Alzheimer's Disease

Question 1

What is dementia

Answer 1

• Significant loss of intellectual abilities like memory capacity
• Severe enough to interfere with social or occupational functioning
• Not one disease but many from different causes

Question 2

Criteria for the diagnosis of dementia

Answer 2

• Includes
• Impairment of attention
• Orientation
• Memory
• Judgement
• Language
• Motor and spatial
• Functioning
• Not due to major depression or schizophrenia

Question 3

What is mixed dementia

Answer 3

• People who have more than one type of dementia
• 50% of people autopsied with dementia have this

Question 4

Can dementia be reversible

Answer 4

• If it’s not that severe it can be

Question 5

Alzheimer’s Disease

Answer 5

• Difficult to predict symptoms
• The order they will appear, or it’s progression rate
• Symptoms may be minimal in the beginning with them progressing slowly
• Characterized by plaque and tangle build up in the brain
• Some areas affected include cognition, emotion/mood, behaviour, physical abilities
• Affects short term memories first and then long

Question 6

Plaque build up with AD

Answer 6

• Build up of beta amyloid in the brain that makes it harder for nerve cells to move through the brain causing them to die

Question 7

Early Stages AD

Answer 7

• Marked by memory loss
• Disorientation to time and space
• Poor judgement
• Personality changes
• Brain changes for before the symptoms appear
• Typically first in the hippocampus or entorhinal cortex which is important for memory before spreading
• Typically between 1-9 years but can range up to 20

Question 8

Middle Stages AD

Answer 8

• Increased memory problems
• Difficulties with speech
• Restlessness
• Irritability and loss of impulse control
• Build up goes beyond original regions thus affecting more areas
• Typically last 2-10 year

Question 9

Late Stage AD

Answer 9

• Incontinence of urine and feces
• Loss of motor skills
• Decreased appetite
• Difficulty with speech and language
• May not recognize family or themselves
• Losses most/all of self care abilities
• Decreased ability to fight infection
• Plaque is spread through the brain
• Typically lasts 1-5 years

Question 10

What was seen on the original AD patients autopsy

Answer 10

• Dramatic atrophy, especially of the cerebral cortex
• Widespread fatty deposits in small blood vessels causing less blood flow
• Dead and dying brain cells
• Abnormal deposits in and around cells now called plaques and tangles

Question 11

Brain changes in AD

Answer 11

• Atrophy
• Senile plaques: build up of beta-amyloid may interfere with neuronal communication
• Neurofibrillary tangles: Threads of tau protein become twisted

Question 12

Structural changes in AD

Answer 12

• Amyloid build up
• Tau build up
• Neurodegeneration/atrophy

Question 13

Cerebrovascular Disease and AD

Answer 13

• CVD is observed in over 70% of people with AD
• Often measured using white matter hyperintensities (WMHs)
• Similar to AD pathology, CVD pathology is know to occur before declines in cognition
• Cerebrovascular lesions: Atrophy around the hippocampus resulting in less brain volume which isn’t good

Question 14

Risk factors for AD

Answer 14

• Age
• Genetics
• Mild cognitive impairment: objective memory impairment but no dementia
• Health status: high blood pressure, high cholesterol, poorly controlled diabetes
• Education is a protective factor
• We don’t know all of them we just know that these factors are involved

Question 15

AD Prevention

Answer 15

• 1/3 of AD cases are attributed to 7 modifiable risk factors

1. Education
2. Midlife hypertension
3. Midlife obesity
4. Physical inactivity
5. Diabetes
6. Smoking
7. Depression

• Multifactorial therefore multicomponent interventions that target several risk factors simultaneously may be needed for optional preventative effects
• Finger study: 2 year intervention program which included nutritional guidance, physical exercise, cognitive training, social stimulation, and management of vascular and metabolic risk factors. This improved/maintained cognitive functioning in older adults at risk of dementia

Question 16

Where do plaque and tangles form

Answer 16

• Plaque form outside the cells
• Tangle form inside the cells

Question 17

How is the hippocampus related to AD

Answer 17

• It is one of the first areas affected
• It has a role in memory creation, so creating new memories is challenging and older memories don’t depend so much on the older than new ones