Alzheimer's

Question 1

Dementia type?

Answer 1

Degenerative

Question 2

Aetiology? (2)

Answer 2

Selective neuronal and synaptic loss (up to 50%) neurochemical abnormalities (cholinergic) and cortical atrophy (temporal + parietal)

B-Amyloid plaques & neurofibrillary tangles (filament w/ tau protein) in hippocampus, amygdala and cerebral cortex

Question 3

5 A’s of Alzheimers?

Answer 3

Amnesia (short term)
Aphasia
Agnosia - unable to recognise faces or objects
Apraxia - doing (motor)
Associated behaviours: behaviour (wandering, irritable, aggression, sexual disinhibition, incontinence), personality change, visual hallucinations, delusions, depression

Question 4

Other symptoms?

Answer 4

Disorientation

Deterioration in self-care

Question 5

Investigations? (6)

Answer 5

Cognitive assessment (MMSE)/AMTS
Physical examination
Blood: FBC, U&E’s, glucose, calcium, LFT’s, TFT’s
Midstream urine test (rule out delirium)
CT (cortical atrophy espc. parietal and temporal)
MRI (grey matter atrophy atrophy of cerebral cortex, amygdala and hippocampus)

Question 6

1st line biological treatment? (3)

Answer 6

Acetylcholine-esterase inhibitors (ACh-i):
Donezapil
Galantamine
Rivastigmine

Question 7

2nd line biological treatment?

Answer 7

Memantine (NMDA antagonist)