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Running head: GLOSSARY
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ACT on Alzheimer’s
Alzheimer’s Disease Curriculum
Glossary
GUIDELINES FOR AND RESTRICTIONS ON USE OF CURRICULUM MODULES
This curriculum was created for faculty across multiple disciplines to use in existing coursework
and/or to develop a stand-alone course in dementia. Due to the fact that not all modules will be
used for all disciplines, topics have been divided into ten modules that can be used alone or in
combination with other modules. Users may reproduce, combine, and/or customize any module
text and accompanying teaching slides to meet course needs. Our only restriction on re-use is
that the modules not be sold in their current or modified form.
NOTE: Recognizing that not all modules will be used with all potential audiences, there is some
duplication across the modules to ensure that key information is contained in each module (e.g.,
screening module is completely duplicated in the diagnosis module because the diagnosis module
is not appropriate for all audiences).
© 2012
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Acknowledgement
We gratefully acknowledge our funding organizations, which made development of this
curriculum possible: The Alzheimer’s Association MN/ND Chapter and The Minnesota
Area Geriatric Education Center (MAGEC), which is housed in the University of MN
School of Public Health, and is funded by the Health Resources and Services
Administration (HRSA).
We also specially acknowledge the principal drafters of one or more curriculum modules,
including Mike Rosenbloom, MD, Olivia Mastry, MPH, JD, Gregg Colburn, MBA and
The Alzheimer’s Association.
In addition, we would like to thank the following contributors and the peer review team:
Michelle Barclay, MA
Terry Barclay, PhD
Marsha Berry, MA, CAEd
Erin Hussey, DPT, MS, NCS
Helen Kivnik, PhD
Kenndy Lewis, MS
Riley McCarten, MD
Teresa McCarthy, MD, MS
Lynne Morishita, GNP, MSN
Becky Olson-Kellogg, PT, DPT, GCS
Jim Pacala, MD, MS
Nicole Rennie
Patricia Schaber, PhD, OTR/L
John Selstad
Erica Tung, MD, MPH
Jean Wyman
This curriculum is available for use and/or customization by anyone, as long as it is not
sold in its current or modified form.
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Overview of Alzheimer’s Disease Curriculum
This module is part of the Alzheimer’s Disease Curriculum developed by ACT on Alzheimer’s.
ACT on Alzheimer’s is a statewide, voluntary collaboration that includes over 50 organizations
and 150 individuals seeking to prepare for the budgetary, social, and personal impacts of
Alzheimer’s disease. All of the modules can be found online at www.ACTonALZ.org
Module I:
Disease Description
Module II:
Demographics
Module III:
Societal Impact
Module IV:
Effective Interactions
Module V:
Cognitive Assessment and the Value of Early Detection
Module VI:
Screening
Module VII: Disease Diagnosis
Module VIII: Quality Interventions
Module IX:
Dementia as an Organizing Principle of Care
Module X:
Caregiver Support
Module XI:
Alzheimer’s Disease Research
Module XII: Glossary
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Module XII
Glossary
Activities of Daily Living (ADL’s) – six basic self-care skills that a person with normal
functional abilities can perform without help including: eating, bathing, dressing,
toileting, transferring, and continence.
Alzheimer's disease (AD) – a progressive degenerative disease of the brain that
causes impairment of memory, loss of function, and progressive deterioration in
cognitive domains including language, perceptual skills, attention, construction,
orientation, and problem solving.
Amyloid precursor protein (APP) – the larger protein from which beta-amyloid
is formed.
ApoE gene – a gene that codes for a protein that carries cholesterol to and within cells;
different forms of the ApoE gene are associated with differing risks for late-onset
Alzheimer's disease. This gene may be referred to as a risk factor gene or a "susceptibility
gene" because one form of the gene, called APOE4, is associated with the risk of
developing late onset AD.
Amnestic – characterized by memory problems; amnestic MCI is a subtype in which
memory problems are the most important feature.
Aricept® (Donepezil) – one of a group of drugs called cholinesterase inhibitors approved
by the U.S. Food and Drug Administration to treat the symptoms of Alzheimer's disease.
Other approved drugs of the type commonly being prescribed are Razadyne®
(galantamine) and Exelon® (rivastigmine). Another medication called Namenda®
(mementine) is a different type of drug, an N-methyl D-asparate (NMDA) antagonist, and
is prescribed to delay some of the symptoms of moderate to severe Alzheimer's disease.
Assisted Living – facilities for adults who need help with everyday tasks such as
dressing, eating, bathing, or using the bathroom, but who don't require full-time nursing
care. Some facilities have special units for memory-impaired residents.
Axon – the extension from a neuron that transmits outgoing signals to other neurons.
Beta-amyloid (A-beta) – derived from the amyloid precursor protein and found in
plaques, the insoluble deposits outside neurons.
Beta-amyloid plaque – a largely insoluble deposit found in the space between nerve cells
in the brain. The plaques in Alzheimer's disease are made of beta-amyloid and other
molecules, surrounded by non-nerve cells (glia) and damaged axons and dendrites from
nearby neurons.
Biomarkers blood-brain barrier – a barrier that prevents most large molecules, red and
white blood cells, and disease-causing organisms (such as bacteria) in the bloodstream
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from moving into the brain. The barrier is formed by a type of glial cell aided by tight
junctions that act like little "spot welds" between adjacent endothelial cells that constitute
the lining of brain blood vessels.
Brain-derived neurotrophic factor (BDNF) – a growth factor that stimulates survival,
growth, and adaptability of some neurons. Increased levels in some brain regions are
related to physical exercise, in animal experiments.
Capillaries – billions of tiny blood vessels in the brain that carry oxygen, glucose (the
brain's principal source of energy), nutrients, and hormones like insulin to brain cells so
they can do their work, and remove carbon dioxide and cell waste products.
Cerebral cortex – the outermost layer of the cerebral hemispheres sometimes referred
to as the gray matter. It is composed of neurons and nerve fibers and associated support
cells called glia.
Cerebrospinal fluid (CSF) – the fluid found in and around the brain and spinal cord.
Its function is to transport substances to and away from the brain itself and to cushion
the brain hydraulically. Measuring cerebrospinal fluid and its contents helps scientists
understand chemistry of the brain. CSF is collected by a procedure called lumbar
puncture.
Cholesterol – chromosomes’ threadlike structures in the nucleus of a cell that contain
the DNA. Sequences of DNA make up genes. Most human cells have twenty-three
pairs of chromosomes containing a total of approximately thirty thousand genes.
Clinical Dementia Rating (CDR) – a numeric scale used to quantify the severity of
symptoms of dementia (i.e. stage).
Clinical trial – a research study involving humans; these studies rigorously test the
safety, side effects, and the effectiveness of a medication or behavioral treatment.
Cognition – conscious thought and mental activity, including learning, perceiving,
making decisions, and remembering.
Cognitive reserve – the brain's ability to operate effectively even when some damage
to cells or brain cell communications has occurred.
Computed tomography (CT) scan – a diagnostic procedure that uses special X-ray
equipment and computers to create cross-sectional pictures of the body.
Delusion – an abnormal mental state characterized by false beliefs that persist despite the
facts. People with Alzheimer's may experience delusions that cause them to feel
suspicious or paranoid.
Dementia – a broad term referring to a decline in cognitive function that interferes with
daily life and activities. Alzheimer's disease is one form of dementia.
Dendrite – a branch-like extension of a neuron that receives messages from other
neurons.
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Diabetes – chronic metabolic disorder in which the body doesn't produce or properly
use insulin, a hormone that is made in the pancreas and is essential for the healthy
functioning of all cells in the body.
Diagnostics and Statistical Manual-IV(DSM-IV TR) – a diagnostic manual published
by the American Psychiatric Association that provides a common language and standard
criteria for the classification of mental disorders including Alzheimer’s Disease.
DNA (deoxyribonucleic acid) – DNA forms two long, intertwined, thread-like strands
called chromosomes. Each cell has 46 chromosomes in 23 pairs, which are found in the
nucleus. The DNA in chromosomes is made up of four chemicals, or bases, strung
together in various sequence patterns. The DNA in nearly all cells of an individual is
identical. Each chromosome contains many thousands of segments, called genes.
Early-onset Alzheimer's disease – a rare form of AD that usually affects people between
ages thirty and sixty. It is called familial AD (FAD) if it runs in the family.
Entorhinal cortex – an area within the brain where damage from AD often begins.
Epidemiological study – a study of the causes, distribution, and control of disease
in populations, with emphasis on investigating relationships between personal
characteristics (demographic, socioeconomic, lifestyle, biological, and genetic) and
occurrence of disease.
Enzyme – a protein that causes or speeds up a biochemical reaction.
Free radical – a highly reactive molecule (typically oxygen or nitrogen) that combines
easily with other molecules because it contains an unpaired electron. The combination
with other molecules sometimes damages cells.
Functional MRI (fMRI) – an adaptation of an MRI (see magnetic resonance imaging)
technique that measures brain activity during a mental task, such as one involving
memory, language, or attention.
Geriatric Depression Scale (GDS) – a screening measure for depression in older adults.
Genetic risk factor – a variant in a cell's DNA that does not cause a disease by itself but
may increase the chance that a person will develop a disease.
Glial cell – a type of brain cell that supports, protects, or nourishes neurons. One form
of glia is called microglia and they appear to be part of an inflammatory response that
helps the brain clear accumulating beta amyloid.
Hachinski Ischemia Score – a screening tool used to differentiate vascular causes of
dementia from neurodegenerative causes. A score of ≥7 is suggestive of a vascular
etiology.
Hallucination – a false perception experienced by some people with Alzheimer's, in
which they see, hear, smell, taste, and/or feel something that isn't there.
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Hippocampal formation – a structure in the brain that plays a major role in learning
and memory and is involved in converting short-term to long-term memory. Also called
the hippocampus.
Hospice Care – end-of-life care focused on providing comfort and support rather than
curing disease, it is provided by health professionals and volunteers. Hospice care can
take place at home, at a hospice center, in a hospital, or in a skilled nursing facility.
Instrumental Activities of Daily Living (IADL’s) – life functional tasks that include:
obtaining food, housecleaning, cooking, managing medications, phone usage, and doing
laundering.
Inflammation – the process by which the body responds to cellular injury by attempting
to eliminate foreign matter and damaged tissue.
Insulin resistance – a condition in which the pancreas makes enough insulin, but the
cells do not respond properly to it; characterizes and precedes type 2 diabetes.
Late-onset Alzheimer's disease – the most common form of AD. It occurs in people
aged sixty and older.
Magnetic resonance imaging (MRI) – a diagnostic and research technique that uses
magnetic fields to generate a computer image of internal structures in the body.
Memory – the process of which information is encoded, stored, and retrieved.
Metabolism – all the chemical processes that take place inside the body. In some
metabolic reactions, complex molecules are broken down to release energy. In others, the
cells use energy to make complex compounds out of simpler ones (like making proteins
from amino acids).
Microtubule – an internal support structure for cells including a neuron that guides
organelles and molecules from the body of the cell to the end of the axon.
Mild Alzheimer’s disease – an early stage of the disease that include symptoms such as
repeating statements, getting lost, mood changes, poor judgment, and troubles handling
money.
Mild cognitive impairment (MCI) – a condition in which a person has cognitive
problems greater than those expected for his or her age. Amnestic MCI includes memory
problems, but not the personality or other cognitive problems that characterize AD.
Mini Mental State Exam (MMSE) – a 30 point cognitive screening tool that assesses
orientation, working memory, short term memory, visuospatial construction, and
language.
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Moderate Alzheimer’s disease – stage of the disease that includes symptoms such as
memory loss, confusion, problems recognizing friends and family, impulse control, and
difficultly completing tasks that have several steps like cooking or dressing.
Mutation – a permanent change in the DNA of a cell that can affect the structure of a
protein to such an extent that it causes a disease.
Myelin – whitish layers of compacted glial cell membranes that surround and insulate an
axon, allowing the axon to transmit electrical messages more rapidly from the cell body
to the synapse.
National Institute of Neurological and Communicative Disorders and Stroke and the
Alzheimer’s Disease and Related Disorders Association (NINCDS-ADRDA) criteria
– criteria used to diagnose definite, probable, possible, and unlikely Alzheimer’s disease
for research and clinical purposes. These criteria specify eight cognitive domains that may
be impaired in AD: memory, language, perceptual skills, attention, constructive abilities,
orientation, problem solving, and functional abilities. These require that symptoms are
confirmed by neuropsychological testing or screening in probable AD.
Neurodegenerative disease – a disease characterized by a progressive decline in the
structure and function of brain tissue. These diseases include AD, Parkinson's disease,
frontotemporal lobar degeneration, and dementia with Lewy bodies. They are usually
more common in older people.
Neurofibrillary tangle – a collection of twisted and hyperphosphorylated tau found in
the cell body, axons, and dendrites of a neuron in AD.
Neurologist – a physician trained in diagnosing and treating diseases of the nervous
system, including diseases of the brain, spinal cord, nerves, and muscles.
Neuron – a nerve cell.
Neurotransmitter – a chemical messenger between neurons. These substances are
released by the axon of one neuron and excite or inhibit activity in a neighboring neuron.
Nonamnestic – not characterized by memory problems; nonamnestic MCI is
characterized by declines in other cognitive skills and is not thought to be an early stage
of Alzheimer's disease.
Nucleus – the structure within a cell that contains the chromosomes and controls many of
the cell's activities.
Oligomers – clusters of a small number of beta-amyloid peptides.
Oxidative damage – damage that can occur to cells when they are exposed to too many
free radicals.
Pathology – structural and functional changes to cells and tissues of the body that result
from a disease process.
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Positron Emission Tomography (PET) – an imaging technique using radioisotopes
that allows researchers to observe and measure activity in different parts of the brain by
monitoring blood flow and concentrations of substances such as oxygen and glucose, as
well as other specific constituents of brain tissues.
Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) –
a validated neurocognitive battery measuring immediate and delayed memory,
attention, language, and visuospatial skills.
Severe Alzheimer’s disease – the last stage of the disease that includes symptoms such
as weight loss, inability to communicate, lack of bowel and bladder control, and difficulty
swallowing.
Skill Nursing Facility – also known as a nursing home or a long-term care facility, a
facility for adults who need help with all Activities of Daily Living (ADL’s) and fulltime nursing care is provided. Some facilities have special units for memory-impaired
residents.
Sundowning – behavioral problems such as restlessness, agitation, and irritability that
occur in people with dementia typically at the end of the day and sometimes into the
night. Doctors are not certain what causes sundowning, but it can be troubling for
caregivers.
Support Group – a group that provides members with information and assistance by
sharing experiences and concerns, and factual information. Some are moderated by
health professionals, while others have peer leaders. Caregivers often find support
groups helpful, and they may meet in person or sometimes online. There are now
groups to address the special issues of people who are diagnosed at the earliest stages
of Alzheimer's disease.
Susceptibility Gene – a variant in a cell's DNA that does not cause a disease by itself but
may increase the chance that a person will develop a disease.
Synapse – the tiny gap between nerve cells across which neurotransmitters and nerve
signals pass.
Tangles – a protein that helps to maintain the structure of microtubules in normal nerve
cells. Abnormal tau is a principal component of the paired helical filaments in
neurofibrillary tangles.
Tau – a protein that helps to maintain the structure of microtubules in normal nerve cells.
Abnormal tau is a principal component of the paired helical filaments in neurofibrillary
tangles.
Transgenic – an animal that has had a gene (such as the human APP gene) inserted into
its chromosomes for the purpose of research. Mice carrying a mutated human APP gene
often develop plaques in their brains as they age.
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