia

Hi there, my name is Dr. Doe Buckley and it is my pleasure to welcome you to this video where we will discuss neuropsychology of memory and Alzheimer's and dementia in particular. So just to provide you with a little bit of an overview, this is kind of an outline of the lecture. So first we're going to define dementia. And we're going to talk about the four different types of dementia. We're also going to talk about the warning signs and risk factors associated with Alzheimer's in particular. We're going to talk about the neural substrates of Alzheimer's or how it affects the brain. Then we're going to talk about specific memory impairments associated with Alzheimer's disease. And then we'll talk about how Alzheimer's is diagnosed and treated. So dementia is an umbrella term describing symptoms that occur when the brain is affected by disease. They are typically progressive conditions and often associated with aging, although earlier forms of dementia do occur. There is a range of types of which the following are the most common. So Alzheimer's is the most common cause of dementia. And it accounts for 60 to 80% of dementia cases. And I want to pause here and just let you know that I have videos linked throughout the lecture to provide some supplementary information. So what I would like you to do is download the PowerPoint slides from Canvas and then just play the presentation as if you were presenting, and that will enable you to click on the links. Vascular dementia is typically caused by reduced oxygen supply to the brain that may lead to cell death. So vascular dementia typically follows a stroke or more gradually through a series of many strokes. Dementia with Lewy bodies is a condition associated with Parkinson's disease. So it's comprised of not only motor deficits, but also memory deficits and deficits in vision as well. So it's named for the small spherical structures called Lewy bodies that develop inside nerve cells, leading to the degeneration of neural tissue. So initial symptoms tend to be visual or vision loss as opposed to memory problems. And it's been suggested that it may be related to dementia that sometimes occurs with Parkinson's disease. So, again, it also includes disruption of motor symptoms. There's also a lot of symptoms of anxiety and depression with dementia with Lewy bodies. And sometimes there can be disruptions. with reality. So for example, hallucinations can develop. And in fact, this was the condition that Robin Williams was diagnosed with prior to his unfortunate suicide. Frontotemporal dementia involves sort of global neural death. That's particularly concentrated in the frontal and temporal lobes, and it results in dramatic changes in behavior and personality, and it also leads to a lot of difficulties with language. It's relatively rare, but a highly publicized case was Bruce Williams. He developed this condition, and that's why he retired early from acting. is that he couldn't memorize lines that were given to him for various movies. And in fact, the last film that he participated in, the director actually had him wear an earpiece, and each line was repeated to him multiple times, and then essentially he would repeat it or parrot it back. Semantic dementia involves progressive loss of semantic memory. So this typically presents as failing to comprehend both words and pictures. And it typically develops as a result of atrophy of the temporal lobes, particularly the frontotemporal region. And it's relatively rare, but it has resulted in sort of a flourishing of research into the domain of semantic memory, so much so that we now know a lot about how semantic memory typically operates as a result of these patients. So what are the early warning signs associated with Alzheimer's disease? Well just like any other neuropsychological disorder, Really what we're looking for is a significant loss of function, right? And specifically a loss of function that was present, you know, prior to the development of the disease, obviously. So the first thing we notice with Alzheimer's is a loss of well-learned skills that were present previously. To the extent that it... inhibits one's ability to perform kind of standard actions, right? So what we see is memory loss that causes difficulty performing, for example, job skills and also difficulty performing familiar tasks, right? So job skills might be a sudden inability to, for example, interact with a particular computer program, right? So, for example, my mom is a, was a, she's retired now, but she was an admin assistant for a real estate company, right? And real estate companies have, you know, you think we at Mercer have a lot of programs. We have Canvas. We have Mercer, right? Well, if you're a real estate, you have even more specialized programs for like posting houses. that are up for sale and checking taxes and millage rates and stuff like that. So, for example, if someone was in that position for 30 years and suddenly couldn't remember how to calculate taxes or post a new house that was available, that would be indicative of the development of Alzheimer's potentially. Just like somebody who is a long haul trucker, right? If they suddenly can't remember how to drive in Atlanta traffic, that would be potentially indicative of Alzheimer's. Also difficulty just performing familiar tasks. So maybe difficulty answering the phone or difficulty, you know, operating a... a computer or, you know, difficulty trying to think of everyday tasks, but difficulty doing familiar things, right? Another example of Alzheimer's that's a little bit less diagnostic is problems with language, right? And this can be a tricky one because pretty much after the age of 55, when you are an aging person, you're going to have a lot of trouble with language. So, person, often one of the symptoms of aging is difficulty with language, specifically a subclinical form of aphasia where you just have difficulty retrieving common words. So you have difficulty, for example, and you substitute the incorrect word. So for example, saying table instead of chair. bread instead of tread or something like that, right? But with typical aging, one would be able to correct themselves quickly, right? And not say, oh, I meant chair, not table, right? Whereas individuals with Alzheimer's may not notice the error and they might have difficulty expressing themselves or engaging in conversation in a way that's noticeable. One of the most common symptoms of early Alzheimer's is also disorientation to time and place, right? So really what this looks like is suddenly the individual is late for appointments, right? And even regularly scheduled appointments. So, for example, they're late to pick up their grandkids. They're late for Sunday dinner, right? Or maybe they're going to a familiar location that they've been to many, many times and they suddenly can't remember how to get there. Right. And kind of a similar manifestation of this is misplacing things. Right. So misplacing, for example, your keys or your purse. Right. And then that is also something that we see with typically developing people. Right. But this misplacing of objects can happen even when you put them away very recently or even when you have a very typical place in your home where you would put these objects. And so in addition to these difficulties with finding things and finding a location and using language and using familiar skills, We also have difficulty that is kind of localized to dysfunction in the prefrontal cortex, right? So that could be changes in mood and behavior, changes in personality, problems with abstract thinking, maybe poor or decreased judgment, right? So, for example, maybe your loved one who is known for being... a good critical thinker suddenly falls for scams, right? So suddenly they're giving their social security number or they're purchasing gift cards for somebody posing as a member of the IRS, right? So these very, very easy to detect scams, suddenly they're falling victim to, right? So that would be another example of some of the symptoms of Alzheimer's. Also very similar to other types of mental health disorders, we see loss of initiative, right? So someone who was at one time very active and got up early in the morning and walked their dog, maybe read a book, always cooked their meals, suddenly has difficulty sort of getting up in the morning. and sort of starting their day, right? So we see that a lot with bipolar and major depressive disorder and even disorders like schizophrenia, right? And that's also present in Alzheimer's, which is why a lot of individuals with Alzheimer's are also diagnosed, or excuse me, are also provided mild antidepressants for the same reason as sort of coping with those changes in mood. initiative. So those are some of the warning signs, early warning signs of Alzheimer's. So when it comes to risk factors for Alzheimer's disease, the greatest known risk factor is actually age, right? So increasing age even though like I said these disorders are not part of normal aging, right? But because Alzheimer's disease is a disease process that results from deterioration of the brain, right? The older you are, the more susceptible you are to that neural degeneration. So most individuals with Alzheimer's who don't have the early onset forms of Alzheimer's typically develop it after the age of 65. And after the age of 85, the risk actually reaches nearly one third. So 33 percent of individuals older than 85 are at risk to develop Alzheimer's. Like a lot of neuropsychological disorders, Alzheimer's is also somewhat heritable. Right. So another risk factor of. developing Alzheimer's disease is family history, right? So if you have a parent, a brother or sister with Alzheimer's, you are more likely to develop the disease yourself. And the risk increases if you have more than one family member with the illness. So Alzheimer's tends to run in families, although both heredity or your genes and environment play a role. in the development of the disease. Another risk factor for Alzheimer's disease, given that it is a neurodegenerative condition, is if you have a head injury, right? So if you sustain many concussions over the years or you have a traumatic brain injury, then that puts you at risk to develop some form of dementia, including Alzheimer's disease. So another really significant risk factor for Alzheimer's disease is a lack of heart health. So some of the strongest evidence links brain health to heart health. And the connection makes sense because the brain is nourished by one of the body's richest networks of bloods and vessels, and the heart is responsible for pumping blood through these vessels to the brain. So the risk of developing either Alzheimer's or vascular dementia appears to be increased by many conditions that damage the heart and the blood vessels. These include heart disease, diabetes, stroke, high blood pressure, and high cholesterol. So what's actually encouraging about that is these are all conditions that can be relatively well managed. prior to the development of Alzheimer's disease. So this is an example of a preventable risk factor, whereas obviously increasing age and family history are not preventable. So this is what we mean when we talk about genetic risk versus environmental risk. And one of the really interesting forms of research that has been done is looking at donated brain tissue from people that have passed away from Alzheimer's disease. And the connection in this case was very clear. So the characteristic tangles that develop as a result of Alzheimer's disease are much more likely to occur in brains that have been damaged by stroke, for example. So having a stroke... greatly increases your chance of developing either vascular dementia or Alzheimer's disease. So now we're going to talk a little bit more about how Alzheimer's affects the brain. So as we know, the brain is endowed with billions of neurons, each of which has an axon and connects to many other neurons via the dendrites. And so to stay healthy, Neurons must communicate with each other, carry out metabolic and repair functions among themselves. And unfortunately, Alzheimer's disease develops all three of these very essential jobs. So the two sort of neural markers of Alzheimer's disease are beta amyloid plaques and neurofibrillic. Neurofibrillary tangles. And so beta amyloid plaques are dense deposits of protein and cellular material that accumulate outside of the nerve cells. So the beta amyloid plaques are the nature of the disease process that affects neural communication. Tangles are twisted fibers that build up. inside the nerve cells. So these are the deposits that actually disrupt normal functioning of the neuron, metabolic functions, repair functions, and that they also affect the nucleus of the cell, which contains all of the machinery that are important for the functioning of the cell. So essentially the development of tangles causes neural death. So on this slide I have a picture of a PET scan of the brain of a healthy patient versus a patient with Alzheimer's disease. And high brain activity is indicated by the color orange and low activity is represented as blue and black. So the scan on the right shows a reduction of both function and blood flow in both sides of the brain, which is a feature seen in Alzheimer's disease. So Alzheimer's disease progresses through a series of stages, and those stages are indicative of specific changes, both structural and cellular, within the brain. So we call preclinical Alzheimer's disease sort of the earliest stage. And, um... Signs of Alzheimer's disease in terms of the neural substrates begin in an area of the brain called the interhinal cortex and then progress to the hippocampus. So the interhinal cortex is an area of the medial temporal lobe and its functions include being a widespread network hub for memory, navigation and the perception of time. Right. So that's understandable when we think about a lot of the earliest symptoms of Alzheimer's disease, being difficulty navigating in familiar locations, often being chronically late for appointments, and so difficulty with navigation and perception of time makes sense. And so affected regions of the interhinal cortex, neurons, begin to shrink and die, again as a result of those neurofibrillary tangles. And changes in the interhinal cortex typically begin 10 to 20 years before symptoms actually appear. And memory loss is, of course, the first sign of Alzheimer's disease. So mild to moderate Alzheimer's disease, begins to develop when neurons and structures in the cerebral cortex start to shrink and more neurons stop working and die, right? So mild Alzheimer's disease includes signs such as memory loss, confusion, trouble handling money, poor judgment, mood changes, and increased anxiety. which is again why selective serotonin reuptake inhibitors and norepinephrine uptake inhibitors can be really helpful in the treatment of alzheimer's disease because it combats those mood changes and increased anxiety and also the loss of volition or initiative moderate alzheimer's disease progresses when we have increased memory loss and confusion, problems recognizing familiar people, difficulty with language and thoughts, restlessness, agitation, wandering, and repetitive statement. In severe Alzheimer's disease, we see extreme shrinkage and atrophy that occurs all throughout the brain. And at this stage, patients are gonna be completely dependent on others for care. So symptoms can include weight loss, seizures, and because of a decreased movement, we often see like bed sores and skin infections. Because verbal speech is no longer present, we often see groaning and moaning or grunting. There's a lot of pervasive difficulty sleeping, whether that means not getting enough sleep or sleeping too much. There's a loss of bladder control that accompanies deterioration of not just the cerebral cortex, which is the more recently evolved part of the brain, but also the early or primate brain, as it's sometimes called. So there can be difficulty with basic respiration and also control of involuntary muscles and death. typically occurs either as a result of sepsis or severe infection or aspiration pneumonia as a result of weakening of the lungs and the heart and caregivers at this point would consider hospice and other forms of palliative care so now let's discuss how each of the memory systems are impacted by alzheimer's disease Right. So let's start with episodic memory. Right. So so episodic memory is the memory system that we use when we're consciously remembering a particular episode of our life, such as, you know, if we received a marriage proposal or the day that we got married or our first day of college, things like that. And episodic memory is very, very sensitive to the effects of both aging and is extremely disruptive in Alzheimer's disease. And it's the first memory system to show the decline in both normal and pathological aging, like Alzheimer's and dementia. So very early in the disease, we see episodic memory become affected when symptoms such as... Missing appointments, misplacing keys, and also paying bills late, right? And individuals and their family members often treat these instances as occasional and maybe sort of innocuous incidents of forgetfulness, and they even attribute it to normal aging, right? So distraction or senior moments. But in fact, this is indicative of early Alzheimer's disease in some cases. So one of the interesting things that we see in Alzheimer's disease, which we also see in the amnesic syndromes, such as those that affected He Miliacin or HM, for example, we see that for the most part, by the time Alzheimer's disease is diagnosed, patients are likely to show a substantial effect in episodic memory, whether measured by recall or recognition. whether we use verbal or visual material, or even sort of real world examples of memory processes. So, for example, having people memorize a grocery list or something like that. Right. So all of these different processes, no matter how we measure them, are going to be impacted in Alzheimer's disease. And we also see a decline of. Primacy effects, right? So primacy effects are in healthy patients, we would see better memory for items presented early in a list than items in the middle of the list. And this is, of course, a function of long-term memory, right? So we're able to rehearse those early items. And so we, in effect, transfer them into long-term memory prior to the recall test. And this is very much disrupted even in the early stages of Alzheimer's disease. And eventually recency effects will decline as well. OK, so what about semantic memory? Well, again, semantic memory is our memory system for conceptual or factual knowledge, such as the color of broccoli or the purpose of a fork. Right. and studies have consistently shown that semantic memory is also disrupted in alzheimer's disease and patients exhibit particular deficits when it comes to naming both words and objects and there are a multitude of different explanations for this one of the explanations is that there's simply a breakdown of the semantic network so there's a failure to kind of create this integrated network where different concepts are stored in accordance with their properties. There's a breakdown of that. There might also be a loss of access or an inability to retrieve concepts and categories, or both might be true. So one of the interesting, one of the most interesting. case studies that have ever been published with respect to semantic memory loss in Alzheimer's disease is the case study of Oxford philosopher and novelist Iris Murdoch. So this was described in a paper by Gerard and colleagues in 2005. And so basically, they took different novels that she had written. and they compared the sentence content and structure in one of her early novels prior to the onset of alzheimer's disease. So they compared Flight from the Enchanter, which is a novel, and also The Sea, and The Sea was her final novel. So they compared, sorry, Flight of the Enchanter, which... with The Sea and her final novel, Jackson's Dilemma. And they found that her last novel was considerably shorter in terms of the sentence content, and there were more high-frequency words suggesting that she was adapting to her growing language constraints. So as the disease progressed, her linguistic problems increased, including word-finding difficulties, which she avoided by circumlocutions. So circumlocutions, for example, would be describing a bus as something carried along, right? So something carried along that goes down a road, right, would be a circumlocution because you can't think of the word, right? The also showed major problems in word definition, right? And her spelling deteriorated with the words such as cruise, which we would spell C-R-U-I-S-E, being written as cruise, C-R-E-W-E-S. And her capacity to generate pictures or items from a given semantic category, such as animals, was increasingly impaired, right? So an example of a semantic impairment would be, tell me the names of all the animals you can think of, or tell me the names of all the vegetables you can think of. And that becomes increasingly difficult as semantic memory is disrupted. We also see deficits in implicit memory, right? So, Explicit memory includes both episodic and semantic memory, whereas implicit memory includes things like classical conditioning, motor memory, procedural memory, things like that. And so one of the first studies published showing these kinds of deficits were conducted in the 1980s. So for example, Handel and colleagues tested patients with Alzheimer's disease. on something called the pursuit rotor task, which requires them to hold a stylus and keep the stylus continuously or consistently in contact with a moving target. And they found that the patients performed less well initially, but they improved at the same rate as an elderly group. And similarly, Moskowitz in 1982 found a little impairment in the rate at which Alzheimer's patients learned to read mirror-reversed words. So the data is somewhat mixed, right? So this would suggest that similar to amnesic syndromes such as HMs, for example, implicit memory is relatively preserved. But other evidence suggests that it can be impaired in certain contexts. So, for example, Fleshman and colleagues found normal priming in a lexical decision task. So when they were, for example, given a sequence of letters and they had to decide if it was a real word or not, they showed normal performance. However, when they tested implicit memory with STEM completion. So, for example, patients were shown a word such as stamp and asked to guess a word beginning with ST, they didn't show improved performance relative to a condition where they didn't see the word stamp, right? So in general, patients with Alzheimer's disease tend to show intact priming on automatic tasks, but reduced priming on more complex tasks, right? So when you're required to remember an earlier episode in order to benefit from the priming condition, they fail to show that benefit. Studies also indicate that several forms of classical conditioning is impaired in Alzheimer's patients. So for example, fear conditioning and eye blink conditioning is very much disrupted, which makes sense because... Fear conditioning is dependent upon the amygdala, which is a structure that's adjacent to the hippocampus and the interhinal cortex. So fear conditioning, for example, an example of fear conditioning is eye blink conditioning. So for example, any time that you see a particular color light or hear a tone, there's a blast of air being sort of injected into your eye. So that's an example. Or when you see a light or hear a tone and there's suddenly a loud noise, that would also be an example of fear conditioning. And both of those paradigms have shown significant reduction in fear conditioning among patients with Alzheimer's disease. So we also see a less severe disruption of working memory, but patients with Alzheimer's disease do show reliable deficits in both the digit span task and the course of course I blocking test, which is the test of the visual spatial sketchpad. So patients are able to maintain small amounts of material over an unfilled delay, right? But when the delay is filled with an articulatory suppression task, where, for example, the patients have to say the, the, the over and over again, and therefore can't rehearse the information in their verbal working memory or their phonological loop, they're going to rapidly forget. Whereas, um, healthy elderly patients. show a decline only when the task that fills the delay is challenging. So they would be able to remember after articulatory suppression, but they would have difficulty if they had to count back by threes, for example. And what that suggests is that short-term memory remains relatively preserved. So simply engaging in rehearsal, you're able to do that. But for more complex or attentional demanding forms of working memory, that is disrupted in Alzheimer's disease. So when someone suspects that they may have Alzheimer's disease, how do neuropsychologists go about assessing them? Most tests of Alzheimer's include what are called cognitive status tests. Cognitive status tests are mental cognitive testing that evaluates all sorts of aspects of cognition. It can include memory, thinking, problem solving. Some of the tests are quite brief, while others can be much more intensive and complex. And more comprehensive... Mental cognitive status tests are often given by, like I said, a neuropsychologist, and those more complex tests can evaluate things like executive function, judgment, attention, and language. Such tests are intended to give a sense of whether the patient is aware of symptoms, whether they are oriented to time and space, so do they know the date, the time, and where they are. And also, can they remember a short list of words, follow instructions, and do simple calculations? So one of the most common types of cognitive tests are the mini mental status or mental state exam and the mini cog test. So the MMSC and the mini cog test are the most commonly used assessments. So during the MMSE, a health professional asks the patient a series of questions designed to test a range of everyday memory skills. So the maximum MMSE score is 30 points. A score of 20 to 24 suggests mild dementia, 13 to 20 suggests moderate dementia, and less than 12 indicates severe dementia. The average MMSC score of a person with Alzheimer's declines 2 to 4 points every 6 months to a year. So just to give you a sense of what these tests are like, for the mini cognitive exam, this is the shorter one, a person is asked to complete two tasks. So for example, they're asked to remember and a few minutes later repeat the names of three common objects. And they're also asked to draw a clock face with all 12 numbers showing and the hands at a time specified by the experimenter. So at this point in the video, if you do have the PowerPoint open, I would encourage you to watch the two videos. So the first video is... from the clinician's perspective, sort of going over what questions are asked with someone just pretending to be a patient. And then the second video is an actual patient being tested with this mini-cog exam. and the MMSE as well. So now let's talk about what pharmacological treatments are available in the treatment of Alzheimer's. So the US Food and Drug Administration has approved medications that fall into two categories. Drugs that actually change disease progression in people with Alzheimer's and drugs that are designed to manage the symptoms. associated with Alzheimer's disease. So for example, drugs that actually attempt to slow disease progression, one example is aducanumab, which is an anti-amyloid antibody IV infusion therapy. And so basically it works by targeting the beta-amyloid protein. And this is the one that forms in the brain and accumulates into plaques, right? So these plaques are going to disrupt communication between nerve cells in the brain and may also activate immune system cells that trigger inflammation and devour disabled nerve cells. So while scientists actually aren't sure what causes cell death and tissue loss during the course of Alzheimer's disease, amyloid plaques are one of the hallmarks of the disease and are one of its potential contributors. So aducanumab is the first therapy to demonstrate that removing amyloid proteins from the brain is reasonably likely to reduce the cognitive and functional declines that are associated with the early stages of the disease. Other drugs that can help manage symptoms are cholinesterase inhibitors. So these drugs work to treat the symptoms related to memory, thinking, language, and judgment, and other thought processes. Essentially what these drugs attempt to do is prevent the breakdown of acetylcholine. So one of the hallmarks of Alzheimer's disease is reduced acetylcholine. And acetylcholine is going to be really important for both learning and memory. So these drugs support communication between nerve cells, reducing these declines. Other drugs that can help manage symptoms are glutamate regulators. So glutamate regulators are prescribed, and obviously they improve a wide variety of cognitive functions. And this drug works by regulating the amount of glutamate, which is one of the chemical messengers that gets disrupted in Alzheimer's disease. So other than the pharmacological options, what are some of the other interventions that can be effective in Alzheimer's disease? And again, I would encourage you to watch the videos linked in this slide. External memory aids are very, very helpful. So, for example, using message boards or calendars, right, that allows caregivers to not have to answer as many repetitive questions as they would have to without those external memory aids. And a related approach uses other aids in the environment to help the patient. So, for example, Moffitt in 1989, they wrote up a case study of a patient who was constantly misplacing both his glasses and his tobacco pipe. And so his frustration level was reduced by a training that basically got him a little orange bag and told him to always keep those items in the orange bag. And so with repeated training and instances, He was eventually able to recall that the orange bag contains those items, and so he wouldn't lose them as frequently. So simple things like that, manipulating the environment so that there are more retrieval cues present is a really effective treatment in the early and moderate stages of Alzheimer's disease. Another really promising and interesting form of treatment is something called reality orientation training. And again, I would encourage you to watch the video linked in the slide. And that involves helping patients become oriented to time and place. So this is, again, something that gets really disrupted in Alzheimer's disease as a result of degradation and episodic memory. So again, another case study written up by an occupational therapist tells the story of an elderly man who was admitted to a hospital. And that hospital was a very old but sort of grand Victorian building. And so he was he didn't have Alzheimer's disease, but he did have global amnesia. And rather than interpreting his situation as that he was in the hospital due to his memory difficulties, he thought that he was actually on vacation. And so what they tried to do with this patient is they put a calendar in his room. And you can do any number of things. You can put a calendar in there and say, you know, it's Wednesday, July 17th. You can talk about maybe the weather that day, is it sunny or rainy, and also of course the date. And so this worked with the patient to some extent. So he knew the date and he announced the name of the hospital, but he sort of winked and said, but I know I'm really at a grand hotel at the seaside. So, even with those external cues, there can still sort of be disruption. Another really effective environmental sort of manipulation with Alzheimer's disease is something called reminiscence therapy. So, reminiscence therapy is again harnessing environmental cues to help promote recollection of lost memories. The easiest way to implement reminiscence therapy is to have patients, with the help of their family members, create a scrapbook with old photographs, right? And those photographs can help serve as retrieval cues for them to access memories of specific people and experiences. But nursing homes and care facilities have actually taken it one step further. And you'll be able to see this in the linked video where they've actually created wings of the nursing home that So the first the first hospital to do this was actually in Los Angeles And so what they did is they they enlisted the help of set designers Who worked, you know in Hollywood and built sets for plays and TV shows and movies? And they actually built an apartment that was fashioned to resemble an apartment in the 1940s. And so they had a little living room and a kitchen with all of the, you know, fixtures and appliances from back then. And so for many of the patients coming into this area and having these familiar objects and also playing music, the radio from that period served to kind of jog their memories and in fact there was one instance of a college student who went to visit her grandmother and her grandmother hadn't recognized her in many many years and wasn't really able to engage in conversation but she but she was in a nursing home that did this And when she went into the kitchen and sat with her granddaughter, she started to tell her stories of, you know, helping her mom with the laundry and the cooking and different sort of household chores they did back then. And at the end of this encounter, her grandmother actually told her goodbye and knew her name. So in some cases, this can, reminiscence therapy can be very powerful. And again, that's effective for not only Alzheimer's and dementia, but also other causes of global amnesia. OK, so I apologize. We couldn't talk more about this. Honestly, Alzheimer's and dementia is such a fruitful area of research. And there's and there's such complexity and and many different avenues that we could sort of progress talking about it. But hopefully you found it interesting and informative. And certainly, like I said, go back and watch those videos. And if you have any questions, please don't hesitate to reach out. So I hope you enjoyed this video and I hope I will get a chance to interact with you soon. Take care.

We're also going to talk about the warning signs and risk factors associated with Alzheimer's in particular. We're going to talk about the neural substrates of Alzheimer's or how it affects the brain. Then we're going to talk about specific memory impairments associated with Alzheimer's disease.

And then we'll talk about how Alzheimer's is diagnosed and treated. So dementia is an umbrella term describing symptoms that occur when the brain is affected by disease. They are typically progressive conditions and often associated with aging, although earlier forms of dementia do occur.

There is a range of types of which the following are the most common. So Alzheimer's is the most common cause of dementia. And it accounts for 60 to 80% of dementia cases.

And I want to pause here and just let you know that I have videos linked throughout the lecture to provide some supplementary information. So what I would like you to do is download the PowerPoint slides from Canvas and then just play the presentation as if you were presenting, and that will enable you to click on the links. Vascular dementia is typically caused by reduced oxygen supply to the brain that may lead to cell death. So vascular dementia typically follows a stroke or more gradually through a series of many strokes.

Dementia with Lewy bodies is a condition associated with Parkinson's disease. So it's comprised of not only motor deficits, but also memory deficits and deficits in vision as well. So it's named for the small spherical structures called Lewy bodies that develop inside nerve cells, leading to the degeneration of neural tissue.

So initial symptoms tend to be visual or vision loss as opposed to memory problems. And it's been suggested that it may be related to dementia that sometimes occurs with Parkinson's disease. So, again, it also includes disruption of motor symptoms.

There's also a lot of symptoms of anxiety and depression with dementia with Lewy bodies. And sometimes there can be disruptions. with reality. So for example, hallucinations can develop. And in fact, this was the condition that Robin Williams was diagnosed with prior to his unfortunate suicide.

Frontotemporal dementia involves sort of global neural death. That's particularly concentrated in the frontal and temporal lobes, and it results in dramatic changes in behavior and personality, and it also leads to a lot of difficulties with language. It's relatively rare, but a highly publicized case was Bruce Williams. He developed this condition, and that's why he retired early from acting.

is that he couldn't memorize lines that were given to him for various movies. And in fact, the last film that he participated in, the director actually had him wear an earpiece, and each line was repeated to him multiple times, and then essentially he would repeat it or parrot it back. Semantic dementia involves progressive loss of semantic memory. So this typically presents as failing to comprehend both words and pictures. And it typically develops as a result of atrophy of the temporal lobes, particularly the frontotemporal region.

And it's relatively rare, but it has resulted in sort of a flourishing of research into the domain of semantic memory, so much so that we now know a lot about how semantic memory typically operates as a result of these patients. So what are the early warning signs associated with Alzheimer's disease? Well just like any other neuropsychological disorder, Really what we're looking for is a significant loss of function, right?

And specifically a loss of function that was present, you know, prior to the development of the disease, obviously. So the first thing we notice with Alzheimer's is a loss of well-learned skills that were present previously. To the extent that it...

inhibits one's ability to perform kind of standard actions, right? So what we see is memory loss that causes difficulty performing, for example, job skills and also difficulty performing familiar tasks, right? So job skills might be a sudden inability to, for example, interact with a particular computer program, right? So, for example, my mom is a, was a, she's retired now, but she was an admin assistant for a real estate company, right? And real estate companies have, you know, you think we at Mercer have a lot of programs.

We have Canvas. We have Mercer, right? Well, if you're a real estate, you have even more specialized programs for like posting houses. that are up for sale and checking taxes and millage rates and stuff like that.

So, for example, if someone was in that position for 30 years and suddenly couldn't remember how to calculate taxes or post a new house that was available, that would be indicative of the development of Alzheimer's potentially. Just like somebody who is a long haul trucker, right? If they suddenly can't remember how to drive in Atlanta traffic, that would be potentially indicative of Alzheimer's.

Also difficulty just performing familiar tasks. So maybe difficulty answering the phone or difficulty, you know, operating a... a computer or, you know, difficulty trying to think of everyday tasks, but difficulty doing familiar things, right?

Another example of Alzheimer's that's a little bit less diagnostic is problems with language, right? And this can be a tricky one because pretty much after the age of 55, when you are an aging person, you're going to have a lot of trouble with language. So, person, often one of the symptoms of aging is difficulty with language, specifically a subclinical form of aphasia where you just have difficulty retrieving common words.

So you have difficulty, for example, and you substitute the incorrect word. So for example, saying table instead of chair. bread instead of tread or something like that, right? But with typical aging, one would be able to correct themselves quickly, right? And not say, oh, I meant chair, not table, right?

Whereas individuals with Alzheimer's may not notice the error and they might have difficulty expressing themselves or engaging in conversation in a way that's noticeable. One of the most common symptoms of early Alzheimer's is also disorientation to time and place, right? So really what this looks like is suddenly the individual is late for appointments, right? And even regularly scheduled appointments. So, for example, they're late to pick up their grandkids.

They're late for Sunday dinner, right? Or maybe they're going to a familiar location that they've been to many, many times and they suddenly can't remember how to get there. Right.

And kind of a similar manifestation of this is misplacing things. Right. So misplacing, for example, your keys or your purse.

Right. And then that is also something that we see with typically developing people. Right. But this misplacing of objects can happen even when you put them away very recently or even when you have a very typical place in your home where you would put these objects.

And so in addition to these difficulties with finding things and finding a location and using language and using familiar skills, We also have difficulty that is kind of localized to dysfunction in the prefrontal cortex, right? So that could be changes in mood and behavior, changes in personality, problems with abstract thinking, maybe poor or decreased judgment, right? So, for example, maybe your loved one who is known for being...

a good critical thinker suddenly falls for scams, right? So suddenly they're giving their social security number or they're purchasing gift cards for somebody posing as a member of the IRS, right? So these very, very easy to detect scams, suddenly they're falling victim to, right?

So that would be another example of some of the symptoms of Alzheimer's. Also very similar to other types of mental health disorders, we see loss of initiative, right? So someone who was at one time very active and got up early in the morning and walked their dog, maybe read a book, always cooked their meals, suddenly has difficulty sort of getting up in the morning. and sort of starting their day, right? So we see that a lot with bipolar and major depressive disorder and even disorders like schizophrenia, right?

And that's also present in Alzheimer's, which is why a lot of individuals with Alzheimer's are also diagnosed, or excuse me, are also provided mild antidepressants for the same reason as sort of coping with those changes in mood. initiative. So those are some of the warning signs, early warning signs of Alzheimer's.

So when it comes to risk factors for Alzheimer's disease, the greatest known risk factor is actually age, right? So increasing age even though like I said these disorders are not part of normal aging, right? But because Alzheimer's disease is a disease process that results from deterioration of the brain, right? The older you are, the more susceptible you are to that neural degeneration. So most individuals with Alzheimer's who don't have the early onset forms of Alzheimer's typically develop it after the age of 65. And after the age of 85, the risk actually reaches nearly one third.

So 33 percent of individuals older than 85 are at risk to develop Alzheimer's. Like a lot of neuropsychological disorders, Alzheimer's is also somewhat heritable. Right. So another risk factor of.

developing Alzheimer's disease is family history, right? So if you have a parent, a brother or sister with Alzheimer's, you are more likely to develop the disease yourself. And the risk increases if you have more than one family member with the illness.

So Alzheimer's tends to run in families, although both heredity or your genes and environment play a role. in the development of the disease. Another risk factor for Alzheimer's disease, given that it is a neurodegenerative condition, is if you have a head injury, right? So if you sustain many concussions over the years or you have a traumatic brain injury, then that puts you at risk to develop some form of dementia, including Alzheimer's disease. So another really significant risk factor for Alzheimer's disease is a lack of heart health.

So some of the strongest evidence links brain health to heart health. And the connection makes sense because the brain is nourished by one of the body's richest networks of bloods and vessels, and the heart is responsible for pumping blood through these vessels to the brain. So the risk of developing either Alzheimer's or vascular dementia appears to be increased by many conditions that damage the heart and the blood vessels.

These include heart disease, diabetes, stroke, high blood pressure, and high cholesterol. So what's actually encouraging about that is these are all conditions that can be relatively well managed. prior to the development of Alzheimer's disease.

So this is an example of a preventable risk factor, whereas obviously increasing age and family history are not preventable. So this is what we mean when we talk about genetic risk versus environmental risk. And one of the really interesting forms of research that has been done is looking at donated brain tissue from people that have passed away from Alzheimer's disease. And the connection in this case was very clear. So the characteristic tangles that develop as a result of Alzheimer's disease are much more likely to occur in brains that have been damaged by stroke, for example.

So having a stroke... greatly increases your chance of developing either vascular dementia or Alzheimer's disease. So now we're going to talk a little bit more about how Alzheimer's affects the brain. So as we know, the brain is endowed with billions of neurons, each of which has an axon and connects to many other neurons via the dendrites. And so to stay healthy, Neurons must communicate with each other, carry out metabolic and repair functions among themselves.

And unfortunately, Alzheimer's disease develops all three of these very essential jobs. So the two sort of neural markers of Alzheimer's disease are beta amyloid plaques and neurofibrillic. Neurofibrillary tangles. And so beta amyloid plaques are dense deposits of protein and cellular material that accumulate outside of the nerve cells.

So the beta amyloid plaques are the nature of the disease process that affects neural communication. Tangles are twisted fibers that build up. inside the nerve cells.

So these are the deposits that actually disrupt normal functioning of the neuron, metabolic functions, repair functions, and that they also affect the nucleus of the cell, which contains all of the machinery that are important for the functioning of the cell. So essentially the development of tangles causes neural death. So on this slide I have a picture of a PET scan of the brain of a healthy patient versus a patient with Alzheimer's disease. And high brain activity is indicated by the color orange and low activity is represented as blue and black. So the scan on the right shows a reduction of both function and blood flow in both sides of the brain, which is a feature seen in Alzheimer's disease.

So Alzheimer's disease progresses through a series of stages, and those stages are indicative of specific changes, both structural and cellular, within the brain. So we call preclinical Alzheimer's disease sort of the earliest stage. And, um...

Signs of Alzheimer's disease in terms of the neural substrates begin in an area of the brain called the interhinal cortex and then progress to the hippocampus. So the interhinal cortex is an area of the medial temporal lobe and its functions include being a widespread network hub for memory, navigation and the perception of time. Right. So that's understandable when we think about a lot of the earliest symptoms of Alzheimer's disease, being difficulty navigating in familiar locations, often being chronically late for appointments, and so difficulty with navigation and perception of time makes sense.

And so affected regions of the interhinal cortex, neurons, begin to shrink and die, again as a result of those neurofibrillary tangles. And changes in the interhinal cortex typically begin 10 to 20 years before symptoms actually appear. And memory loss is, of course, the first sign of Alzheimer's disease. So mild to moderate Alzheimer's disease, begins to develop when neurons and structures in the cerebral cortex start to shrink and more neurons stop working and die, right?

So mild Alzheimer's disease includes signs such as memory loss, confusion, trouble handling money, poor judgment, mood changes, and increased anxiety. which is again why selective serotonin reuptake inhibitors and norepinephrine uptake inhibitors can be really helpful in the treatment of alzheimer's disease because it combats those mood changes and increased anxiety and also the loss of volition or initiative moderate alzheimer's disease progresses when we have increased memory loss and confusion, problems recognizing familiar people, difficulty with language and thoughts, restlessness, agitation, wandering, and repetitive statement. In severe Alzheimer's disease, we see extreme shrinkage and atrophy that occurs all throughout the brain.

And at this stage, patients are gonna be completely dependent on others for care. So symptoms can include weight loss, seizures, and because of a decreased movement, we often see like bed sores and skin infections. Because verbal speech is no longer present, we often see groaning and moaning or grunting. There's a lot of pervasive difficulty sleeping, whether that means not getting enough sleep or sleeping too much. There's a loss of bladder control that accompanies deterioration of not just the cerebral cortex, which is the more recently evolved part of the brain, but also the early or primate brain, as it's sometimes called.

So there can be difficulty with basic respiration and also control of involuntary muscles and death. typically occurs either as a result of sepsis or severe infection or aspiration pneumonia as a result of weakening of the lungs and the heart and caregivers at this point would consider hospice and other forms of palliative care so now let's discuss how each of the memory systems are impacted by alzheimer's disease Right. So let's start with episodic memory. Right.

So so episodic memory is the memory system that we use when we're consciously remembering a particular episode of our life, such as, you know, if we received a marriage proposal or the day that we got married or our first day of college, things like that. And episodic memory is very, very sensitive to the effects of both aging and is extremely disruptive in Alzheimer's disease. And it's the first memory system to show the decline in both normal and pathological aging, like Alzheimer's and dementia.

So very early in the disease, we see episodic memory become affected when symptoms such as... Missing appointments, misplacing keys, and also paying bills late, right? And individuals and their family members often treat these instances as occasional and maybe sort of innocuous incidents of forgetfulness, and they even attribute it to normal aging, right?

So distraction or senior moments. But in fact, this is indicative of early Alzheimer's disease in some cases. So one of the interesting things that we see in Alzheimer's disease, which we also see in the amnesic syndromes, such as those that affected He Miliacin or HM, for example, we see that for the most part, by the time Alzheimer's disease is diagnosed, patients are likely to show a substantial effect in episodic memory, whether measured by recall or recognition.

whether we use verbal or visual material, or even sort of real world examples of memory processes. So, for example, having people memorize a grocery list or something like that. Right.

So all of these different processes, no matter how we measure them, are going to be impacted in Alzheimer's disease. And we also see a decline of. Primacy effects, right? So primacy effects are in healthy patients, we would see better memory for items presented early in a list than items in the middle of the list.

And this is, of course, a function of long-term memory, right? So we're able to rehearse those early items. And so we, in effect, transfer them into long-term memory prior to the recall test.

And this is very much disrupted even in the early stages of Alzheimer's disease. And eventually recency effects will decline as well. OK, so what about semantic memory?

Well, again, semantic memory is our memory system for conceptual or factual knowledge, such as the color of broccoli or the purpose of a fork. Right. and studies have consistently shown that semantic memory is also disrupted in alzheimer's disease and patients exhibit particular deficits when it comes to naming both words and objects and there are a multitude of different explanations for this one of the explanations is that there's simply a breakdown of the semantic network so there's a failure to kind of create this integrated network where different concepts are stored in accordance with their properties.

There's a breakdown of that. There might also be a loss of access or an inability to retrieve concepts and categories, or both might be true. So one of the interesting, one of the most interesting. case studies that have ever been published with respect to semantic memory loss in Alzheimer's disease is the case study of Oxford philosopher and novelist Iris Murdoch.

So this was described in a paper by Gerard and colleagues in 2005. And so basically, they took different novels that she had written. and they compared the sentence content and structure in one of her early novels prior to the onset of alzheimer's disease. So they compared Flight from the Enchanter, which is a novel, and also The Sea, and The Sea was her final novel.

So they compared, sorry, Flight of the Enchanter, which... with The Sea and her final novel, Jackson's Dilemma. And they found that her last novel was considerably shorter in terms of the sentence content, and there were more high-frequency words suggesting that she was adapting to her growing language constraints. So as the disease progressed, her linguistic problems increased, including word-finding difficulties, which she avoided by circumlocutions.

So circumlocutions, for example, would be describing a bus as something carried along, right? So something carried along that goes down a road, right, would be a circumlocution because you can't think of the word, right? The also showed major problems in word definition, right? And her spelling deteriorated with the words such as cruise, which we would spell C-R-U-I-S-E, being written as cruise, C-R-E-W-E-S.

And her capacity to generate pictures or items from a given semantic category, such as animals, was increasingly impaired, right? So an example of a semantic impairment would be, tell me the names of all the animals you can think of, or tell me the names of all the vegetables you can think of. And that becomes increasingly difficult as semantic memory is disrupted. We also see deficits in implicit memory, right? So, Explicit memory includes both episodic and semantic memory, whereas implicit memory includes things like classical conditioning, motor memory, procedural memory, things like that.

And so one of the first studies published showing these kinds of deficits were conducted in the 1980s. So for example, Handel and colleagues tested patients with Alzheimer's disease. on something called the pursuit rotor task, which requires them to hold a stylus and keep the stylus continuously or consistently in contact with a moving target.

And they found that the patients performed less well initially, but they improved at the same rate as an elderly group. And similarly, Moskowitz in 1982 found a little impairment in the rate at which Alzheimer's patients learned to read mirror-reversed words. So the data is somewhat mixed, right?

So this would suggest that similar to amnesic syndromes such as HMs, for example, implicit memory is relatively preserved. But other evidence suggests that it can be impaired in certain contexts. So, for example, Fleshman and colleagues found normal priming in a lexical decision task.

So when they were, for example, given a sequence of letters and they had to decide if it was a real word or not, they showed normal performance. However, when they tested implicit memory with STEM completion. So, for example, patients were shown a word such as stamp and asked to guess a word beginning with ST, they didn't show improved performance relative to a condition where they didn't see the word stamp, right? So in general, patients with Alzheimer's disease tend to show intact priming on automatic tasks, but reduced priming on more complex tasks, right? So when you're required to remember an earlier episode in order to benefit from the priming condition, they fail to show that benefit.

Studies also indicate that several forms of classical conditioning is impaired in Alzheimer's patients. So for example, fear conditioning and eye blink conditioning is very much disrupted, which makes sense because... Fear conditioning is dependent upon the amygdala, which is a structure that's adjacent to the hippocampus and the interhinal cortex.

So fear conditioning, for example, an example of fear conditioning is eye blink conditioning. So for example, any time that you see a particular color light or hear a tone, there's a blast of air being sort of injected into your eye. So that's an example. Or when you see a light or hear a tone and there's suddenly a loud noise, that would also be an example of fear conditioning. And both of those paradigms have shown significant reduction in fear conditioning among patients with Alzheimer's disease.

So we also see a less severe disruption of working memory, but patients with Alzheimer's disease do show reliable deficits in both the digit span task and the course of course I blocking test, which is the test of the visual spatial sketchpad. So patients are able to maintain small amounts of material over an unfilled delay, right? But when the delay is filled with an articulatory suppression task, where, for example, the patients have to say the, the, the over and over again, and therefore can't rehearse the information in their verbal working memory or their phonological loop, they're going to rapidly forget.

Whereas, um, healthy elderly patients. show a decline only when the task that fills the delay is challenging. So they would be able to remember after articulatory suppression, but they would have difficulty if they had to count back by threes, for example.

And what that suggests is that short-term memory remains relatively preserved. So simply engaging in rehearsal, you're able to do that. But for more complex or attentional demanding forms of working memory, that is disrupted in Alzheimer's disease.

So when someone suspects that they may have Alzheimer's disease, how do neuropsychologists go about assessing them? Most tests of Alzheimer's include what are called cognitive status tests. Cognitive status tests are mental cognitive testing that evaluates all sorts of aspects of cognition. It can include memory, thinking, problem solving. Some of the tests are quite brief, while others can be much more intensive and complex.

And more comprehensive... Mental cognitive status tests are often given by, like I said, a neuropsychologist, and those more complex tests can evaluate things like executive function, judgment, attention, and language. Such tests are intended to give a sense of whether the patient is aware of symptoms, whether they are oriented to time and space, so do they know the date, the time, and where they are.

And also, can they remember a short list of words, follow instructions, and do simple calculations? So one of the most common types of cognitive tests are the mini mental status or mental state exam and the mini cog test. So the MMSC and the mini cog test are the most commonly used assessments. So during the MMSE, a health professional asks the patient a series of questions designed to test a range of everyday memory skills.

So the maximum MMSE score is 30 points. A score of 20 to 24 suggests mild dementia, 13 to 20 suggests moderate dementia, and less than 12 indicates severe dementia. The average MMSC score of a person with Alzheimer's declines 2 to 4 points every 6 months to a year.

So just to give you a sense of what these tests are like, for the mini cognitive exam, this is the shorter one, a person is asked to complete two tasks. So for example, they're asked to remember and a few minutes later repeat the names of three common objects. And they're also asked to draw a clock face with all 12 numbers showing and the hands at a time specified by the experimenter.

So at this point in the video, if you do have the PowerPoint open, I would encourage you to watch the two videos. So the first video is... from the clinician's perspective, sort of going over what questions are asked with someone just pretending to be a patient.

And then the second video is an actual patient being tested with this mini-cog exam. and the MMSE as well. So now let's talk about what pharmacological treatments are available in the treatment of Alzheimer's.

So the US Food and Drug Administration has approved medications that fall into two categories. Drugs that actually change disease progression in people with Alzheimer's and drugs that are designed to manage the symptoms. associated with Alzheimer's disease.

So for example, drugs that actually attempt to slow disease progression, one example is aducanumab, which is an anti-amyloid antibody IV infusion therapy. And so basically it works by targeting the beta-amyloid protein. And this is the one that forms in the brain and accumulates into plaques, right? So these plaques are going to disrupt communication between nerve cells in the brain and may also activate immune system cells that trigger inflammation and devour disabled nerve cells.

So while scientists actually aren't sure what causes cell death and tissue loss during the course of Alzheimer's disease, amyloid plaques are one of the hallmarks of the disease and are one of its potential contributors. So aducanumab is the first therapy to demonstrate that removing amyloid proteins from the brain is reasonably likely to reduce the cognitive and functional declines that are associated with the early stages of the disease. Other drugs that can help manage symptoms are cholinesterase inhibitors.

So these drugs work to treat the symptoms related to memory, thinking, language, and judgment, and other thought processes. Essentially what these drugs attempt to do is prevent the breakdown of acetylcholine. So one of the hallmarks of Alzheimer's disease is reduced acetylcholine. And acetylcholine is going to be really important for both learning and memory. So these drugs support communication between nerve cells, reducing these declines.

Other drugs that can help manage symptoms are glutamate regulators. So glutamate regulators are prescribed, and obviously they improve a wide variety of cognitive functions. And this drug works by regulating the amount of glutamate, which is one of the chemical messengers that gets disrupted in Alzheimer's disease. So other than the pharmacological options, what are some of the other interventions that can be effective in Alzheimer's disease?

And again, I would encourage you to watch the videos linked in this slide. External memory aids are very, very helpful. So, for example, using message boards or calendars, right, that allows caregivers to not have to answer as many repetitive questions as they would have to without those external memory aids.

And a related approach uses other aids in the environment to help the patient. So, for example, Moffitt in 1989, they wrote up a case study of a patient who was constantly misplacing both his glasses and his tobacco pipe. And so his frustration level was reduced by a training that basically got him a little orange bag and told him to always keep those items in the orange bag.

And so with repeated training and instances, He was eventually able to recall that the orange bag contains those items, and so he wouldn't lose them as frequently. So simple things like that, manipulating the environment so that there are more retrieval cues present is a really effective treatment in the early and moderate stages of Alzheimer's disease. Another really promising and interesting form of treatment is something called reality orientation training. And again, I would encourage you to watch the video linked in the slide. And that involves helping patients become oriented to time and place.

So this is, again, something that gets really disrupted in Alzheimer's disease as a result of degradation and episodic memory. So again, another case study written up by an occupational therapist tells the story of an elderly man who was admitted to a hospital. And that hospital was a very old but sort of grand Victorian building. And so he was he didn't have Alzheimer's disease, but he did have global amnesia. And rather than interpreting his situation as that he was in the hospital due to his memory difficulties, he thought that he was actually on vacation.

And so what they tried to do with this patient is they put a calendar in his room. And you can do any number of things. You can put a calendar in there and say, you know, it's Wednesday, July 17th. You can talk about maybe the weather that day, is it sunny or rainy, and also of course the date.

And so this worked with the patient to some extent. So he knew the date and he announced the name of the hospital, but he sort of winked and said, but I know I'm really at a grand hotel at the seaside. So, even with those external cues, there can still sort of be disruption. Another really effective environmental sort of manipulation with Alzheimer's disease is something called reminiscence therapy.

So, reminiscence therapy is again harnessing environmental cues to help promote recollection of lost memories. The easiest way to implement reminiscence therapy is to have patients, with the help of their family members, create a scrapbook with old photographs, right? And those photographs can help serve as retrieval cues for them to access memories of specific people and experiences. But nursing homes and care facilities have actually taken it one step further. And you'll be able to see this in the linked video where they've actually created wings of the nursing home that So the first the first hospital to do this was actually in Los Angeles And so what they did is they they enlisted the help of set designers Who worked, you know in Hollywood and built sets for plays and TV shows and movies?

And they actually built an apartment that was fashioned to resemble an apartment in the 1940s. And so they had a little living room and a kitchen with all of the, you know, fixtures and appliances from back then. And so for many of the patients coming into this area and having these familiar objects and also playing music, the radio from that period served to kind of jog their memories and in fact there was one instance of a college student who went to visit her grandmother and her grandmother hadn't recognized her in many many years and wasn't really able to engage in conversation but she but she was in a nursing home that did this And when she went into the kitchen and sat with her granddaughter, she started to tell her stories of, you know, helping her mom with the laundry and the cooking and different sort of household chores they did back then. And at the end of this encounter, her grandmother actually told her goodbye and knew her name.

So in some cases, this can, reminiscence therapy can be very powerful. And again, that's effective for not only Alzheimer's and dementia, but also other causes of global amnesia. OK, so I apologize.

We couldn't talk more about this. Honestly, Alzheimer's and dementia is such a fruitful area of research. And there's and there's such complexity and and many different avenues that we could sort of progress talking about it. But hopefully you found it interesting and informative. And certainly, like I said, go back and watch those videos.

And if you have any questions, please don't hesitate to reach out. So I hope you enjoyed this video and I hope I will get a chance to interact with you soon. Take care.

Transcript for:Neuropsychology of Memory: Alzheimer's and Dementia

Transcript for:
Neuropsychology of Memory: Alzheimer's and Dementia