Alzheimers

Question 1

Onset

Answer 1

• 40-90

- most often after the age of 65

Question 2

Risk

Answer 2

• 1% at the age of 60
• 5% at the age of 65
• doubles every 5 years
• 40% at 85

Question 3

More common with increasing age

Answer 3

-among those older than 75 the risk is 6x greater than the risk for vascular dementia

Question 4

AD is more common than vascular

Answer 4

• AD is 50-70%

- VD is 15-20%

Question 5

Risks for Downs

Answer 5

• Age, Downs, Apolipoprotein e4 allele
• female sex, head injury, postmenopausal oestrogen decline
• possible risk factors: family history of Downs, PD and vascular factors

Question 6

Protective factors

Answer 6

• apolipoprotein E2 allee

- smoking, NSAIDS, oestrogen, premorbid intelligence and education

Question 7

Presenelin 2 gene

Answer 7

• on chromosome 1

- linked to early onset

Question 8

Presenelin 1 gene

Answer 8

• chromosome 14

- early onset

Question 9

Beta amyloid precursor protein gene

Answer 9

• chromosome 21
• APP coding area is on the long arm of ch21 and is impllicated in early onset dementia (Downs have 3x copies)
• mutation on codon717 on APP genecan cause excessive deposition of beta amyloid protein

Question 10

Apolipoprotein E4

Answer 10

• chromosome 19
• increases risk of late onset dementia of Alzheimers type
• if you have one copy you have 3x incidence of AD than no E4 gene, multiple copies increase the risk

Question 11

Diagnosis

Answer 11

• clinical examination
• MMSE
• Blessed dementia scale
• neuropsychological tests
• need deficits in 2 or more areas of cognition
• progressive worsening of memory and other cogniive functions
• no disturbance of consciousness
• absence of other diseases that could account for cognitive deficits

Question 12

Diagnostic procedures in AD

Answer 12

• CT excludes other causes
• MRI shows reduced grey matter, hippocampus, amygdala and temporal lobe volumes
• SPECY- reduced blood flow to temporal and parietal regions
• PET- reduced blood flow and metabolism in temporal and parietal regions
• MRS- abnormal synthesis of membrane phospholipids early in the disease
• amyloid PET imaging- shows deposition of beta amyloid even in preclinical stages of dementia

Question 13

Psychiatric symptoms in AD

Answer 13

• delusions in 15%
• auditory and visual hallucinations 10-15%
• depression requiring treatment in 20% of patients

Question 14

Behavioural symptoms in AD

Answer 14

• BPSD
• apathy in 59.6%
• depression in 58.5%
• irritability in 44.6%
• anxiety in 44%
• agitation in 41.5%

Question 15

Average survival rate in AD

Answer 15

-8 years

Question 16

Progression of AD

Answer 16

• increased agitation
• frequent emotional outbursts
• poor sleep
• wandering
• terminal phase: v. disorientated, amnestic and incontinent

Question 17

AMTS

Answer 17

• cut off is 7 or 8/`0

- looks at memory and orientation only

Question 18

MMSE

Answer 18

• cut off 24/30
• takes 5-10 minutes to complete
• tests orientation, memory , concentration, language, praxis and gnosis

Question 19

CAPE

Answer 19

• comprehensive Clifton assessment for the elderly

- intended to assess level of disability and estimate need for care

Question 20

DRS

Answer 20

• clinical dementia rating scale
• used to measure severity and stage of clinical illness
• ranges from 0-0.5, through to mild and moderate to severe dementia
• 6 domains

Question 21

ACE

Answer 21

Addenbrooke Cognitive Examination

-100 point scale

Question 22

NPI

Answer 22

Neuropsychiatric inventory

• rates frequence and severity of a range of neuropsychiatric symptoms
• 12 behavioural areas

Question 23

CAMCOG

Answer 23

• comprehensive cognitive test
• takes 40 mins
• score out of 104
• tests orientation, comprehension, perception, memory and abstract thinking

Question 24

Clock drawing test

Answer 24

-reveals test of praxis and offers qualitative and quantitative information

Question 25

Cholinesterase inhibitorys

Answer 25

• Donepezil (aricept), rivastigmine (exelon) and galantamine (reminyl)
• used in mild to moderate cognitive impairment
• potentiate the cholinergic neurotransmitter to improve memory and goal directed thought

Question 26

Donepezil

Answer 26

• well tolerated
• widely used
• long plasma half life of 70 hours
• permits once daily dosing
• total plasma protein binding
• highly selective reversible inhibition of ACh
• side effects: GI, headache, dizzinesss, muscle cramps
• 5mg OD-10mg OD

Question 27

Rivastigmine

Answer 27

• more likely to cause GI S/Es than donepezil
• may be better in PDD
• affects acetylcholinesterase and butylrylcholinesterase
• can be given as a patch
• 1.5mg BD to 6mg BD

Question 28

Galantamine

Answer 28

• more likely to cause GI S/Es
• direct nicotinic stimulatory action
• 4mg BD-12mg BD

Question 29

Memantine

Answer 29

• non-competitive
• PCP site, NMDA antagonist
• protects neurons from glutamate
• better tolerated than AChE Inhibitors
• used in treatment of moderate to severe AD or those who do not tolerate ACHEIs
• 5mg-10mg OD

Question 30

Olanzapine and risperidone

Answer 30

-increase stroke risk x2 and are not used in dementia

Question 31

Poor prognositc factors in AD

Answer 31

• male
• onset before 65
• prominent behavioural problems
• parietal lobe damage
• observed depression
• severe cognitive deficits such as apraxia
• absence of misidentification syndrome

Question 32

Psychosis in AD

Answer 32

• 30-50%
• delusions more common than hallucinations
• Capgras
• the phantom boarder (someone living in their house)
• mirror sign
• TV sign
• magazine sign