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Neurology > Alzheimer's Disease > Flashcards

Alzheimer's Disease Flashcards

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1
Q

Risk factors in Alzheimers Disease

A

Birth order
Age of birth?
Family hx of Down’s

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2
Q

MAJOR SYMPTOM in AD

A

gradual dev’t of forgetfulness

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3
Q

Law that applies to AD

A

The Ribot law of memory

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4
Q

CF of AD

A

Insidous course

Unusual degree of CONFUSION in relation to febrile illness, operation, head injury, institution of medicine

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5
Q

CF (speech) of AD

A

halting speech, restricted vocab
cant carry out complicated request
cant speak in full sentence
echolalia

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6
Q

CF (detoriation in arithmetic)

A

dyscalculia/acalculia

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7
Q

Apraxia in AD

A

ideational ans ideomotor

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8
Q

Alterations in AD

A

Alterations in social graces, restlessness and agitation

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9
Q

Neglect in AD

A

Neglect in self care

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10
Q

Disturbed in?

A

Sleep pattern

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11
Q

Affect in AD

A

Coarsening if affect

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12
Q

Sex in AD

A

Sexual indiscretions

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13
Q

Later stage in AD, these 2 reflexes are affected. What lobe releases these signs?

A

Grasp and sucking reflex

Frontal lobe

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14
Q

in AD, there is difficulty in locomotion which will lead to unsteadiness and finally

A

persistenr vegitative state

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15
Q

Symptomatic course in AD spans over how many years

A

5 years

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16
Q

Pathologic changes occur how many years

A

15 years

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17
Q

This is one of the early manifestations of AD which is describe as failure of short and long term memory

A

Amnesia

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18
Q

This is one of the early manifestations of AD which is describe as forgetting of words

A

Dysnomia

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19
Q

This is one of the early manifestations of AD which is caused by posterior cortical atrophy

A

Visuospatial disorientation

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20
Q

This is one of the early manifestations of AD (psychiatry)

A

Paranoia and personality changes

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21
Q

This is one of the early manifestations of AD which affects the coordinating and planning tasks

A

Executive function

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22
Q 
NINCDS CRITERIA
Probable AD (5)
A

1) Deficits in 2 or more domains of cognition
2) Progressive decline of memory and other cognitove functions
3) Preserved consciousness
4) Onset between ages 40 and 90
5) Absence of systemic or other brain disease that could account for symptoms

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23
Q

NINDCS CRITERIA

Possible AD

A

1) Atypical onset, presentation, or clinical course of dimentia
2) Presence of another illness capable of producing dementia

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24
Q

NINCDS

Definite AD

A

1) Clinical criteria for probable AD

2) Tissue dx by autopsy or biopsy

25
Q

Seen in advanced state of AD

A

Diffuse cortical atrophy in frontal, temporal and parietal lobes

26
Q

Most prominent pathology in AD

A

Hippocampal atrophy

27
Q

Microscopically, there is widespread loss of nerve cells in AD. In what 6 areas of the brain it is found?

A 
1 Hippocampus
2 Medial temporal cortex
3 Ant nuclei of thalamus
4 Septal nuclei
5 Diagonal band of Broca
6 Amygdala
28
Q

In AD, cerebral cortex cells are also loss. What neurons in the cerebral cortex is predominantly affected?

A

Large pyramidal neurons

29
Q

3 hallmark microscopic changes

A

1) Neurofibrillary tangles (NFTs) - silver staining material w/in cell cytoplasm (made of TAU protein)
2) Protein amyloid surrounded by neuritic plaques
3) Granulovacuolar degeneration of neurons - pyramidal layer of hippocampus

30
Q

NFT correlate best with what?

A

NFT correlate best with severity of dimentia

the HIGHER The number of NFT, the severe the disease is

31
Q

4 regions disproportionately affected in AD

A

1) Hippocampus (CA1 and CA2 zones)
2) Entorrhinal cortex
3) Subiculum
4) Amygdala

32
Q

Amyloid precursor protein (APP) contains what protein

A

Aβ protein

33
Q

Aβ cleaved from APP by what enzymes

A

alpha, beta, gamma secretase

34
Q

APP cleaved NORMALLY by what enzyme?

A

alpha or beta secretase

35
Q

Abnormal cleavage of APP of what enzyme will result to toxin causing AD

A

beta and gamma secretase

36
Q

APP —- beta and gamma secretase—>

A

Aβ40 and Aβ42 (toxic)

37
Q

In AD, there are also neurotransmitter abnormalities. What 2 neurotransmitters in the hippocampus and neocortex are reduced?

A

Choline acetyltransferase and acetylcholine

38
Q

What cells are reduced AD?

A

Cells in nucleus basalis of Meynert

39
Q

4 neurotransmitters that are low in AD

A

Glutamate
Substance P
Somatostatin
Cholecystokinin

40
Q

[GENETICS]

This modifies risk for acquiring AD (tripling of risk)

A

Apo E4

41
Q

Defective genes code this protein at chromosome 21

A

errant APP

42
Q

Component of gamma secretase (enzyme that produce AB42)

A

Presenillin 1 and 2

43
Q

3 results of MRI in AD

A
  1. Atrophy of hippocampi with enlargement of temporal horns of lateral ventricles
  2. Lateral and 3rd ventricles enlarged twice normal size
  3. Cerebral sulci widened
44
Q

MRI

A

Posterior predominant cortical atrophy, medial temporal lobe atrophy

45
Q

Mild early? form of AD; 50% of this case develops AD

A

Mild congnitive impairement.

46
Q

Tx of AD which has modest effects

A

Cholinergic precursors and agonists

47
Q

Tx for late stage of AD

A

NMDA glutaminergic antagonists

48
Q

NMDA gluteminergic antagonists for late stage of Alzheimer

A

Memantine 20 mg daily

49
Q

Acetylcholinesterase inhibitors

A

Donezepil 10 mg OD
Rivastigmine 6 mg BID or 9.5 mg OD patch
Galantamine 24 mg OD

50
Q

NMDA glutamate antagonist

A

Memantine 10 mg BID

51
Q

Tx of AD

A

Cholinergic precursors and agonists
Acetylcholinesterase inhibitors
NMDA glutaminergic antagonists
NMDA glutamate antagonists

52
Q

Other tx of AD

A

Gingko Biloba
Statins
Role of Insulin
Vaccine against Aβ

53
Q

Other Tx of AD most benefit by 1 controlled trial

A

Gingko biloba

54
Q

Bedside screening testfor cognitive deficits

A

MMSE and MoCA

55
Q

What’s included in MoCA

A

Clockdrawing test and trail test

56
Q

More sensitive screening test in detection of MILD impairment

A

MoCA

57
Q

Maximum score in MoCA

A

30

58
Q

Normal score of MoCA

A

26 - 30

Neurology (4 decks)

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