Alzheimer's Disease

Question 1

Pathophysiology of Alzheimer’s

Answer 1

Amyloid Cascade Hypothesis
Neurofibrillary Tangles (NFT)
Inflammatory Mediators
The Cholinergic Hypothesis
Brain Vascular Disease and High Cholesterol
Other: Oxidative Stress, Mitochondrial dysfunction, and loss of oestrogen

Question 2

Physical Changes associated with AD

Answer 2

Brain shrinks dramatically due to nerve cell death and tissue loss

Plaques: abnormal clusters of protein fragments

Tangles: twisted strands of another protein

Question 3

Causes of AD

Answer 3

Mainly unknown 
May be linked to:
Age 
Genetics
Environment 
Lifestyle 
Comordities

Question 4

Warning Signs of Alzheimer’s

Answer 4

Memory loss that disrupts ADL
Challenges in planning or solving problems
Difficulty completing familiar tasks
Confusion w/ time or place
Trouble understanding visual images and spatial relationships

Question 5

Warning Signs of Alzheimer’s

Answer 5

New problems with words in speaking or writing
Misplacing things and losing the ability to retrace steps
Decreased or poor judgement
Withdrawal from work or social activities
Changes in mood and personality

Question 6

Clinical Presentation AD

Answer 6

General: memory complaints and gradual cognitive decline

Functional: Inability to care for self

Question 7

Clinical Presentation Symptoms

Answer 7

(Cognitive)
Memory loss
Aphasia 
Apraxia 
Agnosia 
Disorientation 
Impaired executive function

Question 8

(Non-cognitive symptoms of AD)

Answer 8

Depression

Behavioural disturbances

Question 9

Mild AD (Early stage)

Answer 9

Forget familiar words
Forgetting material just read
Increased trouble planning and organising

Question 10

Moderate AD ( Middle)

Answer 10

Forgetfulness of personal history
Confusion about place or time
Need for help with bathing, toileting, dressing 
Changes in sleep patterns
Increased risk of wandering
Personality and behavioral changes

Question 11

Severe Alzheimers (Late-Stage)

Answer 11

Typically longest stage 
Requires full-time care 
Vulnerable to infections
Changes in physical abilities 
Loss of awareness of recent experiences and surroundings

Question 12

Risk Factors AD

Answer 12

Age: Doubles every 5 years after 65

Family History
Genetics
Education 
Race&Ethnicity: African American 2 x greater risk
Sex: Women more likely 

Modifiable RF
Moderate (2.3 times greater) and Severe (4.5 times greater) traumatic brain injury

Lifestyle 
Midlife Obesity inc. risk 
Smoking inc. risk
Physical activity dec. risk 
Heart-healthy diets: DASH etc dec risk 

Heart Head Connection
High BP
Stroke 
Diabetes 
Heart Disease

Question 13

Diagnosis of AD

Answer 13

Medical Evaluation
Mental Status Exam
Physical and Neuro exams

Lab Tests
Rule out B12 and folate deficiencies
Rule out hypothyroidism with thyroid function test
CBC, Serum electrolytes, LFTs

Diagnostic Tests
CT
MRI

Question 14

Treatment of AD (pharmacological)

Answer 14

Pharmacological 
Mild-Moderate 
Donepezil 5 mg OD 
Rivastigmine (oral) 1.5 mg BID
Rivastigmine (patch) 4.6 mg once daily 
Galantamine (oral tabs/sol) 4 mg BID 
Galantamine (ER caps) 8 mg OD 

Moderate to Severe
Donepezil 5 mg OD
Rivastigmine (patch) 4.6 mg once daily
Memantine 5 mg OD or Memantine XR 7 mg OD
Combination ChEI + memantine 7 mg BID or 10 mg OD

Question 15

Treatment of AD (Non-pharm)

Answer 15

Educate pt and caregiver on condition 
Stress management techniques
Support group options 
Create a calm environment and remove stressors and triggers
Exercise 
Maintain general health

light therapy 
Music therapy 
aroma therapy 
massage and touch therapy 
multisensory stimulation

Question 16

Goals of Therapy AD

Answer 16

Promote social engagement 
Foster safe environment 
Maximize function in daily activities 
Maintain QoL 
Enhance cognition, mood, behaviour