GLOSSARY2
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).
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© 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.
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
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 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.
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.
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, thecells 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.
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.
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 full-time 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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