Alzheimer's Disease Flashcards
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Risk factors in Alzheimers Disease
Birth order
Age of birth?
Family hx of Down’s
MAJOR SYMPTOM in AD
gradual dev’t of forgetfulness
Law that applies to AD
The Ribot law of memory
CF of AD
Insidous course
Unusual degree of CONFUSION in relation to febrile illness, operation, head injury, institution of medicine
CF (speech) of AD
halting speech, restricted vocab
cant carry out complicated request
cant speak in full sentence
echolalia
CF (detoriation in arithmetic)
dyscalculia/acalculia
Apraxia in AD
ideational ans ideomotor
Alterations in AD
Alterations in social graces, restlessness and agitation
Neglect in AD
Neglect in self care
Disturbed in?
Sleep pattern
Affect in AD
Coarsening if affect
Sex in AD
Sexual indiscretions
Later stage in AD, these 2 reflexes are affected. What lobe releases these signs?
Grasp and sucking reflex
Frontal lobe
in AD, there is difficulty in locomotion which will lead to unsteadiness and finally
persistenr vegitative state
Symptomatic course in AD spans over how many years
5 years
Pathologic changes occur how many years
15 years
This is one of the early manifestations of AD which is describe as failure of short and long term memory
Amnesia
This is one of the early manifestations of AD which is describe as forgetting of words
Dysnomia
This is one of the early manifestations of AD which is caused by posterior cortical atrophy
Visuospatial disorientation
This is one of the early manifestations of AD (psychiatry)
Paranoia and personality changes
This is one of the early manifestations of AD which affects the coordinating and planning tasks
Executive function
NINCDS CRITERIA Probable AD (5)
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
NINDCS CRITERIA
Possible AD
1) Atypical onset, presentation, or clinical course of dimentia
2) Presence of another illness capable of producing dementia
NINCDS
Definite AD
1) Clinical criteria for probable AD
2) Tissue dx by autopsy or biopsy
Seen in advanced state of AD
Diffuse cortical atrophy in frontal, temporal and parietal lobes
Most prominent pathology in AD
Hippocampal atrophy
Microscopically, there is widespread loss of nerve cells in AD. In what 6 areas of the brain it is found?
1 Hippocampus 2 Medial temporal cortex 3 Ant nuclei of thalamus 4 Septal nuclei 5 Diagonal band of Broca 6 Amygdala
In AD, cerebral cortex cells are also loss. What neurons in the cerebral cortex is predominantly affected?
Large pyramidal neurons
3 hallmark microscopic changes
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
NFT correlate best with what?
NFT correlate best with severity of dimentia
the HIGHER The number of NFT, the severe the disease is
4 regions disproportionately affected in AD
1) Hippocampus (CA1 and CA2 zones)
2) Entorrhinal cortex
3) Subiculum
4) Amygdala
Amyloid precursor protein (APP) contains what protein
Aβ protein
Aβ cleaved from APP by what enzymes
alpha, beta, gamma secretase
APP cleaved NORMALLY by what enzyme?
alpha or beta secretase
Abnormal cleavage of APP of what enzyme will result to toxin causing AD
beta and gamma secretase
APP —- beta and gamma secretase—>
Aβ40 and Aβ42 (toxic)
In AD, there are also neurotransmitter abnormalities. What 2 neurotransmitters in the hippocampus and neocortex are reduced?
Choline acetyltransferase and acetylcholine
What cells are reduced AD?
Cells in nucleus basalis of Meynert
4 neurotransmitters that are low in AD
Glutamate
Substance P
Somatostatin
Cholecystokinin
[GENETICS]
This modifies risk for acquiring AD (tripling of risk)
Apo E4
Defective genes code this protein at chromosome 21
errant APP
Component of gamma secretase (enzyme that produce AB42)
Presenillin 1 and 2
3 results of MRI in AD
- Atrophy of hippocampi with enlargement of temporal horns of lateral ventricles
- Lateral and 3rd ventricles enlarged twice normal size
- Cerebral sulci widened
MRI
Posterior predominant cortical atrophy, medial temporal lobe atrophy
Mild early? form of AD; 50% of this case develops AD
Mild congnitive impairement.
Tx of AD which has modest effects
Cholinergic precursors and agonists
Tx for late stage of AD
NMDA glutaminergic antagonists
NMDA gluteminergic antagonists for late stage of Alzheimer
Memantine 20 mg daily
Acetylcholinesterase inhibitors
Donezepil 10 mg OD
Rivastigmine 6 mg BID or 9.5 mg OD patch
Galantamine 24 mg OD
NMDA glutamate antagonist
Memantine 10 mg BID
Tx of AD
Cholinergic precursors and agonists
Acetylcholinesterase inhibitors
NMDA glutaminergic antagonists
NMDA glutamate antagonists
Other tx of AD
Gingko Biloba
Statins
Role of Insulin
Vaccine against Aβ
Other Tx of AD most benefit by 1 controlled trial
Gingko biloba
Bedside screening testfor cognitive deficits
MMSE and MoCA
What’s included in MoCA
Clockdrawing test and trail test
More sensitive screening test in detection of MILD impairment
MoCA
Maximum score in MoCA
30
Normal score of MoCA
26 - 30
