Alzheimers

Question 1

Risk factors for Alzheimer’s?

Answer 1

increasing age, family history, caucasian ethnicity, Down’s syndrome, autosomal dominant trait 5% , apoprotein e allele e4 (cholesterol transport protein)

Question 2

which are the autosomal dominant mutations causing Alzheimers?

Answer 2

amyloid precursor protein (chromosome 21), presenilin 1 (chromosome 14), presenilin 2 (chromosome 1)

Question 3

pathological changes of Alzheimers?

Answer 3

cerebral atrophy: cortex and hippocampus esp
cortical plaques- type a beta amyloid protein and intraneuronal neurofibrillary tangles
hyperphosphorylation of tau
deficit in acetylcholine

Question 4

Management of Alzheimer’s?

Answer 4

cognitive rehabilitation, cognitive stimulation therapy, range of activities to promote wellbeing

3 acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine) mild/moderate Alzheimers

memantine 2nd line for intolerant or add on or monotherapy for severe

Question 5

donepezil is contraindicated in?

Answer 5

patients with bradycardia
adverse effect include insomnia

Question 6

Assessment tools for Dementia?

Answer 6

10-point cognitive screener
6-item cognitive impairment test
abbreviated mental test score
general practitioner assessment of cognition
mini-mental state examination

Question 7

what score in MMSE suggests dementia?

Answer 7

24 or less

Question 8

what blood tests should be done in primary care for dementia?

Answer 8

FBC, U&E, LFTs, calcium, glucose, ESR/CRP, TFTs, vitamin B12 and folate levels

Question 9

what is an essential investigation of dementia?

Answer 9

structural imaging

Question 10

potentially treatable causes of Dementia?

Answer 10

hypothyroidism, addisions, b12, folate thiamine deficiency, brain tumour, syphilis, normal pressure hydrocephalus, subdural heamatoma, depression, chronic alcohol and chronic bartbiturates