Alzheimer's Disease ☺️ Flashcards
Epidemiology
Genetics
Risk factor
Most common dementia
Genetic
Sporadic late onset - APOE e4 gene
Inherited - APP, PSEN 1 2, apoE
Risk factor - Downs
Environmental
- Physical - brain injury, CV injury
- Diet - drugs, alcohol, vitamin deficiency
- Excitotoxicity - cancers, SC injury, hypoglycemia, hypocalcemia
- Infection - HIV, HSV, syphillis
Pathological changes in brain
-pathophysiology on a macroscopic, microscopic and biochemical level
Macroscopic -
- widespread cerebral atrophy (esp cortex, medial temporal lobe)
- wide sulci, narrow gyri
- enlarged ventricles
Microscopic => neuronal death
-amyloid protein deposition and intraneural hyperphosphorylated tau tangles => cortical plaques
Biochemical -
-low ACh
Signs and symptoms
Gradual decline
Early - poor short term memory and recall
-confusion, increased anxiety
Later
- agnosia, aphasia, apraxia, amnesia
- hallucinations, delusions, depression, disinhibition
Normal gait and posture
LONG TERM PROGRESSIVE COGNITIVE IMPAIRMENT AFFECTING FUNCTIONAL DOMAINS
Management - supportive, lifestyle
OT input
- household adaptations to increase safety
- written reminders
- telecare (pendants, GPS)
- sleep hygiene
- promoting wellbeing
Communication
- short simple instructions
- decrease distractions
- closed questions
Management - definitive pharmacological
- managing depression
- managing agitation, hallucinations, delusions
1st LINE - cholinesterase inhibitors
- donepezil, rivastigmine, galantamine
- donepezil CI in bradycardia, can cause insomnia
2nd LINE - NMDA antagonist - memantine
- to be used if moderate disease or 1st line CI
- can be added to 1st line/monotherapy
- reduce AD induced glutamate excitotoxicity
Avoid antidepressants
Antipsychotics to be used only if risk to others/self or symptoms causing severe distress
Differentials you want to rule out
- reversible causes you want to assess
- endocrine
- nutritional
- infection
- malignant
- trauma
- mental
- drugs
Endocrine
-hypothyroid, Addisons
Nutritional
-B12 (ataxia, memory loss, gait abnormalities)/folate/thiamine (Wernicke’s enceph, Korsakoff psychosis) deficiency
Infection
-syphillis
Malignant
-brain tumour
Trauma
-subdural hematoma
Mental
-depression
Drugs - medication review (BZ, opioids, anticholinergics, antipsychotics, antidepressants, alcohol)
