15 - AD clinical Flashcards
dementia: def
loss of mental function (memory, learning, orientation, insight, judgement, language) that is severe enough to interfere with daily functioning and quality of life
how many ppl with AD (canada + alberta?)
quarter of a million in canada; 40 000 in AB, 12 000 in edmonton
criteria for diagnosis of probably AD
interference w/ ability to function; not explained by delerium or major psych disorder. cognitive impairment involving 2: memory, reasoning, language, visuospacial function, personality, behaviour, learning
2 examples of cognitive tests
MOCA: montreal cognitive assessment. MMSE mini mental status exam, not as sensitive or specific but scores are adjusted based on age/education
5 potential biomarkers for AD
AB accumulation = abnormal tracer retention, decreased CSF AB. neuronal degeneration = increased CSF tau, decreased FDG uptake on PET, atrophy on MRI.
differential digaonsis examples
depression, delirium, mild cognitive impairment, other dementias
ABCs?
want history of: activities of daily living, behavioural changes, cognitive changes
5 things that may defer AD?
cognitive activity, physical activity, social engagement, dietary management, vascular risk factor management
non modifable risk factors for AD
age, genetics
3 causative genes? what other genes associated?
PSEN1 and PSEN2 and APP = early onset. sporadic: apoE4, sortilin related receptor gene
6 other likely risk factors
vascular (smoking, diabetes, BP, cholesterol). depression . obesity. mild cognitive impairment. decreased social engagement. decreased physical activity.
mediterranean diet benefits?
lowers risk of cardiovascular disease. associated with decreased AD risk
physical activity benefits?
observational studies: more physically active = lower risk for dementia, strongest effect on attention and executive function
3 examples of cognitive intervention
cognitive stimulation. rehabilitation. training.
primary, secondary, tertiary functions of training?
1: enhance cognitive reserve + risk reduction in healthy adults. 2: restoration function to prevent further decline. 3: slow rate of decline
what is training (cogn intervention)?
repetitive practice directly training specified cognitive processes like memory, attention and problem solving
what cogn. interventions worked best?
grou based, frequent and longer than 30 mins
drug therapy for AD?
cholinesterase inhibitors for symptomatic treatment of mild to moderate AD: doesn’t cure
drug therapy: if you stop? what is essential? toleration?
benefits lost in 6 weeks with stopping. early and continuous treatment essential. if one drug can’t be tolerated, can be switched to another
6 side effects of CI
risk of blackouts. GI problems. incontinence. headaches. nightmares. dystonia.
memantine: does what? why?
blocks glutamate at NMDA-Rs: because damaged nerve cells release glutamtate = excitotoxic calcium influx, cell death
therapies that don’t work
statins, gingko biloba, estrogen, vitamin E/B, anti-inflammatories, omega-3
other therpaeutic strageies
neurotrophic/neuroprotective agents, IV-Ig, intranasal insulin, DBS, TMS, epigenetic modifiers, mitochondria targeted therapies
what behaviours are less likely to respond to medications
wandering, pacing, exit seeking, repetitive mannerisms, inappropriate verbalization, hoarding, inappropriate disrobing or defacation, eating unedibles, resistance to care
