Alzheimers disease

Question 1

Px

Answer 1

-3 domains-
Cog- mem, lang (word finding, vocab, aphasia, anomia, agnosia, empty speech, echolalia), visuospat, executive func.
Func- ADLs.
Neuropysch- affect, aggress, anx, hallucin, delsuions, sleep.
-early-
Fail immed and ST mem, less effic ADL, spatial dysfunc, behav eg wandering and irrit, cog deficit.
-middle-
Aphasia, apraxia (cant carry out prev learned movem desp norm coord and strength), agnosia, behav, personality, orientation, impaired visuopsatial (directions, driving, copying) and executive function (prob solv, abstraction, reasoning, decis making, judgment, planning, org, processing).
-late-
Fully dependant. Fail LT mem. Incontin, gait abn, spasticity, seiz, termor, wl, primit reflexes, EP signs, musc rigid. Logoclonia. Psychotic symps. Aggress, restless, wandering. Dysphasia.
-psychiatric-
Delsuions 15% eg paranoid, aud or vis hallucination 15%, dep 20%.
-behav-
Agress, wandering, sexual disnihib, incontin, excess eat, searching, stubborn, resis, suspicion, abusive, hiding things, restless, catastrophic reac.
-personality-
Exagg of traits, coarse affect, egocentric, indiff, lack concern, reduc affection, lack motiv, agitat.
-parieto temporal= aphasia, agnosia, apraxia, apathy.
-frontal= irrit, disinhib.

Question 2

Mx

Answer 2

1st gen achEI eg tacrine
2nd gen eg donepezil, rivastigmine, galantamine. MMSE 12-20. Still plaque formation and cell death. For mild to mod. 
NMDA R partial agonists eg memantine for mod to sev. 
Antioxidants eg vit E, selegiline.
Anti inflamms
Secretase inhibs
Metal chelators
Amyloid beta pep vacc
Chol lowering
Red wine

Question 3

Investigation

Answer 3

hx incl eg IQCODE questionnnaire.
MSE
MMSE
Phsycial exam- focal signs, reflexes, gait, parkinsons.
Bloods
EEG
CT- cortical atrophy esp parietal and temporal, ventric enlargemn.
MRI- GM atrophy (hippo, amygdala, medial temoral)
SPECT- low BF to temporal and post parietal.
PET- reduc O and gluc metab in temporal and post parietal.
MR spectroscopy.

Question 4

Aetiology

Answer 4

-amyloid plaques-
Insol beta amyloid pleated sheet deposits in hippocampus, amygdala, cerebral cortex. High density with advanced dis.
-neurofibrillary tangles-
Plates tau prot in cortex, hippocampus, SN.
-co occurance of plaques and tangles is hallmark.
-up to 50% loss neuroens and syns in hippoc and cortex. Wide sulsi, large ventrics. Medial temporal atrophy.
-genetcis
-cholinergic hyp-
Degen cholinergic nuc in BFN= decr Ach.
-specif neuronal tract decay from- hippocampus, parietal lobe assoc areas.

Question 5

Prognosis

Answer 5

Grad onset, slow prog. Av under 10yr surv after diag.
-poor facs-
Sev at px, male, early onset, parietal lobe damage, lot behav probs, focal cog deficits eg apraxia, dep, no misID syndrome.

Question 6

Prevalence

Answer 6

70% of dementia in older people.
500K uk, 30mill world.
Risk incr with age- 1% at 60 then doubles ev 5 yr.
40% of over 85s.
50% excess in women.
RFs- downs, head inj, hypothyr, parkinsons fam hx.
Protective- smok, oestrogen, NSAId, vit E, high educated.

Question 7

Diffs

Answer 7

-

Question 8

Subtypes and course

Answer 8

• most commonly gradual and progressive decline without disting feats.
• early onset under 65, more aphasia and apraxia. Rapid course, severe intell decline, poor survival.
• EP signs, sev func imapir, psychptic.
• benign- little or no progression in 4 yrs.

Question 9

5 As

Answer 9

Anomia
Apraxia
Agnosia
Amnesia
Aphasia