Alzheimer's disease Flashcards
1
Q
How does alzheimers look on a CT scan
A
- disease of brain loss
- lateral ventricles- white matter around it is lost and increase in CSF
2
Q
What occurs with alzheimer’s disease
physically?
A
- nerve cell death and tissue loss causing the brain to shrink and coretx to decrease in size
- Hippocampus decreases the most - affects short term memory
- ventricular enlargement occurs as degeneration continues
- patients may develop akinetic mutism over time (stop moving/talking)
3
Q
What does alzheimers result in
B-amyloid plagues and tau protein
A
- fewer nerve cells and synpases than a health brain
- plaques, abnormal clusters of B-amyloid protein fragments that build up between nerve cells
- Plaques are scarring in the brain
- Dead and dying nerve cells contain tangles, which are made up of twisted strands of tau protein
- B-amyloid and tau protein impair neuronal transport leading to cell death
4
Q
Describe Beta-amyloid
A
- chemically sticky
- breaks down and moves outside the cell in neurons of people with alzheimer’s
- gradually builds up into plaques that block synpases
- may also activate immune system cells that trigger inflammation and phagocytosis of damaged cells
5
Q
Describe tangles in people with Alzheimer’s
vs what normally occurs in healthy areas
A
- tangles destroy a vital cell transport system made of proteins
in health areas:
- the transport system is organized in orderly parallel strands of microtubules
- carry nutrition and other chemicals important for cell function
- tau protein important in maintaining microtubule structure
6
Q
What happens in areas where tangles are forming
A
- tau collapses into twisted stands called tangles
- microtubules collapse and disintegrate
- cell death occurs
7
Q
Describe what happens in those with Alzheimer’s who have a genetic mutation
A
- APP mutations: Presenilin 1 and 2 mutations
- apolipoprotein E4 LRP cholesterol alpha2 macoglobulin - immunotherapy cholesterol lowering agents NSAIDs and Bsheet breakers
- diffuse plaque forms
- antinflammatory agents
- Diffuse plaque and inflammation
- antioxidant agents and O2 free radicals
- Make neuritic plaque and inflammation and tau neurties
8 healthy neuon hyperphophorylation of tau - healthy neuron now has neurofibrillary tangle
8
Q
risk factors for Alzheimer’s
A
- age: affects generally 80+
- family history and genetics
- HTN: promotes inflammation
- type 2 DM: related to lifestyle and small vessel disease
- brain trauma- CTE
- environment: move toxins exposed to increases risk
- education: more education lowers your risk
- linguistic and writing ability: how well you can use your temporal lobe
- gender: w>M could be becuase women live longer
9
Q
Genetic predisposition: APOE
A
- chromosome 19, apolipoprotein E gene
- thought to play a role in cholesterol transport, neuron health, desposition of amyloid protein in brain (plaque in BV)
- APOE 2 allele may be protective
- APOE 4 allele may be associated with increased risk of familial late onset AD
- copy of APOE4 risk increaases 25-60%
- two copies of APOE4: 50-90%
- APOE 4: abnormal cholesterol transport
- increased risk of atherosclerosis: increased risk of hypercholesteremia increased risk of Alzheimer’s
10
Q
Genetic predisposition: chromosome 21
A
- amyloid precursor protein APP is on Chromosome 21
- APOE removes B-amyloid: people with APOE 4 have greater deposits of B-amyloid
- genes that control APP may be related to early onset AD
- in down syndrome increased B-APP
11
Q
Genetic predisposition: presenilin
for alzheimers disease
A
- presenilin 1: located on chromosome 14
- presenilin 2: located on chromosome 1
- process APP, creates B-amyloid protein
- increase in PSEN1 or PSEN2 assoicated with early onset AD
12
Q
Neurotransmitters and AD
A
- ACH: decreased ACh in brain, fewer ACH receptors in hippocampus
- Glutamate: overactiviation of NMDA receptors (glutamate) stimulates glutamate release,
- too much glutamate causes exciotoxicity: increase in intracellular calcuim causing cell death
13
Q
Medications for Alzheimer’s
A
- lecanemab: newer biologic drug to breakdown B-amyloid plaques
- Cholinesterase inhibitors: keeping ACh in brain, donepezil(aricept), rivastigmaine(Exelon), galantamine (razadyne)
- NMDA antagnoists/glutamate regulator to decrease glutamate release: memantine (namenda)
- diet
14
Q
Alzheimer’s clinical symptoms
A
- memory loss
- misplacing objects
- Mild cognitive impairment
- poor judgement
- visuospatial perception (parietotemporal area affected)
- word finding diffculty
- personality and mood over time less expressive
- social withdrawal
- psychological symptoms
- motor symptoms: lack of motion long term, some fidgeting short term know they should be doing something
- sleep changes
15
Q
A
16
Q
Mild cognitive impairment
A
- greater forgetfulness than assoicated with normal aging
- imapired short term memory
- impaired dual task performance
- impaired problem solving
- increased time to complete tasks
17
Q
how is Alzheimer’s diagnosed
A
- medical hx exam: including neurologic exam, gait speed, olfaction (assoicated due to temporal lobe closeness)
- mental status tests: neuropsychological test (clock test)
- blood test (plasma P-tau217) not definite
- imaging: CT, MRI, PET
- CSF: tau protein in CSF
18
Q
Early onset Alzheimer’s
A
- cognitive changes and memory loss earlier than 65 years old
- may be genetic link
- tend to develop 30s,40s, 50s,
19
Q
Early behavioral changes with Alzheimer’s
A
- irritability
- anxiety
- depression
- especially if they are aware of Dx
20
Q
Alzheimer’s Disease
Later behavioral changes
A
- anger
- agitation
- aggression
- general emotional distress
- physical or verbal outburst
- restlessnes, pacing, shredding paper or tissues
- hallucination: seeing/hearing something not there
- delusions: thinking something thats not true
- sleep disturbances
21
Q
Triggers for behavioral changes
in patients with alzheimers
A
- changes in environment
- changes in caregivers
- situtation or people perceived as threats
- being asked to bathe or change clothes
22
Q
Alzheimer’s disease
Causes of behavior change: if sudden consider:
A
- infection or physical discomfort
- drug side effect
- impaired vision or hearing
23
Q
Alzheimer’s disease
managing behavior
A
- maintaining personal comfort
- modify environment (noise, glare, TV)
- avoid confrontation
- redirection
- rest between events
- security object
- monitoring sleep, activity
24
Q
Medical treatment for behavior changes
A
- anti-agitation: brexpiprazole
- anti-insomnia: suvorexant
- anti-depressants
- anxiolytics
- antipsychotics (risk of stroke and death)
25
Sleep changes with patients with alzheimers
- causes unknown
- changes in sleep patterns
- sundowning
- preventive/treatment methods
26
# Alzheimers
PT interventions
- exercise: including aerobic
- functional mobility
- bed positioning
- ROM
- breathing, coughing, secretion clearance
- environmental modifications
- fall risk education
- incontinence
27
Strategies with lower congitive demand for giving directions
- talk less
- plan carefully
- repetition matters
- give limited choices
- maintain dignity
- keep simple
- selective problem solving
28
Common reasons for preventable therapist-induced agitation
| patients with alzheimers
- too frequent feedback
- contrived treatment or practice
- delay in assistance or feedback
- premature request to self-monitor
- retention testing, gaming or quizzing
- task overload
29
Considerations for PT interventions
| for patient's with alzheimers
- type of practice
- type of feedback
- safety
- challenges
30
other causes of dementia
- Drugs
- Emotional disorders (depression)
- Metabolic/endocrine
- EYE and ear disorders
- Nutritional disorder
- Tumor or trauma
- Infection
- Alcoholism, Atheroscleorsis
| D.E.M.E.N.T.I.A
31
Other types of dementia
- vascular dementia
- dementia with lewy body disease
- mixed dementia
- parkinson's disease
- frontotemporal dementia
- creuzfeldt-jakob disease
- normal pressure hydrocephalus
- huntington's disease
- wernicke-korsakoff disease
32
Multi-infact dementia
- second-leading cause of dementia
- affects men more than women
- stepwise progression of symptoms
