NP: Chapter 19 Alzheimers disease Flashcards
diagnosis of alzhheimers is made when … or more cognitive domains are affected
2
hoeveel jaar te leven na onset of the disease AD
7-8 jaar maar…
prevalence AD
46 million
double aging
- the number of elderly people will increase over the next decade
- the average life expectancy has increased and continues to do so
4 risk factors for AD
- age
- woman
- genetic predisposition, 5% van de cases are caused by familial type of the disease. + APOE E4 allele
- vascular risk factors: hypertension, diabetes, smoking
diagnosis bij dementia
- severity of the symptoms is determined
- type of dementia = ethiological diagnosis
op basis waarvan wordt de etiological diagnosis gesteld
national institiute of aging and alzheimer association NIA-AA, met low/medium/high probability of underlying AD pathology
= probable AD
definite diagnosis voor AD
kan alleen bij post-mortem AD
probable AD 4 factors
- evidence of ad genetic mutation
- clear decline in memory + in one other cogn. domain
- steadily progressive, gradual decline in cognition without extended plateaus
- no evidence of mixed ethiology
in what patients with MCI is risk of developing AD the highest
patients with amnestic type of MCI, impairment in episodic memory
hoe meet je episodic memory in deze patienten
met delayed recall on memory learning task
mild neurocognitive disorder dsm 5
evidence of modest cog. decline in one or more domains
do not interfere with independence in daily living
not due to delirium
not due to other mental disorder
major neurocognitive disorder dsm 5
evidence of substantial cogn. decline in one or more domains
interference with independence in daily life
not due to delirium
not due to other mental disorder
cognitive domains
learning and memory
attention
language
perception
praxis
executive functioning
social cognition
senile plaques
accumulations of amyloid beta protein BETWEEN the cells
neurofribrillary tangles
phosphorylated tau protein WITHIN the cells
the presence of senile plaques and neurofibrillary tangles causes…
necrosis and atrophy
dus welke is extraneuronal
the senile plaques
dus welke is extraneuronal
the senile plaques
amyloid cascade hypothesis
normally there is a balance between the amount of amyloid beta is produced from APP.
maar bij AD: abnormal cleavage of APP, daardoor imbalance between production and breakdown of amyloid beta protein -> aggregation and form plaques.
later: tau protein added.
limitation van amyloid cascade
why do some ppl develop ad and others do not even though they have app
the vascular hypothesis
cerebrovascular damage plays an important role in ad.
vascular risk factors -> reduction in blood circulation -> deficiency of oxygen -> hardening and decreased flexibility of blood vessels -> vessels become fragile and damage
what is the main symptom of ad during the first stage
anterograde loss of episodic memory. later ook decreased sense of orientation en later ook soms language impairments
wat zijn nog meer problemen
executive functions, attention, apraxia, deficits in visual perception
wat kan je voor ad doen met neuroimaging
uitsluiten van andere diagnosen
of evidence voor ad: atrophy in medial temporal lobe (vooral ook hippocampus)
wat voor drugs voor ad
niks wat het oplost
cholinesterase inhibitors: positive effect on cog. functioning and daily functioning in patients with mild to moderate ad
waarom zouden cholinesterase inhibitors werken
cholinergic hypothesis: the loss of cholinergic neurons leidt tot presynaptic cholinergic deficiency (zorgen er voor dat acetylcholine is broken down less quickly)
