Dementia: Alzheimer's Disease

Question 1

Most common symptom prior to and after diagnosis

Answer 1

Social withdrawl

Agitation

Question 2

All auto dominant forms of AD lead to

Answer 2

Increased amyloid production

Question 3

APP
ApoE
PS1
PS 2

Chromosome and what are they linked to?

Answer 3

fAD (21)
Late onset (19)
fAD(14)
fAD(1)

Question 4

Other things that genetics could alter in AD

Answer 4

Cholesterol
Inflammation
Synapse function
Brain develoment

Question 5

AD biomarkers

Answer 5

MRI - visualize neuron losss
CSF - measure B-amyloid and tau
FDG-PET look for hypometavbolism of sugars

Question 6

What causes the symptoms?

Answer 6

The tangles from tau…NOT the plauqes

Question 7

Progression of AD

Answer 7

pAD—-MCI—-AD

Amyloid plauqes
Cell death (tau)
Brain malfunction (PET)
Brain shrinkage (MRI)
Memory loss
Functional loss

Question 8

Difference between pAD, MCI, and AD

Answer 8

MCI will have cognitive decline whhile AD will have functional and cognitive decline

pAD can have amyloid plaques, tangles, brain atrophy but NOT decline

Question 9

Diagnosis of dementia

Answer 9

Functional decline from previous level of function

NOT delirium

TWO or more cog domains affected

Question 10

Reversible causes of dementia

Answer 10

Vascular
Infection
Trauma
AI
Metabolic
Inflammatory
Neoplams
Seizure

Question 11

Dementia vs. delirium

Answer 11

Dementia - level of consciousness is same…chronic (subacute)…static

Delirium - altered consciousness, acute/subacute…fluctuates

Question 12

Probable AD

Answer 12

Positive for Abeta OR neuronal injury but NOT both

Intermediate biomarker probability

Question 13

Definite and unlikely AD

Answer 13

Unlikely if both Abeta and injury neg

Definite if both Abeta and injury positive

Question 14

3 structures to look at using MRI and what to use

Answer 14

HC
Entorhinal cortex
Perirhinal cortex

Use T2

Question 15

Stages

Answer 15

0 - normal thickness and no widending of collateral

1 - slight decrease or mininaml widening or both

2 - mild decrease or mild widening or bioth

3- moderate decrease or both moderate decrease and widening

4- severe decrease or both severe decrease and widening of clalateeral

Question 16

Cholinergic pathway and AD and how to tx

Answer 16

Basal nucleus of meynert is atrophied so it cannot provide Ach

AchE inhibitors (donepizil)

Question 17

Memantine

Answer 17

Acts via glutamate receptors found widespread through cortex

Partial NMDA receptor antagonist…because when nerves injured, become calcium permable and increases background calcium and eradicates LT potentiation …this inhibits that effect

Main effect is on cognition