Alzheimer's disease Flashcards
What is the most common presenting symptom of Alzheimer’s disease?
Memory loss
Begins with inability to recall new information, memory declines as disease progresses
Disorientation to time/place closely related to memory impairment
What cognitive abilities are effected in Alzheumer’s disease?
1) Executive functions eg Problem solving, decision making, Planning, processing
2) Visuospatial abilities eg Driving, getting lost, copying figures
3) Language disturbances eg Reduced conversational output, word finding difficulties, decreased vocabulary, global aphasia
Define Global aphasia
Severe form of nonfluent aphasia that affects both receptive and expressive language skills
Define Apraxia
Inability to carry out previously learned actions despite normal co ordination and strength eg using utensils, dressing
Define Agnosia
Impaired recognition of sensory stimuli not attributed to sensory impairment/loss or language disturbance eg object agnosia, auditory agnosia, Prosopognosia (Inability to recognise faces of familiar people)
What are some of the non cognitive symptoms of Alzheimer’s disease?
Disturbed perceptions (hallucinations), thought content (delusions), emotions (depression, apathy) and behaviour (wandering, aggression)
What pathological features are found in Alzheimer’s disease?
Shrunken cortex
Wide sulci/large ventricles
Atrophy (Can be in medial temporal lobes)
Specific neuronal tract delay from Hippocampus, Entorohinal cortex + parietal lobe association areas
What are the 3 pathological hallmarks of Alzheimer’s disease?
Beta Amyloid deposition as plaques
Neurofibrillary Tau Tangle formation
Neuronal loss
What symptoms occur due to Parieto-temporal lobe damage in Alzheimer’s disease?
Aphasia
Agnosia
Apraxia
Apathy
What symptoms occur due to Frontal lobe damage in Alzheimer’s disease?
Irritability
Disinhibition
What are some of the symptoms of advanced Alzhemer’s disease?
Parkinsonian symptoms
Logoclonia (repetition of words or parts of words, particularly the end syllables)
Seizures
What is the usual presentation of mild Alzheimer’s disease?
Forgetfulness
Normal activities of daily living
Gradual onset with slow progression, prognosis ~10years
What is the usual presentation of moderate Alzheimer’s disease?
Significant memory loss with personality/behavioural changes
Difficulties in language and orientation
Impairment with activities of daily living
What is the usual presentation of advanced Alzheimer’s disease?
Dysphasia with disordered + fragmented speech
Aggression, restlessness, wandering
Hallucinations
Delusions
Incontinence
Immobility/Rigidity leading to recurrent falls
General physical deterioration
What is the specific primary prevention for Alzheimer’s disease?
Strategies addressing the vascular pathway in the development of AD include measures against;
Hypertension
Obesity
Increased glucose levels/DM
Cardiac failure
Very low BP, need to maintain sufficient cerebral perfusion
What is the specific secondary prevention for Alzheimer’s disease?
Identify the pre-clinical stage of AD for early diagnosis and intervention eg Biochemical markers such as tau protein, imaging
What is the tertiary prevention for Alzhemer’s disease/Dementia?
Reduce functional disability and improve quality of life with;
Cognitive training
Psychosocial support for carer/family + patient
Treatment with Acetylcholinesterase inhibitors eg Rivastigmine
Treatment with N-methyl D-aspartate receptor antagonists eg memantine
Antidepressants
What drugs can be used in the treatment of Alzheimer’s disease?
Acetylcholinesterase inhibitors eg Donepezil, Rivastigmine, Galantamine. Effects on cognition, global change, function + behaviour
NMDA antagonist eg Memantine. Approved for moderate-severe AD.
May be used in conjunction
