Alzheimer's Disease

Question 1

How does AD typically present?

Answer 1

Slow, insidious cognitive decline, particularly:

• Memory first then other cognitive functions
• Praxis
• Language - word finding difficulty (anomia)
• Executive function
• Visuospatial
• Personality change

Question 2

What are the histopathological features in AD?

Answer 2

Neurofilbrillary tangles - loss of normal cytoskeleton

Amyloid deposition (beta4 protein stain on autopsy)

• Plaques
• Vascular amyloid

Question 3

What hard neurological signs are found in AD?

Answer 3

None usually

Question 4

Which part of the brain is generally affected in AD?

Answer 4

Hippocampus

Medial Temporal lobe

Question 5

What pharmacotherapy is used for AD? What is their mechanism of action? What are their SEs?

Answer 5

Cholinesterase inhibitors such as

Donepezil, galantamine, and rivastigmine

Loss of cholinergic neurons (which makes up a high proportion of total neurons) causes a paucity of ACh and therefore neurotransmission, therefore supplementing ACh helps symptom control

GI upset - common

Memantine - NMDA antagonist

Question 6

What are some risk factors for AD?

Answer 6

T2DM and glucose intolerance

Midlife hypertension (30s, 40s, and 50s cf to 80s and 90s)

Midlife obesity (30-65)

Physical inactivity

Depression - hippocampal neurons may be more susceptible to stress hormones

Smoking

Low educational attainment