Alzheimer's

Question 1

Alzheimer’s Pathogenesis

Answer 1

• Widespread cortical atrophy
• Neurons develop amyloid plaques, neurofibrillary tangles, produce less ACh
• Cause unknown

Question 2

Alzheimer’s Epidemiology

Answer 2

-Most common form of dementia

Question 3

Alzheimer’s RFs

Answer 3

• Age
• Caucasian
• FHx
• Female sex
• ApoE4

Question 4

Alzheimer’s Diagnostic Criteria

Answer 4

• NINCDS/ADRDA
• Dementia established by examination and assessment
• Deficits in two or more areas of cognition
• Insidious onset
• No disturbances of consciousness
• Onset between 40-90
• Absence of systemic disorders or other brain diseases
• Can have mild cognitive impairment as pre-demetia stage

Question 5

Alzheimer’s Presentation

Answer 5

• Usually progresses over 7-10 years
• Memory lapses
• Forgetting names of people places
• Difficulty finding words for things
• Inability to remember recent events
• Progresses to difficulties with language, apraxia, problems with planning and decision making, confusion
• In later stages; wandering, apathy, psychiatric symptoms, behavioural problems, incontinence

Question 6

Alzheimer’s Differentials

Answer 6

• Ageing
• Other forms of dementia
• Normal pressure hydrocephalus
• Parkinson’s

Question 7

Alzheimer’s Ix

Answer 7

• MRI to rule out cerebral pathology

- SPECT to differentiate between vascular or frontotemporal

Question 8

Alzheimer’s Non-Pharmacological Management

Answer 8

• Supportive treatment and environmental, control
• Cognitive stimulation
• Memory enhancement clinics
• CBT for depression and anxiety

Question 9

Alzheimer’s Pharmacological Management

Answer 9

• Four drugs
• AChEi for mild or moderate
• Memantine 2nd line or for severe disease
• Antidepressants (avoid tricyclics and other anticholinergics)
• Antipsychotics (usually avoid these!)