Chapter 11 - Alzheimer's Disease Flashcards
What is dementia?
- umbrella term referring to changes in cognitive function great enough to interfere w/ daily function
- called neurocognitive disorder in the DSM5
- degenerative
- most common is AZ
What is MCI?
- clinical diagnosis describing the transitional state btwn normal aging and mild dementia
- pts @ a greater risk for developing AZ
- mild mem impairment w/ preservation of other cog functions
Amnestic MCI
- cognitive impairment limited to episodic memory
- 80% pts progress to AZ
Amnestic Multiple Domain MCI
- mild impairment on multiple domains such as mild behavioral changes, executive dysfunction, and visuospatial deficits
Non-amnestic Single Domain MCI
- mild isolated cog impairment of behavior, executive function, lang., visuospatial processing
- NOT episodic memory
- high risk for other dementias
Non-amnestic Multiple Domain MCI
- mild cog impairment on multiple domains such as mild behavioral changes, executive dysfunction, visuospatial deficits
- NOT episodic memory
- high risk for other dementias
Clinical description of MCI
- pt has memory complaint
- memory dysfunction for age and education
- largely intact activities of daily living
- not demented
- use of the Clinical Dementia Rating Scale and the Global Deterioration Scale
What are the risk factors for AZ?
- increasing age
- presence of APOE e4 increases risk
- CV disease
- TBI
- depression
- lower educational achievement
- Down syndrome
Clinical evolution of AZ can be divided into 3 categories, what are they?
- progressive memory impairment
- progressive cortical dysfunction
- neuropsychiatric disturbances
AZ has an ________ onset and a _______ progression of an amnesic memory disturbance with difficulties of _________ and _____.
- insidious
- gradual
- learning
- recall
Early stage of AZ
- aka mild
- STM loss, difficulty w/ recall
- changes in language
- changes in mood
- decreased judgement
Clinical manifestations of AZ
- cog impairment, mainly episodic
- behavioral disturbances (aggression, delusions, wandering)
- affective disturbances (changes in mood and personality)
- motor impairments (seen towards late stages, resembles Parkinson’s)
Mild stage of AZ
- aka moderate
- personality changes,
- LTM loss
- behavioral problems (agitation, anxiety, aggression, wandering, insomnia)
- needing assistance in daily activities
End stage of AZ
- aka severe
- behavioral changes
- loss of ability to perform daily activities
- incontinence
- loss of motor skills
Diagnosis of AZ
- MMSE
- general neurologic exam
- health hx
- CT or MRI to see atrophy
Amyloid plaques
- neuritic plaques caused by the abnormal processing of amyloid-beta proteins
- lead to excitotoxicity and apoptosis
Neurofibrillary tangles
- Tau, a microtubule stabilizing protein, clump together in pts with AZ
- microtubules collapse
What neurotransmitter is affected in AZ?
acetylcholine
- cholinergic neurons are lost in the basal forebrain
glutamate
- reduction of NMDA receptors in the hippocampus
Genetic factors of AZ
- abnormal amyloid precursor protein (21q)
- PSEN1 and PSEN2
- apolipoprotein E e4 allele (APOEe4) increases risk, APOEe2 decreases risk
What are the nonpharmacological tx for AZ?
- CBT
- support
What are the pharmacological tx for AZ?
- cholinesterase inhibitors and NMDA are the known treatments
- antidepressants, anxiolytics, antipsychotics, mood stabilizers, sleep medications are used for adjunctive treatment
Cholinesterase inhibitors
- AChase is the enzyme responsible for breaking down ACh
- cholinesterase inhibitors will reduce the breakdown of ACh, thus preserving cognition
- cannot regain lost function and memory or protect neurons from degeneration
- useful for mild-moderate AZ
- adverse affects: headache, high BP, dizziness, heart burn
EX of cholinesterase inhibitors
- most common in Aricept
- transdermal Exelon patch (no swallowing, less side effects)
NMDA receptor agonists
- the lack of reuptake of glutamate by NMDA receptors has excitotoxic effects in pts with AZ
- can preserve cog, social and motor impairment
- cannot protect neurons from degeneration
- used for moderate-severe AZ
Preventative strategies for AZ
- manage of CV risk factors like high cholesterol, high BP, obesity
- maintaining mental activity
