Neuro

Question 1

Define Dementia?

Answer 1

Clinical syndrome including the following symptoms
Poor memory
Difficulty learning

Question 2

What is Alzheimer Disease

Answer 2

Progressive Neurodegenerative disorder that causes a significant deterioration in mental performance.

Most common cause of dementia
Incurable condition

Question 3

What are the risk factors for developing Alzheimer disease?

Answer 3

Old Age
Genetics - Autosomal dominance inheritance (Mutations in Amyloid Precursor Protein and Presenilin genes 
Cardiovascular disease
Low social engagement and support 
Depression
Smoking and diabetes
Downs Syndrome

Question 4

What are the two types of AD?

Answer 4

Sporadic - Most common

Familial (Early-onset), Associated w/ genes PSen1/2, APOE E4

Question 5

What are the clinical features of dementia?

Answer 5

Cognitive Impairment - Poor memory, language problems (Dysphasia +E), Disorientation, problems with exec functioning (problem solving/planning)
Slow onset symptoms with lack of insight with accommodation to cog or functional changes.

Behaviour + Psychological symptoms
Disinhibition 
Withdrawal/apathy 
Sleep cycle disturbance
Psychosis
Wandering
Depression + Anxiety 
Agitation + Emotional lability

Question 6

What are the main features of AD?

Answer 6

Short term memory loss, difficulty learning new information. 
Disorientation 
Loss of language + Motor skills 
Long-term memory loss 
Bedridden
Infection -> Death

Question 7

What features on brain imaging are seen for AD?

Answer 7

Generalised brain atrophy 
Narrow Gyri (Ridges of brain)
Wider Sulci (Grooves between gyri)
Larger ventricles
Senile plaques (hippocampal, medial + temporal lobe)

Imaging Choice -CT or MRI

Question 8

What are the pharmacological treatments for AD?

Answer 8

Acetylcholinesterase-Inhibitors (Donepezil, Rivastigmine) [Mild-Mod]

NMDA Antagonist - Memantine [Mod-Sev]

MMSE :10-20

Sleep disturbance -Trazodone

Question 9

Pathophysiology behind AD?

Answer 9

1. Senile plaques - Deposits of beta amyloid outside of neurons (Dense insoluble)
   APP cleaved by secretase enzymes (Gamma + Alpha)
2. Neurofibrillary tangles of phosphorylated tau proteins inside neurons.

Both causes interrupt signalling of neurons which leads to impaired brain function due to neuronal cell death.