Unit 6: Alzheimer's

Question 1

What is the role of tau protein in alzhimers?

Answer 1

Collect in the neurones
Normally part of microtubules
Accumulation of amyloid plaques triggers kinase to phospharylate tau.
Tau becomes disfunctional and accumulates inside the neuron
Disregulates cytoskeleton - less acetylcholine synthesis
Trigger apoptosis of the neuron.

Question 2

What is the role of amyloid plaques in alzhiemers?

Answer 2

Amyloid precursor protein - found naturally in cell membrane of neurons
Normally cleaves by alpha and gamma secretase to soluble fragments
When cleaved by alpha and beta secretase creates insoluble fragments called amyloid beta.
These fragments clump together, forming plaques that block communication between different regions of the bran.
May also act as DAMPs causing inflammation.
May diposit around blood vessels increasing the risk of a hemorhage.

Question 3

What genetic mutations are associated with an increased risk of developing Alzheimers disease?

Answer 3

APOE-e4 allele - protein version that is less effective at breaking down beta amyloid so plaques accumulate faster
T21 - APP gene is found on chromosome 21
PSEN-1 and PSEN-2 gene - codes for different version of gamma secretase, changes where the protein is cleaved, may lead to more insoluble version of beta amyloid.

Question 4

What is agnosia?

Answer 4

Inability to recognise a person whilst using more than one of the senses

Question 5

What are the three phases in the progression of dementia?

Answer 5

1 Asymptomatic:
2 Pre-dementia: mild congitive impairment often only mild memory less above the average for the age, but does not yet affect daily activities
3 Dementia - significant memory loss, followed by slow and gradual progression of other cognitive skills such as language and problem solving and behavioural regulation

Question 6

What do the scores on a GPOG test mean?

Answer 6

Above 8 - cognitive impairement
Below 5 - normal cognitive functioning
Between 5 and 8 and informant history is needed, on the informant a score below four indicates impairement

Question 7

What do the scores on a MMSE mean?

Answer 7

Score above 25 are considered normal
Score above 21 are considered mild
Scores above 10 are mild impairment
Score below ten indicates impairment requiring intervention

Question 8

What do the scores on an Adenbrookes test mean?

Answer 8

Score above 87 is considered normal
Score below 83 is abnormal
between these two is inconclusive

Question 9

What is the progression of dementia like? in time spans

Answer 9

Symptoms generally start 2-3yrs before diagnosis is made
General life expectancy after diagnosis is 8-10yrs but some people can live for 15/20yrs after diagnosis

Question 10

What is the most common cause of death in alzhiemers?

Answer 10

Respiratory infection

Question 11

What facilities may be found in a specialist dementia care home?

Answer 11

Sensory gardens
Automatic lights to help aid transition from day to night
Colour schemes to help decipher furniture from background - help promt memory e.g toilet seet different colour to rest of bathroom.

Question 12

What are the three ways from the mental health act that allows people to engage in advanced care planning?

Answer 12

1. Advanced statements - expression of wants and preferences, are not legally binding
2. Advanced decisions - legally binding decision related to medical treatment for example a DNR form
3. Lasting power of attorney - giving power to speak on your behalf to a nominated individual, this individual must pledge to act in your best interest.

Question 13

What is a DNAR form?

Answer 13

Prevents resusitation of the cardiovascular or the respiratory system
Inhibits chest compressions, electircal shocks to the heart, certain medications and ventilation
Only completed if the patient is very frail, near the end of their life or has a very serious condition.
Is only legally binding if included in an advanced decisions form.

Question 14

What are the changing symptoms of dementia at a mild, moderate and severe stage?

Answer 14

Mild: memory loss, behavioural/emotional changes, communication and language
Moderate: struggle with everyday tasks, sleep disturbances and disorientation
Severe: incontinence, speech, swallong, unable to recongise loved ones, immobile

Question 15

What happens in a memory clinic and who is referred there?

Answer 15

Require GP referall - for specialist diagnosis and treatment plan for memory conditions
Staffed by neurologists, psychologists and specialist nurses
Often includes an MRI, history and MMSE.
Normally funded by local authority

Question 16

What symptoms are thought of as showing end of life?

Answer 16

Decrease in apetite
Lack of reversibility of illness/symptoms
reduced function
Reduced independence
Increased tiredness
Bed bound
Weight loss

Question 17

What problems are common in patients in their last days of life?

Answer 17

Aggitation
Anxiety
Pain
Breathlessness
Vomitting and nausea
respiratory tract secretions

Question 18

What medications are normally given as part of end of life care?

Answer 18

Pain killers
Antimetics
Laxatives to tackle constipation
Saliva replacements and oral gels

Question 19

In brain anatomy what is meant by commisual fibres?

Answer 19

Connect one cerebral hemisphere to another e.g corpus callosum

Question 20

In brain anatomy what is meant by projections fibres?

Answer 20

Regions of white matter that connet the cortex to other regions of the CNs e.g the corticospinal tract

Question 21

In brain anatomy what is meant by association fibres?

Answer 21

Connect different cortical areas on the same side of the brain.

Question 22

How should we break bad news to patients?

Answer 22

S- setting, quite and comfortable
P - perception, what does the patient already know or expect?
I - invitation, make them aware that bad news is coming, are they okay to be told this now, would they like someone with them
K - knowledge, share what you know, considering waht is important to the patient and cognitive load
E - emotions, explore how the patient is feeling and coping
S - summary and stratergy for next part of the plan.

Question 23

What proportion of people with Alzhiemers also develop depression?

Answer 23

40%.