Alzheimer's Disease Flashcards
What is Alzheimer’s Disease?
- A progressive neurodegenerative disorder that causes significant deterioration in mental performance
What are the different types of dementia?
- Alzheimer’s disease
- Vascular dementia
- Dementia with Lewy Body
- Frontotemporal dementia
- Rare: Parkinson’s disease dementia , Huntington’s disease, Prion disease
What is the proportion of people who typically have dementia?
- Dementia affects older people typically 95 years and older
What are the causes of Dementia?
- Age (older)
- Genetics ( although typically sporadic, some have been linked with mutations in the Amyloid Precursor Protein (APP) and Presenilin genes (PSEN1, PSEN2)
- Cardiovascular disease
- Depression
- Low educational attainment
- Low social engagement and support
What are some of the Risk Factors for Alzheimer’s Disease?
- Increasing Age
- Family History of Alzheimer’s disease
- 5% inherited autosomal dominant trait ( APP, Presenilin 1 and Presenilin 2)
- Apoprotein E allele E4 - encodes a cholestrol transport protein
- Caucasian ethnicity
- Down’s Syndrome
What are some of the macroscopic changes seen in Alzheimer’s?
- Widespread cerebral atrophy
- Seen in the cortex and hippocampus
What are some of the microscopic changes seen in Alzheimer’s?
- Cortical Plaques due to deposition of type A-Beta- amyloid protein and intraneuronal neurofibrillary tangles caused by abnormal aggregation of the tau protein
What are the main two key pathological processes seen in Alzheimer’s Disease?
- Senile Plaques
- Neurofibrillary tangles
What are Senile Plaques?
- Deposits of beta-amyloid
- Dense, insoluable
- Occur outside the neurons
What are Neurofibrillary tangles?
- Aggregations of hyperphosphorylated tau proteins
- Tau is a protein that interacts with tubulin to stabilize microtubules and promote tubulin assembly into microtubules
- Typically occur in areas of the brain involved in memory
- Promote neuronal cell death
Where are SP and NFT typically seen in Alzheimer’s disease?
- Hippocampus and Medial Temporal lobes
What is the significance of Senile Plaques and Neurofibrillary tangles?
- these result in neuronal cell death that leads to memory failure, personality changes and problems with activities of daily living
What are the Clinical Features of Dementia?
- Cognitive impairment: poor memory, disorientation, language problems
- Behavioural and psychological symptoms of dementia: agitation, depression, sleep cycle disturbance, motor disturbance
- Disease specific features: early impairment of memory, short-term memory loss and difficulty learning new information
- Activities of daily living: increasing reliance on others for assistance, problems with high-level functioning (work and finance), problems with basic personal care
What investigations should be done verbally?
- Cognitive Assessment
What domains should be covered in the Cognitive Assessment?
- Attention and concentration
- Recent and remote memory
- Language
- Praxis (planned motor movement- performing a task)
- Executive function
- Visuospatial function
How do you make a diagnosis of AD?
- Refer to Memory Clinic
- History and Examination
- Baseline Investigations
- Neuroimaging
- Diagnostic Criteria: DSM-V
What is included in the Diagnostic Criteria for AD?
- Diagnostic and Statistical Manual of Mental Disorders (DSM-V)
- Functional Ability: Inability to carry out normal functions. Represents a decline from previous functional level
- Cognitive Domains: Impairment involving 2 or more cognitive domains
- Differentials excluded: Clinical features cannot be explained by another cause
What are the Differential Diagnosis for Alzheimer’s Disease?
- Depression and Psychiatric Disorders
- Drugs: anti-histamines, anti-psychotics and anti-epileptics
- Delirium: Acute confusional state
What Bloods would you order?
- FBC
- ESR
- U+E
- Bone Profile
- HBA1c
- LFTs
- TFTs
- Serum B12 and folate levels
What other Investigations would you order?
- ECG
- Virology (HIV)
- Syphilis testing
- CXR
What Neuroimaging would you consider?
- MRI head
- CT head
What is the Pharmacological Managment for Mild to Moderate AD?
- Acetylcholinesterase inhibitors ( donepezil, rivastigmine)
What is the Pharmacological Managment for Moderate to Severe AD?
- N- Methyl- D- Aspartic Acid receptor antagonist (memantine)
- Used in combination with acetylcholinesterase inhibitors
What are the non-pharmacological managment measures for AD?
- Assess capacity and advanced care planning
- Physical and mental health review ( mental health, delirium for acute deterioration)
- Driving (inform the DVLA)
- Non- Pharmacological (exercise, aromatherapy, music/ dancing/ massage)
- Refer to old age psychiatry
- Care plans
- End of Life care
