Alzheimer's

Question 1

what is dementia?

Answer 1

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.

Question 2

what is alzheimer’s disease

Answer 2

a neurodegenerative condition characterised by amyloid and Tau inclusions

Question 3

how many people does alzheimer’s affect?

Answer 3

800000 in the uk,

24. 3 million worldwide in 2001,
25. 3 by 2020,

$216BN in unpaid care

Question 4

what treatments are available for AD

Answer 4

anticholinesterases (donepezil, rivastigmine, galantamine)

NMDA Receptor agonists (Memantine)

antipsychotics,

antidepressants,

anticonvulsants-treatment of agression,

PEG feeding (no evidence)

Question 5

evidence for anti cholinesterases

Answer 5

30RCTs MMSE improves by 1-2 points at 6 months

Question 6

what benefit do NMDA receptor agonists show?

Answer 6

mod-severe AD moderate significant benefit

Question 7

what disease modifying agents are available for AD

Answer 7

immunotherapy (bapineuzab),

secretase inhibitors,

Tau aggregtion inhibitors,

GSK2 inhibitors (stop tau phosphorylation, lithium)

Question 8

whar are the risk factors for AD

Answer 8

genetics,
head injury, 
obesity, 
smoking,
physical activity, hypertension,
stroke, 
diabetes, hypercholesterolemia

Question 9

there is some evidence that “….” may protect against alzheimers

Answer 9

cognitive reserve and intelligence

Question 10

STATINS for AD

Answer 10

no significant results on modifying risk PODCAST

Question 11

B12 and folate and AD

Answer 11

no benefit

Question 12

what are the prominent clinical features of AD

Answer 12

visual and spatial disorientation

amnesia +- cortical deficits

dysphasia

dyscalculia

dyspraxia

lack of physical motor signs

Question 13

why is AD very difficult to diagnose?

Answer 13

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

Question 14

what approach is most useful in diagnosis AD

Answer 14

MDT approach

clinical examination (lab tests, history, neurological)

brain imahing (structural and functional)

neuropsychological assessment

Question 15

what are some CSF and plasma biomarkers for AD

Answer 15

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

Question 16

what are some of the diagnostic criteria for AD?

Answer 16

dubois et al 2007 (research)

McKhann et al 2011 (clinical)

peterson criteria?

Question 17

what is characteristic progression of cognitive loss in AD?

Answer 17

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)

Question 18

why is neuropsychological testing in AD needed

Answer 18

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

Question 19

name some neuropsychological tests useful for cognitive deficits in AD

Answer 19

boston aphasia test-used to test spontaneous speech abilities

semantic fluency (how many animals in one minute)

verbal fluency

constructional apraxia, visuospatial neglect tests

Question 20

semantic fluency decline may be?

Answer 20

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