15 - AD clinical

Question 1

dementia: def

Answer 1

loss of mental function (memory, learning, orientation, insight, judgement, language) that is severe enough to interfere with daily functioning and quality of life

Question 2

how many ppl with AD (canada + alberta?)

Answer 2

quarter of a million in canada; 40 000 in AB, 12 000 in edmonton

Question 3

criteria for diagnosis of probably AD

Answer 3

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

Question 4

2 examples of cognitive tests

Answer 4

MOCA: montreal cognitive assessment. MMSE mini mental status exam, not as sensitive or specific but scores are adjusted based on age/education

Question 5

5 potential biomarkers for AD

Answer 5

AB accumulation = abnormal tracer retention, decreased CSF AB. neuronal degeneration = increased CSF tau, decreased FDG uptake on PET, atrophy on MRI.

Question 6

differential digaonsis examples

Answer 6

depression, delirium, mild cognitive impairment, other dementias

Question 7

ABCs?

Answer 7

want history of: activities of daily living, behavioural changes, cognitive changes

Question 8

5 things that may defer AD?

Answer 8

cognitive activity, physical activity, social engagement, dietary management, vascular risk factor management

Question 9

non modifable risk factors for AD

Answer 9

age, genetics

Question 10

3 causative genes? what other genes associated?

Answer 10

PSEN1 and PSEN2 and APP = early onset. sporadic: apoE4, sortilin related receptor gene

Question 11

6 other likely risk factors

Answer 11

vascular (smoking, diabetes, BP, cholesterol). depression . obesity. mild cognitive impairment. decreased social engagement. decreased physical activity.

Question 12

mediterranean diet benefits?

Answer 12

lowers risk of cardiovascular disease. associated with decreased AD risk

Question 13

physical activity benefits?

Answer 13

observational studies: more physically active = lower risk for dementia, strongest effect on attention and executive function

Question 14

3 examples of cognitive intervention

Answer 14

cognitive stimulation. rehabilitation. training.

Question 15

primary, secondary, tertiary functions of training?

Answer 15

1: enhance cognitive reserve + risk reduction in healthy adults. 2: restoration function to prevent further decline. 3: slow rate of decline

Question 16

what is training (cogn intervention)?

Answer 16

repetitive practice directly training specified cognitive processes like memory, attention and problem solving

Question 17

what cogn. interventions worked best?

Answer 17

grou based, frequent and longer than 30 mins

Question 18

drug therapy for AD?

Answer 18

cholinesterase inhibitors for symptomatic treatment of mild to moderate AD: doesn’t cure

Question 19

drug therapy: if you stop? what is essential? toleration?

Answer 19

benefits lost in 6 weeks with stopping. early and continuous treatment essential. if one drug can’t be tolerated, can be switched to another

Question 20

6 side effects of CI

Answer 20

risk of blackouts. GI problems. incontinence. headaches. nightmares. dystonia.

Question 21

memantine: does what? why?

Answer 21

blocks glutamate at NMDA-Rs: because damaged nerve cells release glutamtate = excitotoxic calcium influx, cell death

Question 22

therapies that don’t work

Answer 22

statins, gingko biloba, estrogen, vitamin E/B, anti-inflammatories, omega-3

Question 23

other therpaeutic strageies

Answer 23

neurotrophic/neuroprotective agents, IV-Ig, intranasal insulin, DBS, TMS, epigenetic modifiers, mitochondria targeted therapies

Question 24

what behaviours are less likely to respond to medications

Answer 24

wandering, pacing, exit seeking, repetitive mannerisms, inappropriate verbalization, hoarding, inappropriate disrobing or defacation, eating unedibles, resistance to care

Question 25

symptoms that respond to medication

Answer 25

depression, apathy, delusions and hallucinations, anxiety, disturbed sleep, sexual disinhibition

Question 26

concl: AD is detected via changes in? what is key? goal is?

Answer 26

ABCs: cognition, behaviour, function. delay onset. focus on specific symptoms + behaviours