Alzheimer's Flashcards
What are the clinical signs of Alzheimer’s?
The 5 As: Amnesia, Anomia, Apraxia, Agnosia, Aphasia
What are the clinical signs of vascular dementia?
Step-wise decline, personality changes, history of vascular disease.
What are the clinical signs of dementia with Lewy bodies?
Slow, stiff movements, tremor, hallucinations, sleep problems
What are the clinical signs of Frontotemporal Dementia?
Inappropriate behaviour, love of sweet food, younger onset (50)
What are the pathology results of Alzheimer’s?
Amyloid-beta plaques
Neurofibrillary tangles (tau)
Loss of brain volume
What are the pathology results of vascular dementia?
Multiple mini-infarcts
What are the pathology results of dementia with Lewy bodies?
Lewy bodies of alpha-synuclein
What are the pathology results of frontotemporal dementia?
“Pick bodies” of tau in frontal lobe
Who are in MDT for this?
GP
Neurologist
(Radiologist, Pathologist)
Physiotherapist
Occupational Health Therapist
Psychologist
Support Groups
Family/Carer
What is difference between definition of mild cognitive impairment and dementia?
The extent to which it impacts activities of daily living
What are the 5As?
Amnesia: loss of memory
Anomia: inability to name objects
Apraxia: loss of dexterity e.g. in dressing
Agnosia: inability to recognise things (including people) – different from anomia, in which the understanding of the object’s role/function is preserved.
Aphasia: inability to talk
What is the pathophysiology in AD?
-Amyloid precursor protein [APP] = transmembrane protein
-Normal = and γ secretase → normal degradation product
-AD = by and γ secretase → abnormal product resistant to degradation → A
-A accumulates outside the cell to form amyloid plaques
-A accumulates outside the cell to form amyloid plaques
-Interferes with neuronal communication (+ inflammation) → dementia
-Tau tangles
Inside the neuron
-Tau = protein that supports microfilaments within the neuron
What does Abeta do?
A triggers phosphorylation of tau, causing it to disassociate from the MF and accumulate into neurofibrillary tangles
Tangles + weakened microfilaments → ↓neuronal function and apoptosis → atrophy
↓ACh
Cortex
Pathological changes → degeneration of cholinergic nuclei → ↓ cortical ACh
What are key phrases for AD pathophysiology?
- β Amyloid → extracellular plaques
- Hyperphosphorylated tau → neurofibrillary tangles
- Neuronal and synaptic loss
Where does Memory retrieval/long-term memory in the brain?
posterior cingulate cortex
hippocampus
Where is short term memory in brain?
Anterior thalamus
Which two enzymes are amyloid plaques produced by?
Beta and gamma secretase
Which neurotransmitter is deficient in Alzheimers?
acetylcholine
What does the MCA say?
assume a person has the capacity to make a decision themselves, unless it’s proved otherwise
wherever possible, help people to make their own decisions
don’t treat a person as lacking the capacity to make a decision just because they make an unwise decision
if you make a decision for someone who doesn’t have capacity, it must be in their best interests
treatment and care provided to someone who lacks capacity should be the least restrictive of their basic rights and freedoms
What is capacity?
-The person must be able to:
-understand the information relevant to the decision
-retain that information
-use or weigh up that information as part of the process of making the decision
-Capacity is decision and time-specific
E.g. may have capacity to choose tea or coffee but may not have capacity to decide whether or not they require help in ADLs.
E.g. may not have capacity today due to fever but may next week when recovered
Who decides best interest?
Technically, you as the medical professional.
BUT must take into account The patient Those caring for the patient /Family Independent advocates/ Lasting power of attorneys/court-appointed guides.
What was the patient?
Patient with memory problems
6-CIT
Diagnosed with probable Alzheimer’s
Clinical communication and ethical challenges
What is dementia?
Umbrella term for cognitive decline
Insidious onset
Progressive
Interfering with activities of daily life
Not situational stress; clear consciousness
Deficits: behaviour, attention, memory,language, visuospatial function
8 or above on the 6-CIT
What is mild cognitive impairment?
Still cognitive decline
Worse than would normally be expected for a healthy person of their age
But NOT interfering with activities of daily life
10-15% progress to dementia per year
6-8 on the 6-CIT
What is normal ageing?
Key differentiators:
Normal aging preserves temporal orientation, visuospatial skills and insight.
Dementia/MCI tend to lose these.
Both tend to lose verbal recall, mental flexibility and sustained attention
