Dementia in the Elderly Flashcards
Alzheimers Disease - Presentation
- Most common dementia in the elderly
4 A’s of Alzehimers:
- Amnesia
- Agnosia
- Aphasia
- Apraxia
Alzheimers Disease - pharmacological management
- Anticholinesterases (Donepezil, Rivastigmine or Galantine)
- If these don’t work, consider memantine (only effective in moderate-severe disease)
Vascular dementia - risk factors
- CVD
- Male
- HTN
- Smoking
- Diabetes
- Hypercholesterolaemia
Vascular dementia - management
- control CVD and risk factors
- Only give anticholinesterase or memantine if there is concomitant Alzheimer’s disease
Dementia with Lewy Bodies - management
- Donezepil or Rivastigmine
- If these are not effective, consider Galantine
- If still ineffective, consider memantine
Presenting features of DLB
- Fluctuating consciousness, altered
- Hallucinations, especially visual hallucinations of people/animals
- Spontaneous Parkinsonian signs
- Autonomic Instability
Alzheimer’s disease - pathophysiology
ATROPHY
There is neuronal loss of the hippocampus, temporal and parietal lobes
PLAQUE FORMATION
APP is cleaved to b-amyloid protein, gregates into solid lumps that are surrounded by dystrophic neurites containing hyperphosphorylated tau protein
INTRACELLULAR NFTs
Intracellular neurofibrillary tangles - abnormal tau protein forms insoluble helical filaments which tangle up and cause neuronal death
CHOLINERGIC LOSS
Pathophysiology of Dementia with Lewy Bodies
- Lewy bodies are collections of alpha-synuclein and ubiquitin
- These are deposited in the brainstem, cingulate gyrus and neocortex
Genetic predisposition to Alzheimer’s
Early-onset Alzheimer’s disease (<65 years)
- Presenilin 1
- Presnilin 2
- APP gene (beta-amyloid precursor protein)
Late-onset Alzheimer’s disease (>65 years)
- Apolipoprotein E4 allele - induces early arteriosclerosis
