ALZHEIMER'S DISEASE

Question 1

What is the most common cause of dementia in the UK?

Answer 1

Alzheimer’s disease (AD).

Question 2

What are the key risk factors for Alzheimer’s disease?

Answer 2

• Increasing age
• Family history of Alzheimer’s disease
• Autosomal dominant mutations (5% of cases)
• Mutations in APP (chromosome 21), presenilin 1 (chromosome 14), and presenilin 2 (chromosome 1)
• Apoprotein E allele E4
• Caucasian ethnicity
• Down’s syndrome

Question 3

What are the macroscopic pathological changes seen in Alzheimer’s disease?

Answer 3

Widespread cerebral atrophy, particularly affecting the cortex and hippocampus.

Question 4

What are the microscopic pathological changes in Alzheimer’s disease?

Answer 4

• Cortical plaques due to deposition of type A-Beta-amyloid protein
• Intraneuronal neurofibrillary tangles due to abnormal tau protein aggregation

Question 5

What biochemical deficit is associated with Alzheimer’s disease?

Answer 5

A deficiency of acetylcholine due to damage to an ascending forebrain projection.

Question 6

What protein is involved in neurofibrillary tangles in Alzheimer’s disease?

Answer 6

Tau protein.

Question 7

How does tau protein contribute to Alzheimer’s disease pathology?

Answer 7

Excessive phosphorylation of tau impairs its ability to stabilize microtubules, leading to neurofibrillary tangles and neuronal dysfunction.

Question 7

What is the role of amyloid precursor protein (APP) in Alzheimer’s disease?

Answer 7

Mutations in APP lead to abnormal A-Beta-amyloid deposition, contributing to cortical plaque formation.

Question 8

Non-pharmacological management options for Alzheimer’s disease:

Answer 8

• Offer a range of activities tailored to the person’s preference to promote wellbeing
• Group cognitive stimulation therapy for patients with mild to moderate dementia (recommended by NICE)
• Other options: Group reminiscence therapy and cognitive rehabilitation

Question 9

The first-line pharmacological treatments for mild to moderate Alzheimer’s disease are:

Answer 9

• Acetylcholinesterase inhibitors: Donepezil, Galantamine, and Rivastigmine.

Question 10

Use of Memantine (an NMDA receptor antagonist) in Alzheimer’s:

Answer 10

• As second-line treatment for moderate Alzheimer’s in patients intolerant to or contraindicated for acetylcholinesterase inhibitors
• As an add-on drug to acetylcholinesterase inhibitors for moderate to severe Alzheimer’s
• As monotherapy for severe Alzheimer’s

Question 11

How are the Non-cognitive symptoms in Alzheimer’s disease are managed ?

Answer 11

• Antidepressants are not recommended for mild to moderate depression in dementia patients.
• Antipsychotics should only be used in patients at risk of harm to themselves or others, or if agitation, hallucinations, or delusions cause severe distress.

Question 12

When prescribing donepezil for Alzheimer’s disease, Things to keep in mind.

Answer 12

• Donepezil is relatively contraindicated in patients with bradycardia.
• Common adverse effects include insomnia.