Alzheimer's disease

Question 1

Genetics

Answer 1

ApoE4

mutations in the amyloid precursor protein (chromosome 21), presenilin 1 (chromosome 14) and presenilin 2 (chromosome 1)

Question 2

What genetic condition is it associated with

Answer 2

Down’s syndrome

Question 3

Macroscopic changes

Answer 3

widespread cerebral atrophy, particularly involving the cortex and hippocampus

Question 4

Microcopic

Answer 4

cortical plaques due to deposition of type A-Beta-amyloid protein and intraneuronal neurofibrillary tangles caused by abnormal aggregation of the tau protein
hyperphosphorylation of the tau protein has been linked to AD

Question 5

Biochemical deficit

Answer 5

deficit of acetylcholine

Question 6

Non-pharmacological management

NICE recommend offering […] […][…] […] for patients with mild and moderate dementia

other options to consider include […] […] […] and cognitive rehabilitation

Answer 6

Non-pharmacological management

NICE recommend offering group cognitive stimulation therapy for patients with mild and moderate dementia
other options to consider include group reminiscence therapy and cognitive rehabilitation

Question 7

Pharma mx

Answer 7

Mild/moderate - AchE inhibitors - donepezil, rivastigmine, galantamine

If intolerant to AchE inhibitors or monetherapy is not efficient –> add Memantine

• use memantine monotherapy for sever AD

Question 8

Managing non-cognitive symptoms

Answer 8

AP e.g. haloperidol if agitate or risk of harm

Question 9

When to avoid donepezil

Answer 9

Insomnia
Bradycardia

Question 10

In which part of the brain are changes most likely to be found in early Alzheimer’s disease

Answer 10

Temporal lobe