alzheimers

Question 1

alzheimers pathology

Answer 1

Degeneration of the cerebral cortex, with cortical atrophy, neurofibrillary tangles, amyloid plaque formation and reduction in
acetylcholine production from affected neurons

accumulation of beta amyloid in senile plaques and neuronal damage with neurofibrillary tangles

cerebral atrophy may be observed

Question 2

hallmark feature of alzheimer dementia

Answer 2

memory decline with loss of recent memory first. Symptoms progress, with new information rapidly lost, and later, only fragments of memory remaining.

Question 3

features of alzheimers

Answer 3

memory loss

disorientation - time and place

misplacing items or getting lost - memory disorientation or visuo-spatial dysfunction.

nominal dysphasia

apathy - passive, sleep more than usual, or not want to perform usual activities

decline in activities of daily living

personality change

physical examination amazing

later stages
- incontinence
- perseveration
- expressive dysphasia 
NOT ASS WITH VISUAL HALLUCINATIONS UNLIKE LEWY BODY

Question 4

DD for alzheimers

Answer 4

Normal ageing
Other forms of dementia - see separate article Dementia. There is often significant overlap.
Normal pressure hydrocephalus.
Parkinson's disease.
Hypothyroidism.
Drug-induced cognitive impairment - eg, benzodiazepines.
Vitamin B12 deficiency.
Depression, schizophrenia.
Acute confusional state, amnesia.
Neurosyphilis, AIDS dementia complex.

Question 5

If GP suspects alzheimers what are they supposed to do

Answer 5

referral to memory clinic

blood tests

physical examination

normal CT

Question 6

at memory clinic what do they do to confirm diagnosis

Answer 6

confirm and expand upon the history by speaking to relative ir carer

arrange brain scan

check blood test results

do a risk assessment

undertake cognitive assessment

Question 7

which test is used in follow up for alzheimers

Answer 7

MMSE

Question 8

driving and alzheimers

Answer 8

the pt should be asked to inform the DVLA

if they do not you can breach confidentiality

doctor will ask family member how they are driving

DVLA assesses the diagnosis

Question 9

Mx for alzheimers

Answer 9

mild to moderate
- donepezil, rivastigmine or galantamine
cholinesterase inhibitor.

If contradicted give memantine

severe - Memantine (NMDA inhibitor)

regualr follw up with specialist

support in the community such as carers, community osych nurses
day centre services

Question 10

what needs to be done before cholinesterase inhibitors are prescribed

Answer 10

ECG - can worsen conduction abnormalities - sick sinus/supraventricualr conduction

enquire about history of peptic ulcer disease and dyspepsia

enquire about history of asthma - worsen it

cardian hostory - arrhythmia

likelihood compliance