Alzheimer’s disease Flashcards

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1
Q

Protective factors

A

smoking
hrt (oestrogen)
NSAIDs
higher level of pre-morbid education

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2
Q

Pathophysiology

micro + macroscopic

A
  • Degeneration of cholinergic neurones in nucleus basalis of Meynert → def. in Ach
  • Microscopic changes: neurofibrillary tangles (intracellular) + beta-amyloid plaque formation (extracellular)
  • Macroscopic changes: cortical atrophy (commonly hippocampal), widened sulci, ventricle enlargement
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3
Q

Genetics

A
  • Early onset Alzheimer’s: presenilin 1 (chromosome 14), presenilin (chromosome 2), amyloid precursor protein (chromosome 21 → TRISOMY 21 [Down’s] therefore more likely to get early onset dementia as more likely to have this gene as 3 chrom. 21s)
  • Later onset Alzheimer’s: ApoE-4 (chromosome 19)
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4
Q

RFs

A
Advancing age
FHx (1st degree)
Genetics (above)
Down’s syndrome
low IQ + lower education attainment
cerebrovascular disease
vascular RFs (Past stroke/MI, smoking, HTN, DM, ^ cholesterol)
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5
Q

CFs

A

Summary: Early memory loss + focal cognitive defects → later manifestations = personality changes

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6
Q

early symptoms

A

Early Sx’s →
failing memory (esp. disorientation for time)
muddled efficiency w/ ADLs, spatial dysfunction
behaviour changes (irritable)
difficulty finding words
forgetting names of people/places

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7
Q

middle symptoms

A
Middle Sx’s → 
intellectual and personality deterioration 
apraxia
confusion
language problems (aphasia)
difficulty w/ executive thinking
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8
Q

late symptoms

A
Late Sx’s → 
eating problems
depression
agitation
personality changes
dependent
physical deterioration
incontinence
gait problems
weight loss
primitive reflexes
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9
Q

psychiatric and behavioural symptoms

A

Psychiatric Sx’s → delusions (esp. paranoid), auditory ± visual hallucinations (simple misidentification), depression (common)

Behavioural Sx’s → aggression, wandering, explosive temper, sexual disinhibition, incontinence, excessive eating, searching behaviour

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10
Q

features of early onset Alzheimer’s

A

<65y/o
rapid
aphasia
apraxia

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11
Q

define aphasia

A

person’s problem in ability to understand speech

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12
Q

define apraxia

A

inability to carry out previously learnt purposeful movements (including speech) despite normal coordination + strength
(cant give x’s cos can’t move their mouth)

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13
Q

What 5 things do pts have impairment with relating to cognitive and executive functions

A
  1. Executive → problem solving, abstract thinking, reasoning, deciding, judgement, planning, organising, processing
  2. Visuospacial abilities → getting lost, copying figures
  3. Language disturbances (decreased vocab, word finding difficulty, preservation [repetition], aphasia…)
  4. Apraxia → inability to carry out previously learnt purposeful movements (including speech) despite normal coordination + strength
  5. Agnosia (impaired recognition of sensory stimuli w/out sensory loss)
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14
Q

Ix

A
  1. Hx
  2. MSE: important to note clouding of consciousness (delirium)
  3. Cognitive testing: MMSE + AMT
  4. Physical examination: focal signs, reflexes, plantar responses, gait disturbance, PD signs
  5. Blood tests
    a. FBC, , LFT, U/E, glucose, ESR, TSH/TFTs, calcium, magnesium, phosphate, syphilis tests, HIV screen, vit B12, folate, CRP, blood culture
  6. LP → exclude CJD (Creutzfeldt-Jakob disease)
  7. EEG → CJD + frontotemporal dementia
  8. CXR (pneumonia, lung tumour [e.g. SCLC → hyponatraemia [confusion]])
  9. Urine dipstick (UTI)
  10. ECG → CVD
  11. Brain imaging → indicated if <60
    a. CT (head)/MRI
  12. Genetic tests: HD + familial dementia
  13. Referral to memory clinic

ALWAYS remember that calcium is separate from U+Es (therefore give both in answers)

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15
Q

ICD-10 criteria for disease (early onset and late onset)

A
  1. Criteria for dementia met
  2. No evidence for any other possible cause of dementia
  3. Early onset AD:
    (1) + (2) + <65
    o Rapid onset + progression
    o Memory impairment + aphasia, agraphia (decreased ability to communicate through writing), alexia (decreased ability to read), acalculia (decreased ability to perform maths tasks) or apraxia
  4. Late onset AD:
    (1) + (2) + Age >65
    One of:
    • Slow, gradual onset and progression
    • Predominance of memory impairment over intellectual impairment
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16
Q

Treatment - general

A
  • MDT approach: OT, PT, COE doctor, GP, social worker…
  • Pts must contact DVLA
  • Early discussion for advanced planning (before deterioration) → advanced statements or directives, lasting power of attorney…etc
  • Later in disease → Mental capacity act (assessment)
17
Q

Treatment - pharmacological

A
  • Acetylcholinesterase inhibitors → e.g. Rivastigmine (SEs: GI) → ^ ACh in cholinergic synapses in CNS, slowing progression of the disease
  • 2ND line (or add in): Memantine (NMDA-receptor antagonist → binds to excitatory glutamate receptors in CNS)
  • Also: anti-depressants e.g. sertraline, anti-psychotics if challenging behaviour e.g. risperidone
18
Q

Treatment - non pharma

A
  • Social support (support groups) → Alzheimer’s Society UK
  • ^ assistance w/ ADLs
  • Information + education
  • Community dementia teams
  • Home nursing + personal care
  • Community services (e.g. meals on wheels, day centres, care homes…)
  • Non-cognitive symptoms (aromatherapy, massage, music therapy, animal assisted therapy)