Alzheimer's

Question 1

what is DSM-V used for

Answer 1

diagnosis of major neurocognitive disorders
must show significant decline from previous level of performance in 1 or more cognitive domains

Question 2

what is tested in DSM-V

Answer 2

attention
executive function
memory
language
perceptual motor
social cognition

Question 3

what aids in localisation of cognitive symptoms

Answer 3

memory - short/long term
attention/concentration
language - expressive/receptive
visuospatial
behavioural problems/change in personality

Question 4

describe amyotrophic lateral sclerosis

Answer 4

found in motor cortex, brainstem and spinal cord
causes atrophy of motor neurons and muscles
bunina bodies and lewy body-like inclusions

Question 5

describe Alzheimer’s disease

Answer 5

varies with Braak stage - entorhinal, hippocampus, parietotemporal cortex
causes cerebral atrophy
a-beta plaques and tangles

Question 6

describe multiple sclerosis

Answer 6

found in CNS, brainstem and spinal cord
causes damage of myelin sheath and neurons
focal demyelinated plaques

Question 7

describe Parkinson’s

Answer 7

found in midbrain and basal ganglia
causes pallor of substantia nigra
causes Lewy bodies

Question 8

describe Lewy body dementia

Answer 8

found in cerebral cortex, hippocampus and brainstem
causes pallor of substantia nigra
causes cerebral atrophy and Lewy bodies

Question 9

describe functional impairment in dementia

Answer 9

associated impairment in social/occupational functioning
deficits in managing finances, driving, shopping, working, taking medications, keeping appointments
eventual problems with activities of daily living
rate and specific pattern of loss will vary by individual and somewhat by diagnosis

Question 10

describe the onset of Alzheimer’s

Answer 10

gradual onset and progression affecting cognition, personality, behaviours and ADLs

Question 11

what are the characteristics of Alzheimer’s

Answer 11

deficits in short-term memory ( rapid forgetting of new material), language, praxis, visuospatial, executive

Question 12

what is the duration of Alzheimers

Answer 12

5-15 years

Question 13

what are the symptoms of Alzheimers

Answer 13

gradual and steady decline
anosognosia (lack of recognition of disease)
depression in 1/3
delusions and hallucinations in 1/3

Question 14

pathophysiology of Alzheimers

Answer 14

neuritic plaques (extracellular, abnormal insoluble amyloid protein)
neurofibrillary tangles (intracellular, disturbed tau-microtubule complexes, hyperphosphorylated tau)
cholinergic system degeneration with significant loss of neurons in certain areas (often begins in entorhinal cortex and progresses to other limbic structures)

Question 15

what are the cognitive assessments used for alzheimers

Answer 15

structured multi-domain tests - ACE-III, MoCA, ECAS, MMSE, cantab mobile
domain-specific tests - verbal/category fluency, clock drawing, immediate recall

Question 16

how are lesions imaged in Alzheimers

Answer 16

structural imaging - MRI, finds volume and white matter tractography
functional imaging - FP-CIT SPECT, F-FDG PET, HMPAO SPECT
neuropsychology
CSF biomarkers - beta-amyloid, total tau, phospho-tau, alpha synuclein
genetics

Question 17

features of early Alzheimers

Answer 17

2-3 years after diagnosis
primarily memory and visuospatial defects
mild difficulty with executive functioning

Question 18

features of moderately severe Alzheimers

Answer 18

3-6 years after diagnosis
aphasia and apraxia
increased assistance with ADLs
neurophysiological symptoms, particularly paranoia

Question 19

features of advanced Alzheimers

Answer 19

6-12 years after diagnosis
language disturbances (mutism, echolalia, repetitive vocalisations)
agitation, aggression
rigidity, gait distrubances
incontinence
swallowing problems
death

Question 20

management of Alzheimers

Answer 20

detect, assess, differentiate, diagnose, treat and monitor