Alzheimer's Disease

Question 1

What is Alzheimer’s disease?

Answer 1

Neurodegenerative proteinopathy (amyloid)

Question 2

What is Alzheimer’s a common cause of?

Answer 2

Dementia

Question 3

Pathophysiology of Alzheimer’s?

Answer 3

Disruption in cholinergic pathways in the brain and synaptic loss: loss of cortical neurones

• Extracellular B-amyloid plaques form which disrupt normal cell function and induces apoptosis
• Intracellular neurofibrillary tangles- disruption of cytoskeleton- cell death
• Cortical atrophy- narrow gyri and widened sulci

Question 4

Who gets Alzheimer’s?

Answer 4

<65 years old = early onset AD

• Genetic influences
• May be atypical presentation

> 65 years old = Sporadic AD

• Environmental > genetic influences
• Usually typical initial forgetfulness

Question 5

Onset of Alzheimer’s in down syndrome?

Answer 5

Usually 3rd or 4th decade

Question 6

How is genetic Alzheimer’s inherited?

Answer 6

Autosomal dominant

Question 7

Presentation of Alzheimer’s?

Answer 7

• Initial symptom is generally forgetfulness
• Forgetfulness- apraxia/visuospatial difficulties
• Lack of insight
• Impairment of planning, decision making

Question 8

Area which degenerates in dementia?

Answer 8

Medial hippocampus + lateral parietal lobes

Question 9

Unusual initial presentations?

Answer 9

Posterior cortical atrophy=
Visuospatial disturbance
Commonly referred to ophthalmology

Progressive primary aphasia=

• Sematic (naming)
• Logopenic aphasia (repeating)
• Non-fluent aphasia (effortful)

Question 10

Diagnosis of dementia?

Answer 10

MRI: Atrophy of temporal/parietal lobes

SPECT: Temporoparietal decreased metabolism

CSF: Decreased B amyloid: increased tau protein

Amyloid ligand imaging, address vascular RFs, acetylcholine boosting Rx

Use mini mental stat exam

Question 11

RFs for alzheimer’s?

Answer 11

Age
Down syndrome
Head injuries
ApoE4

Question 12

Management of Alzheimer’s?

Answer 12

CBT- If anxious/depressed
Social support
Address vascular RFs

Pharmacolgical:
-Acetylcholinesterase (AChE) inhibitors eg donepezil, galantamine or rivastigamine

-Memantine: NMDA rececptor antagonist, 2nd line if intolerant to AChE

Question 13

1st line drug for Alzheimer’s?

Answer 13

Acetylcholinesterase inhibitors (AChE)

eg
Donepezil
Galantamine
Rivastigmine

Question 14

Complications of Alzheimer’s?

Answer 14

Haemorrhagic stroke due to B amyloid deposits