Wk 31 - Alzheimer's disease 2

Question 1

Outline the pathological events of alzheimer’s disease

Answer 1

• Abnormal hydrolysis of APP -> BA prod (BA40 + BA42)
• Fibrillogenesis: polymerization + formation of B A oligomers
• Aggregation -> final formation of neuritic plaques
• Neurofibrillary degeneration: hyperphosphorylation of T protein -> neurofibrillary tangles
• Glutamate excess in synapses -> excitotoxicity
• Activation of microglia + presence of inflammatory proteins
• Imbalance in intracellular ion homeostasis (calcium, copper, iron, zinc)
• Oxidative stress -> free radicals toxicity
• Alterations of the mitochondrial membrane failure of the cellular energetic system

Question 2

How is AD usually diagnosed?

Answer 2

• True diagnosis once autopsy is done

- Rule out other causes: med history, physical exam + mental status evaluation

Question 3

What is usually involved when diagnosing AD?

Answer 3

• Problem solving, social + language skills
• Genetic test: blood (APOE-e4 gene)
• Imaging: CT, MRI (early diagnosis) or PET

Question 4

What is used as a preventative care for AD?

Answer 4

• Healthy diet + exercising
• Fatty, cold water fish (tuna + salmon)
• Antioxidants: A, E + C (dark fruit + veg) prevent damage caused by free radicals
• Maintain BP
• Keep mentally + socially active

Question 5

What is the mini-mental state examination?

Answer 5

• Measures cognition
• 30 point scale
• 5-10 mins to complete
• Minimal training needed to admin
• Untreated disease deteriorates 3 points per year

Question 6

What is the clinicians interview based impression of change-plus caregiver input?

Answer 6

• Global assessment of functioning
• Assesses: behaviour, psychopathology, cognition, activities of daily living
• Scale 1 (improvement) to 7 (deterioration)
• Based on interview w/ patient + caregiver

Question 7

What is the function activities questionnaire?

Answer 7

• Intended to quantify level of disability
• Scores functional capacity on 1 (normal) to 7 (severely incapacitated)
• 5-10mins to complete
• Filled out by caregiver

Question 8

What is neuropsychiatric inventory-questionnaire?

Answer 8

• Measures disturbed behaviours
• Assesses freq. + severity of 12 symptoms (agitation, irritability, depression)
• 10-15 mins

Question 9

Give examples of lifestyle changes that could be done to help with AD

Answer 9

• Walk w/ caregiver to improve communication skills + red wandering
• Bright light therapy may red insomnia + wandering
• Calming music red wandering + restlessness
• Pets improve behaviour
• Relaxation training + other exercises that require focused attention help social interaction
• Identification bracelet, cards + labels

Question 10

Donepezil dose + side effects

Answer 10

• 5mg OD, inc after month to 10mg

- Diarrhoea, anorexia, muscle cramps + fatigue

Question 11

Rivastigmine dose + side effects

Answer 11

• 1.5mg BD, inc 1.5mg BD every 2 weeks, max 6mg BD
• Patch: 4.6mg, inc 9.5mg per day every 4 weeks
• Vom, di + nausea

Question 12

Galantamine dose + side effects

Answer 12

• 4mg BD for 4 weeks, inc 8mg BD

- Di, nausea, vom, anorexia + weight loss

Question 13

Tacrine side effects

Answer 13

• Di + vom
• Nausea
• Anorexia
• Hepatotoxicity

Question 14

What is memantine?

Answer 14

• Mod-severe
• 5mg OD then inc 5mg weekly intervals to max 20mg daily
• S/e: dizzy, headache, constipation, somnolence + HT
• Red dose if kidney disease

Question 15

Give examples of symptomatic meds to manage secondary complications

Answer 15

• Antipsychotics
• Antidepressants
• Benzodiazepines
• Hypnotics
• Anxiolytics
• Mood stabilizers

Question 16

What are important points to remember?

Answer 16

• Monitor MMSE score every 6 months
• Treatment continued if score remains over 10
• Inc risk of arrhythmias w/ agents that red HR (amiodarone, digoxin + b-blockers)
• Effects antagonised by antimuscarinic
• Exclude reversible cause of cognitive impairment prior to initiating treatment (hypothyroidism)
• Drugs started by specialist