Alzheimer's Disease

Question 1

What is Alzheimer’s disease? Features?

Answer 1

Progressive degenerative disorder in adults usually > 40 years with persistent, progressive and global cognitive impairment:
Visuo-spatial skill
Memory
Verbal abilities
Executive function (planning)
Anosognosia (lack of insight into the problems endangered by disease)

Later there may be irritability, mood disturbance, behavioural change, psychosis, agnosia (not recognise self in mirror)

Question 2

What is the cause of Alzheimer’s disease

Answer 2

Environmental and genetic factors
Accumulation of beta-amyloid peptide - degradation product of amyloid precursor protein results in progressive neuronal damage, neurofibrillary tangles, increased number of amyloid plaques and loss of Each.

Question 3

Where is neuronal loss in Alzheimer’s disease?

Answer 3

Hippocampus, amygdala, temporal neocortex, subcortical nuclei are most vulnerable.

Question 4

What are pathological changes in AD?

Answer 4

Macroscopic - widespread cerebral atrophy particularly involving the cortex and hippocampus
Microscopic - cortical plaques due to deposition of beta amyloid peptide and intraneuronal neurofibrillary tangles caused by abnormal aggregation of tau protein
Biochemical - deficit of Each from damage to ascending forebrain projection

Question 5

What are neurofibrillary tangles?

Answer 5

Paired helical filaments made from Tau protein

Question 6

What are risk factors for AD?

Answer 6

1st degree relative
Down's syndrome
Genetics
Vascular - HTN diabetes, dyslipidaemia, AF
Depression
Loneliness
Smoking

Question 7

What is non-pharmacological management of AD?

Answer 7

Range of activities to promote well being
Group cognitive stimulation therapy
Groups reminiscence therapy
Cognitive rehabilitation
Refer to specialist memory ervice
BP control

Question 8

What is pharmacological management of AD?

Answer 8

Mild-moderate:
Acetylcholinesterase inhibitors:
Donezepil, galantamine, rivastigmine
May have cholinergic effects and exacerbate PUD and heart block - ask about symptoms and do ECG first

Severe or do not tolerate acetylcholinesterase inhibitors
NMDA antagonist
Memantine

Question 9

What are side effects of memantine?

Answer 9

Hallucinations, confusion, hyerptonia, hypersexuality

Question 10

When should you consider antipsychotics?

Answer 10

Severe, non-cognitive symptoms only - psychosis or extreme agitation
Avoid in Lewy body dementia (neuroleptic malignant syndrome

Question 11

Adverse effects of donepezil?

Answer 11

PUD
Heart block
Insomnia

Do ECG first