Alzheimer's Disease

Question 1

What is Alzheimer’s disease?

Answer 1

Condition of progressive dementia characterized by slow decline in memory,
language, visuospatial skills and cognition

Question 2

____% of Alzheimer’s cases are without family history

Answer 2

90%

Question 3

What is assumed to be the cause of Alzheimer’s disease?

Answer 3

Cause is unknown, but it is assumed to be a

relationship between genetic predisposition, abnormal processing of normal cellular substances and aging

Question 4

What is the first structure to show pathologic changes?

Answer 4

Cerebral Cortex

Question 5

What is the most significant finding relative to the cerebral cortex in patients with Alzheimer’s disease?

Answer 5

1. Amyloid plaques

2. Neurofibrillary tangles

Question 6

What 4 things occur pathogenically in patients with AD?

Answer 6

1. Neurofibrillary tangles develop in pyramidal cells
leading to atrophy and necrosis
2. ↑ in ventricular size
3. Deepening of cortical sulci
4. ↓ in brain weight

Question 7

What are the 2 most common symptoms associated with AD?

Answer 7

1. Loss of declarative memory (ability to learn new information)
2. Spatial disorientation

Question 8

What are 3 late changes associated with AD?

Answer 8

1. Global memory loss
2. Loss of comprehension
3. Frontal lobe disinhibition

Question 9

What 3 personality changes are associated with AD?

Answer 9

1. Indifference
2. Impulsivity
3. Irritability

Question 10

What are 4 clinical findings associated with AD?

Answer 10

1. EEG studies show increases in awake time
2. Bowel and bladder incontinence occur later
3. Abulia (lack of spontaneity)
4. Bouts of inappropriate behavior

Question 11

True or False: Motor disorders can be seen in patients with AD.

Answer 11

TRUE

1. Akinesia/dystonias can be seen
2. Rigidity develops in later stages

Question 12

How does Anticholinesterase therapy treat AD?

Answer 12

1. Block the enzyme that normally degrades acetylcholine

2. Used to treat memory, thinking, language, judgment

Question 13

How do NMDA receptor agonists, amphetamines and benzodiazepines treat AD?

Answer 13

NDMA: May improve memory, attention, reasoning, and
language skills

Amphetamines: Given for abulia or inattention

Benzodiazepines: Given for behavior control related to agitation and confusion

Question 14

How is agitation managed non-medically?

Answer 14

1. Manipulation of the environment is an effective
   alternative to physical or chemical restraints
2. Keep lights on in a pts room at nighttime to prevent
   “sundowning”
3. Physical exercise during the day to reduce nighttime
   agitation and daytime drowsiness

Question 15

How should PTs treat patients with AD?

Answer 15

1. Use of a structured environment
2. Maximize repetition and use of functional
   movement patterns

Question 16

Are declarative and procedural memory intact in patients with AD?

Answer 16

Declarative memory often absent in AD due to
hippocampal damage

Procedural memory is often intact in persons
with AD

Question 17

Why does structure help patents with AD?

Answer 17

Intact procedural memory can be utilized to
teach AD patients new tasks.

Repetition of procedures, with little changing of
routine, may be helpful

Question 18

What 3 things are used to diagnose AD?

Answer 18

1. By exclusion
2. MMSE score
3. Presence of personality changes