Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3 > Alzheimer's Disease > Flashcards

Alzheimer's Disease Flashcards

1
Q

what is the DSM-5 criteria for Alzhiemer’s disease

A
  1. evidence of sig cognitive decline from prior level of performance in >/= 1 cognitive domains (complex attention, executive function, learning & memory, language, perceptual-motor/social cognition
  2. cognitive deficts interfere with independence in everyday activities
  3. cognitive deficits do not occur exclusivelt in context of delirium
  4. cognitive deficits are not better explained by another mental disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the pathologic characteristic of AD?

A

brain atrophy esp in mesial temporal lobe, beta-amyloid & neurofibrillay tangles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the onset & course of AD

A

slow onset, gradually over months to years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the non-modifiable risk factors for AD?

A
  1. age (5-65% in >65, 50% in >85)
  2. female
  3. ethnicity (black, hispanic)
  4. genetics (APOE4)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the modifiable risk factors for AD?

A
  1. diabetes
  2. HTN
  3. smoking
  4. obesity
  5. limited physical activity
  6. binge drinking
  7. depression
  8. hearing loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how is AD diagnose?

A
  1. medical hx
  2. physical exam
  3. neuropsychological testing
  4. lab test - rule out other medical condition
  5. imaging of brain (CT/MRI)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the pathophysology of AD?

A
  1. accumulation of Abeta –> form amyloid plaques –> activate microglia to clear them –> inflammation & damage to the axons
  2. neurofibrillary tangles (NFT): abnormal hyperphosphorylated tau protein –> accumulate in synaps

as disease progress, widespread damage & degeneration of neurons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the goal of treatment?

A

reduce suffering caused by cognitive & accompanying symptoms (eg mood & behaviour), while delaying progressive cognitive decline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what pharmacological treatment are there for AD?

A
  1. anticholinerase inhibitors (AI)
  2. NMDA receptor antagonist (memantine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the MOA for anticholinesterase inhibitors?

A

inhibit acetylcholinestearse enzyme –> promote increase in acetylcholine at synpatic cleft for cholinergic neurotransmission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how should anticholinesterase inhibitors be titrated?

A

titrate slowly over 4-8 weeks to reach target dose & minimize side effects
if adverse effects occur, lower the dose temporarily before reescalating more slowly & monitor for adverse effects
alternatively, discontinue & switch to different AI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how should anticholinesterase be monitored?

A

monitor for any improvement in day-to-day life
routine cognitive test (eg MoCA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the MOA for memantine

A

uncompetitve antagonist of NMDA type of glutamate receptors
glutamate: primary excitatory amino acid in CNS, may contribute to pathogenesis of AD by overstimulating various glutamate receptors –> excitatory & neuronal cell death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

when is memantine considered?

A
  1. mod-severe AD
  2. cannot tolerate AI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what should be monitored when on memantine?

A
  1. cognitive feedback (any improvement in day-to-day activities?)
  2. routine cognitive tests
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the 3 anticholinesterase inhibitors available?

A
  1. donepezil
  2. galantamine
  3. rivastigmine
17
Q

when is anticholinesterase inhibitors used?

A

monotherapy for mild to moderare alzhiemer disease

18
Q

when is memantine used?

A

moderate AD if intolerant/contraindication to acetylcholinesterase inhibitors
severe AD
can consider adding on to AI if have moderate disease & taking AI
add on to AI if severe

19
Q

non-pharmacological approaches for AD?

A
  1. cognitive stimulating activities
  2. physical exercise
  3. social interactions
  4. healthy diets
  5. adeuqate sleep
  6. proper personal hygiene
  7. safety inside & outside home
  8. medical & advanced care directives
  9. long-term health care planning in late stage of AD
  10. financial planning
  11. effective communication
  12. psychological health
20
Q

what does BPSD stands for?

A

behavioural & psychological symptoms (BPSD)

21
Q

what is BPSD?

A

involve non-neurological & non-cognitive symptoms, eg aggitation, aggression, psychosis, depression, apathy

22
Q

if pharmacological treatment is indicated, for BPSD what can be used?

A
  1. anticholinesterase inhibitors (donepezil)
  2. memantine
  3. SSRI, mirtazapine
  4. lorazepam
  5. antipsychotics (first line olanzapine, quetapine, risperidone, aripiprazole, clozapine)
23
Q

nonpharmacological approach for BPSD?

A
  1. understand pt background –> insight to potential causes & solutions
  2. understand rs btw person w dementia & carer & stresses that the condition is placing on both
24
Q

when is pharmacological treatment indicated for BPSD?

A

have limited role, consider adverse effects & indication for use
1. prescribe for target symptoms/behaviours for which there is evidence of effectiveness (should not be used for other indication/sedate pt)
2. only consider once potentially reversible causes have been excluded & non-pharmacological interventions have been trialled; unless there is an immediate risk to the patients or others, or pt severely distress
3. combi with non-pharmacological interventions
4. initiate as trial, not indefinitely without need, review response, dose & adverse effect at least every 3month
5. rountinely withdrawn, slowly aft 3 months of improved symptoms unless symptoms severe
6. restart at lowest effective dose if symptoms return, schedule trial 3-6 months

25
Q

drug for depressive symptoms?

A

SSRI - effective for depression & anxiety
citalopram - can reduce agitation, improve symptoms. but can cause dose-dependent risk of increased QTc prolongation & worsening cognition needs
TCA - not prescribed, anti-cholinergics

26
Q

when are antipsychotics used?

A

for aggression, agitation, psychotic symptoms causing severe distress/immediate risk of harm to pt/others
modest effective
increase risk of stroke, CV events, excess mortality

27
Q

adverse effects for amyloid monoclonal antibodies?

A

edema
hemorrhage

3 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions