Alzheimer's Flashcards
what is dementia?
a broad category of brain diseases that cause a long term and often gradual decrease in ability to think and remember such that a person’s daily functioning is affected.
what is alzheimer’s disease
a neurodegenerative condition characterised by amyloid and Tau inclusions
how many people does alzheimer’s affect?
800000 in the uk,
- 3 million worldwide in 2001,
- 3 by 2020,
$216BN in unpaid care
what treatments are available for AD
anticholinesterases (donepezil, rivastigmine, galantamine)
NMDA Receptor agonists (Memantine)
antipsychotics,
antidepressants,
anticonvulsants-treatment of agression,
PEG feeding (no evidence)
evidence for anti cholinesterases
30RCTs MMSE improves by 1-2 points at 6 months
what benefit do NMDA receptor agonists show?
mod-severe AD moderate significant benefit
what disease modifying agents are available for AD
immunotherapy (bapineuzab),
secretase inhibitors,
Tau aggregtion inhibitors,
GSK2 inhibitors (stop tau phosphorylation, lithium)
whar are the risk factors for AD
genetics, head injury, obesity, smoking, physical activity, hypertension, stroke, diabetes, hypercholesterolemia
there is some evidence that “….” may protect against alzheimers
cognitive reserve and intelligence
STATINS for AD
no significant results on modifying risk PODCAST
B12 and folate and AD
no benefit
what are the prominent clinical features of AD
visual and spatial disorientation
amnesia +- cortical deficits
dysphasia
dyscalculia
dyspraxia
lack of physical motor signs
why is AD very difficult to diagnose?
in the very early stages because some of its symptoms overlap with those of normal ageing related decline
no test that can accurely differentiate between MCI and AD on an individual patient level
what approach is most useful in diagnosis AD
MDT approach
clinical examination (lab tests, history, neurological)
brain imahing (structural and functional)
neuropsychological assessment
what are some CSF and plasma biomarkers for AD
CSF: increase in tau/ p tau and decreased AB42
isoprostanes
plasma: Ab 40/42 ratio
isoprostanes
proteomic profiles
these biomarkers may be present in MCI
evolve over time and increase from normal to AD at different rates
what are some of the diagnostic criteria for AD?
dubois et al 2007 (research)
McKhann et al 2011 (clinical)
peterson criteria?
what is characteristic progression of cognitive loss in AD?
pattern is heterogenous
involves gradual regression to earlier stage of cognitive development (concrete thinking still possible, abstract reasoning lost)
follows a temporal gradiant (material acquired earlier in life appears less vulnerable to brain damage)
why is neuropsychological testing in AD needed
difficult to detect subtle cognitive changes in dementia by MMSE MSQ etc
battery of neuropsychological tests needed to be more sensitive
neuropsychological tests low specificity
cannot distinguish between pathologies
name some neuropsychological tests useful for cognitive deficits in AD
boston aphasia test-used to test spontaneous speech abilities
semantic fluency (how many animals in one minute)
verbal fluency
constructional apraxia, visuospatial neglect tests
semantic fluency decline may be?
a preclinical indicator of AD
poor linguistic skills decades before diagnosis *(snowden et al 199^)
semantic fluency associated with low cerebral blood flow in temporo-parietal areas in AD
