Alzheimer's Disease

Question 1

Outline the pathogenesis of Alzheimer’s disease

Answer 1

• Amyloid hypothesis
  
  • Oligomer deposition at synapses
  • Inflammation and excitotoxicity
• Tau hypothesis
  
  • Accumulation of microtubule-stabilising proteins within neurons
• Parietal/temporal/frontal atrophy occurs, with high plaque density in the hippocampus, amygdala, cortex and basal ganglia (in the latter, most damage is to cholinergic neurons)

Question 2

What are the risk factors for development of Alzheimer’s?

Answer 2

• Age
• FHx
• Genetics (APP, presenilin mutations, Down’s syndrome)

Question 3

What might you find on history/examination in a patient with Alzheimer’s?

Answer 3

• Disorientation (time and place)
• Misplacing items, getting lost
• Nominal dysphasia
• Apathy
• Personality change
• Decline in ADLs

Question 4

What are the management principles of a patient with Alzheimer’s?

Answer 4

• Supportive care
  
  • For patient and for carers. Referral to psychologist, community support groups. OT assessment. End-of-life discussions should be considered
• Slow disease progression
  
  • Anti-cholinergics (donepezil, rivastigmine)
  • +/- memantine in severe/unresponsive disease