Old age psychiatry

Question 1

How do you manage Alzheimers dementia

Answer 1

• 3 acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine) as options for managing mild to moderate Alzheimer’s disease
• Memantine (an NMDA receptor antagonist) is reserved for patients with → moderate Alzheimer’s who are intolerant

-Or have a contraindication to, acetylcholinesterase inhibitors
→ severe Alzheimer’s

Question 2

What are the pathological changes in Alzheimer’s?

Answer 2

Macroscopic: widespread cerebral atrophy, particularly involving the cortex and hippocampus

Microscopic: cortical plaques due to deposition of type A-Beta-amyloid protein and intraneuronal neurofibrillary tangles caused by abnormal aggregation of the tau protein

Biochemical: there is a deficit of acetylcholine from damage to an ascending forebrain projection

Question 3

What are the genetics of Alzheimer’s disease

Answer 3

most cases are sporadic
5% of cases are inherited as an autosomal dominant trait
mutations in the amyloid precursor protein (chromosome 21), presenilin 1 (chromosome 14) and presenilin 2 (chromosome 1) genes are thought to cause the inherited form
apoprotein E allele E4 - encodes a cholesterol transport protein