Clinical aspects of dementia and Alzheimer’s disease

Question 1

What is dementia’s prevalence correlated to?

Answer 1

Age-specific

Question 2

What is dementia?

Answer 2

Acquired syndrome characterized by multiple cognitive deficits, severe enough to interfere with daily life/functioning, including social and professional functioning

Question 3

What are the 3 main symptoms of dementia?

Answer 3

1. Cognitive impairment (memory, abstract thinking, judgement, language, executive function, visuospatial abilities)
2. Neuropsychiatric symptoms and challenging behaviours (agitation, anxiety, depression, agitation, delusions, hallucinations)
3. Functional disability

Question 4

Is it possible to say if yes or no you have dementia? Why?

What criteria allows to define if you have it?

Answer 4

No, because it is a continuum (a spectrum)
A lot of old people are in the grey area of the continuum because when you get older some of the symptoms are normal
DSM-5 criterias must be respected to define if you are normal, minor neurocognitive disorders (NCD) or major NCD

Question 5

What are the 3 causes of dementia?

Answer 5

1. Neurodegenerative diseases (Alzheimer’s disease, Lewy Body dementia, Frontotemporal dementia, etc.)
2. Vascular dementia
3. Dementia due to treatable illnesses: minority of cases, but only group that could be cured (toxic, systemic or metabolic, infections, tumor, etc.)

Question 6

What does define the brain of an Alzheimer’s disease patient (3 things) and when does it start?

Answer 6

1. Atrophy (loss of neurons and synapses)
2. Amyloid-rich neuritic plaques
3. Neurofibrillary tangles (Tau protein hypothesis)
   These changes begin years before the onset of clinical symptoms

Question 7

How do the amyloid-rich neuritic plaques come to be (3 steps)?

Answer 7

1. Aß production (from APP gene)
2. Aß aggregation
3. Aß accumulation (senile plaque)

Question 8

What are the 2 ways to diagnose Alzheimer’s disease with neuroimaging?

Answer 8

1. Magnetic Resonance Imaging (MRI): cortical atrophy and atrophy in the medial temporal lobes
2. Positron emission tomography (PET): biomarkers of neuronal degeneration or ß-amyloid deposition

Question 9

What are the 3 factors that can change the time of cognitive deterioration in Alzheimer’s disease?

Answer 9

1. Lifestyle
2. Genetic risk alleles
3. Co-occurrence of brain pathology
   Patients can develop the disease at different rates

Question 10

What are the 2 medical options currently available for Alzheimer’s disease as a prevention?

Answer 10

1. Acetyl-cholinesterase inhibitors

2. Memantine (inhibitor of glutamate)

Question 11

What is the main risk factor of Alzheimer’s disease

Answer 11

Age is the main one!

Question 12

What are modifiable risk factors for dementia?

Answer 12

Diabetes, hypertension, obesity, physical inactivity, social isolation, etc.