Psychiatry through the Lifecourse Flashcards
What is Dementia?
Degenerative disease of the brain with:
cognitive and behavioural impairment
sufficiently severe to interfere significantly with social and occupational function
Describe the pathophysiology of Alzheimers?
Amyloid plaques Neurofibrillary tangles (NFTs)
Up to 50% loss of neurons and synapses in the cortex and hippocampus
What are amyloid plaques?
insoluble β-amyloid peptide deposits as senile plaques or β-pleated sheets in the hippocampus, amygdala, and cerebral cortex. Increased density with advanced disease
What are Neurofibrillary tangles?
consist of phosphorylated tau protein and are found in the cortex, hippocampus, and substantia nigra.
(NFTs also found in normal ageing
What are the genetics involved in dementia?
Chromosome 21,19,14 and 1
What is chromosome 21 responsible for?
the gene for amyloid precursor protein (APP) is found on the long arm. Also implicated in Down’s syndrome.
What is chromosome 19 responsible for?
codes for apolipoprotein E4. Presence of E4 alleles increases risk of AD; some 15% of Europeans carry the allele.
What is chromosome 14 responsible for?
codes for presenilin 1 (implicated in B-amyloid peptide).
What is chromosome 1 responsible for?
codes for presenilin 11 (implicated in B-amyloid peptide).
What is the cholinergic hypothesis?
the pathological changes lead to degeneration of cholinergic nuclei in the basal forebrain (nucleus basalis of Meynert). This results in reduced cortical acetylcholine (ACh).
Give an example of an acetylcholinesterase inhibitor
Donepezil
Give an example of a NMDA receptor antagonist
Memantine
What are the early symptoms of Alzheimers?
Absent-mindedness Difficulty recalling names and words Difficulty learning new information Disorientation in unfamiliar surroundings Reduced social engagement
What are the features of progressive disease?
Marked memory impairment Reduced vocabulary Loss of less complex speech patterns. Mood swings and/or apathy Decline in ADL’s & social skills Emergence of psychotic phenomena.
What is seen in advances Alzheimers Disease?
Monosyllabic speech Psychotic symptoms Behavioural disturbance Loss of bladder and bowel control Reduced mobility