Alzheimer's disease (AD)

Question 1

Name 3 risk factors for developing AD

Answer 1

• Older age
• Family history
• Autosomal dominant mutations (5%)
• Homozygosity for apolipoprotein E allele E4
• Caucasian ethnicity
• Down’s syndrome
• Smoking
• Decreased physical and cognitive activity
• Depression and loneliness

Question 2

1) Mutations in which 3 genes are thought to cause the inherited form of Alzheimer’s
2) Mutations in which gene is most commonly associated with the sporadic form of Alzheimer’s?

Answer 2

1) Amyloid precursor protein (APP), presenilin 1 and presenilin 2
2) Apolipoprotein E allele E4

Question 3

What is the main macroscopic pathological changes associated with Alzheimer’s?

Answer 3

Widespread cerebral atrophy

Question 4

1) What is the main microscopic pathological changes associated with Alzheimer’s, and what does this lead to?
2) AD is associated with a deficit of what neurotransmitter?

Answer 4

1) Deposition and accumulation of beta-amyloid peptide and intraneuronal neurofibrillary tangles caused by abnormal aggregation of the tau protein. This leads to progressive neuronal damage
2) Acetylcholine

Question 4

Name 2 areas of the brain that are predisposed to the cerebral atrophy

Answer 4

• Cortex
• Hippocampus
• Amygdala
• Subcortical nuclei

Question 5

Name 2 clinical features of AD

Answer 5

• Amnesia - memory loss
• Aphasia - difficulty with language or speech
• Apraxia - loss of ability to carry out skilled actions
• Agnosia - inability to interpret sensations

Question 6

1) What is agnosia?
2) What is apraxia?

Answer 6

1) Inability to recognize and identify objects or persons
2) Inability to perform learned movements on command, even though the command is understood and there is a willingness to perform the movement

Question 7

Name a non-pharmacological management of AD

Answer 7

• Activities to promote wellbeing
• Group cognitive stimulation therapy
• Group reminiscence therapy
• Cognitive rehabilitation

Question 8

1) What group of drugs is first line in the management of mild to moderate AD?
2) Name 1 of these drugs

Answer 8

1) Acetylcholinesterase inhibitors
2) Donepezil, galantamine and rivastigmine

Question 9

1) What drugs is second line treatment for AD?
2) What kind of drug is this?

Answer 9

1) Memantine
2) NMDA receptor antagonist