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Clinical 2.0 winter > Alzehimers > Flashcards

Alzehimers Flashcards

1
Q

what is dementia

A

decline in mental ability servere enough to interfere with daily activities
a SYMPTOM

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2
Q

brain changes usually start in the hippocampus so the first symptom that presents is

A

selective memory impairment

then progresses to other parts of the brain and get sensory and motor impairment

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3
Q

what are the hallmark brain changes

A

diffuse neuritic plaques
plaques display marked amyloid beta deposition
neurofibillary tangles made up of phosphorylated tau protein

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4
Q

risk factors

A 
age - over 65 
hyperlipidemia 
hypertension 
CVB
genetic - for rare early onset 
physically inactive 
brain trauma 
obese
diabetes
reduced brain capacity
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5
Q

way to distinguish cognitive decline due to normal aging from dememntia

A

dementia forget more recent events
normally aging you are worried about your memory, in dementia the relative are worried but you are not
dementia can forget a family member name

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6
Q

3 essential things neurons must do

A

communicate with each other, carry out metabolism , repair themselves

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7
Q

issues with caregivers for these peopl

A

takes a huge physical and psychological toll on the person caring for someone with alzheimers

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8
Q

when does the pathological processes begin

A

decades before symptoms present

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9
Q

does severity of disease correlate to the plaque burden

A

no

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10
Q

some brain changes that occur

A 
NFT and amyloid plaque accumulation 
decrease in functing synapses
reducting in accetylcholine
cell death brain atrophy 
vascular dysfuncton....
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11
Q

neurogeneration due to accumulation of

A

neurofibrillary tangles

amyloid plaques

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12
Q

hallmarks of alzheimers

A

neuritic plaques

neurofibrillary tangles

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13
Q

what are the plaques

A

formed from protein pieces that stick together

block cll to cell siignaling at the synaps

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14
Q

what are nuerofibrillary tangles

A

collapsed and twisters fibers of protein called tau that build up insde the nerve cell
tau normally helps to stabalize the transport system for essential materials
wihtout this the nerve cell will die

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15
Q

neurotransmitter changes

A

reduced activity of choline acetyltransferase which makes acetylcholine
loss of certain nicotinic receptor subtypes which reuptake ach
reduced number of cholinergic neurons

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16
Q

symptoms of alz

A 
poor recall 
aphasia - language loss 
decreased motivation 
anosognosia - reduced self awareness
irritable 
wandering 
psychosis 
sleep disturbance
seizure
motor disturbance
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17
Q

other possible causes of cognitive decline

A 
drugs
neurologic disease - stroke
illness - anemia, thyroid, get a blood test to rule out 
surgery 
environment
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18
Q

what are some red flags that require neuroimaging to rule out other things

A 
<60o 
new onset 
rapid progression 
head trauma 
cancer histoyr 
anticoagulant use
early incontinence and gait disorde
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19
Q

anticholinergics that contribute to cognitive decline

A 
antihistamines
antipsychotics
tricyclic antidepressants
antiemetics
oxybutynin
ranitidine
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20
Q

psychoactive drugs that cause cognitive decline

A 
alcohol 
anticonvulsants
antidepressant 
antiparkinsons
muscle relaxant
antipsychotic
opioids
sedative hypnotics
anything that causes cns depression
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21
Q

other drugs that cause cognitive decline

A 
ciprofloxacin
clarithromycin 
antiarrythmics
digoxin 
nsaids
corticosteroids
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22
Q

commnly used cognitive test

A

mini mental state exam

used to estimate severity and monitor change incognitive impairment during therapy

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23
Q

what is required for anticholinesterase coverage

A

MMSE 10-26

mild-mod

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24
Q

normal vs agressive drop in MMSE score

A

normal to drop 1-2 points a year

>3 bad

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25
Q

what is sundowning

A

rapid decline in function in hte evening

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26
Q

mild dementia

A

learning and memory impairment
language difficulty
inability to form purposeful movements

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27
Q

moderate dementia

A 
long term memory loss
inability to recognise close relatives
aimless wandering 
emotional change
urinary incontinence
28
Q

severe dementia

A

complete loss of speech
severe apathy and exhaustion
bedriden
death

29
Q

secondary prevention measures

A 
mediterranean diet
statin?
treat hypertension 
exercise and cognitive training
cognitive reserve from higher education
30
Q

is there a cure for alzheimers

A

no

31
Q

how do cholinesterase inhibitors help

A

stabilize/slow disease
may help with some symptoms
doesnt fix the problem
inhibit anticholinesterase so less ach breakdown

32
Q

side effect of cholinesterase inhibtors

A

urinary incontinence
stimulating
GI
fall risk

33
Q

drugs for mild - mod

A

cholinesterase inhibtors

34
Q

examples of cholinesterase inhibitors

A

donepazil
rivastigmine
galantamine

35
Q

drugs for mod-severe disease

A

add anti glutamatergic or alone

memantine

36
Q

which cholinesterase inhibitor can be used in severe disease

A

donepazil

37
Q

should take cholinesterase inhibitors with

A

food

38
Q

is one cholinesterase better than the other

A

no trials to demonstrate this

39
Q

efficacy of ChEI

A

benefit for about 6-9 months then graduall decline

limited data on relevant outcomes adn there is no delay in institutionalization

40
Q

side effects of ChEI

A

dose depended GI - vomit, diarrhea, anorexia
insomnia
likely to occur at start of treatment of dose escalation prevent by longer titration and taking wiht foo d

41
Q

contradindications for ChEI based on conditions affected by increasing cholinergic tone

A

cardiac conduction abnormalities , bradycardia
active PUD - cheis increase gastric acid secretion
asthma/copd

42
Q

when discontinuing ChEIs taper by

A

25-50% every week to min rebound constipation

43
Q

memantine MOA

A

blocks the sustained activation of NMDA receptors cause by abnormal glutaminergic activity
NMDA antagonist

44
Q

memantine indication

A

moderate to severe

not mild

45
Q

problems with memantine

A

BID dosing
not covered by pharmacare
many DI
not recommended in severe liver impairment

46
Q

memantine side effects

A 
dizzy 
constipation 
confusion 
headache
hypertension
47
Q

cautions of memantine

A

seizures and CV disease

48
Q

how do you mnage sleep disturbances

A

suggest non pharms first and look for causes

trazadone or zoplicone but not benzos or OTCs

49
Q

what are some behavioural and psychological symptoms of dementia

A

depression
anxiety
psychosis
agitation

50
Q

causes of BPSD

A 
poor sleep 
physical confitions
sensory overload
disruption of routine 
sensory deficits....
51
Q

what does PIECES stand for in the causes of dementia

A 
physical 
intellectual 
emotional 
cultural 
environmental 
social
52
Q

non drug measures for BPSD

A 
ABC charting - note of cuases
reduce noise
avoid changes in surroundings
schedule activities 
lots of physical activity 
discourage naps
caregiver education critical
53
Q

when might antopsychoics be potentially appropriate

A

hallucinations
delusions
aggressive behaviour

54
Q

when are psychotics appropriate

A

if the symptom presents danger
significant decline in function
persistent distress

55
Q

when are antipsychotics inappropriate

A 
wandering, incooperative 
unsociability
mild anxiety 
impaired memory 
doesnt represent a danger
56
Q

AE associated with anitpsychotics in alzehiemers

A 
death 
stroke
weight gain 
hyperlipidemia/glycemia 
sedation, falls
anticholinergic*
urinary infection
57
Q

does BPSD resolve

A

usually spontaneously resolves or responds to psychosocial intervention

58
Q

causes of delirium

A

metabolic disorders - thyroid, diabetes
illness
drug and drug witjdrawal
street drugs

59
Q

delirium vs dementiia

A

delirium is more acute and abrupt with a fluctuating course
affects alertness and vitals as well
attention impaired

60
Q

are estrogen or nsaids recommended

A

observational studies
prospective trials dont show benefit
not recommended

61
Q

are statins recommended

A

only if patient has other indications for statin use

62
Q

are vit E and gingko biloba recommended

A

no
get NV, diarrhea
vit e can cause death

63
Q

is polyphenol recommended

A

no recommendation

64
Q

estimation of severity based on MMSE score

A

mild: 20-26
mod: 10-19
severe: <10

65
Q

dosing and timing of antipsychotics for BPSD

A

start low go slow
time based on behavior pattern
titrate up every 1-2 weeks

66
Q

which is the only antipsychotic officially labelled for use in BPSD

A

risperidone

67
Q

reasons to discontinue ChEIs

A

rapid progression - MMSE decrease 2 or more in 12 months
symptoms deteriorate in 3-6 months of therapy
persistant side effects
poor adherence

Clinical 2.0 winter (28 decks)

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