Dementia - Alzheimer's Disease

Question 1

Risk Factors of Alzheimer’s Disease (5).

Answer 1

1. Increasing Age.
2. Family History.
3. Genetic.
4. Caucasian.
5. Down’s syndrome.

Question 2

Pathophysiology of Alzheimer’s Disease.

Answer 2

1. Widespread Cerebral Atrophy (especially Cortex and Hippocampus).
2. Cortical Plaques - Deposition of Type A-Beta-Amyloid Protein.
3. Neurofibrillary Tangles - Abnormal Aggregation of Tau Protein (which can be hyperphosphorylated).
4. Deficit of Acetylcholine.

Question 3

Clinical Features of Dementia (4).

Answer 3

4As :

1. Amnesia (Recent Memories Lost First).
2. Aphasia (Word-Finding Problems).
3. Agnosia (Recognition Problems).
4. Apraxia (Inability to Carry Out Skilled Tasks despite Normal Motor Function).

Question 4

Non-Pharmacological Management of Dementia (3).

Answer 4

1. OFFER a range of activities to promote wellbeing tailored to personal preference.
2. OFFER group cognitive stimulation therapy in Mild/Moderate cases.
3. CONSIDER group reminiscence therapy and cognitive rehabilitation.

Question 5

Pharmacological Management of Dementia.

Answer 5

1. Mild/Moderate : Acetylcholinesterase Inhibitors.

2. 2nd Line : Memantine.

Question 6

Give 3 examples of Acetylcholinesterase Inhibitors that can be used.

Answer 6

1. Donepezil.
2. Galantamine.
3. Rivastigmine.

Question 7

Contraindication and Adverse Effect of Donepezil.

Answer 7

Contraindication : Bradycardia.

Adverse Effect : Insomnia.

Question 8

What is Memantine?

Answer 8

NMDA Receptor Antagonist.

Question 9

Indications of Memantine (2).

Answer 9

1. 2nd Line in Mild/Moderate Alzheimer’s.

2. Monotherapy in Severe Alzheimer’s.

Question 10

Management of Non-Cognitive Symptoms of Alzheimer’s disease (2).

Answer 10

1. NO Antidepressants for Depression in Mild/Moderate Cases.

2. Antipsychotics if Risk of Harm during Agitation, Hallucinations, Delusions.