Alzheimer's

Question 1

What are the clinical signs of Alzheimer’s?

Answer 1

The 5 As: Amnesia, Anomia, Apraxia, Agnosia, Aphasia

Question 2

What are the clinical signs of vascular dementia?

Answer 2

Step-wise decline, personality changes, history of vascular disease.

Question 3

What are the clinical signs of dementia with Lewy bodies?

Answer 3

Slow, stiff movements, tremor, hallucinations, sleep problems

Question 4

What are the clinical signs of Frontotemporal Dementia?

Answer 4

Inappropriate behaviour, love of sweet food, younger onset (50)

Question 5

What are the pathology results of Alzheimer’s?

Answer 5

Amyloid-beta plaques
Neurofibrillary tangles (tau)
Loss of brain volume

Question 6

What are the pathology results of vascular dementia?

Answer 6

Multiple mini-infarcts

Question 7

What are the pathology results of dementia with Lewy bodies?

Answer 7

Lewy bodies of alpha-synuclein

Question 8

What are the pathology results of frontotemporal dementia?

Answer 8

“Pick bodies” of tau in frontal lobe

Question 9

Who are in MDT for this?

Answer 9

GP
Neurologist
(Radiologist, Pathologist)

Physiotherapist
Occupational Health Therapist
Psychologist

Support Groups
Family/Carer

Question 10

What is difference between definition of mild cognitive impairment and dementia?

Answer 10

The extent to which it impacts activities of daily living

Question 11

What are the 5As?

Answer 11

Amnesia: loss of memory
Anomia: inability to name objects
Apraxia: loss of dexterity e.g. in dressing
Agnosia: inability to recognise things (including people) – different from anomia, in which the understanding of the object’s role/function is preserved.
Aphasia: inability to talk

Question 12

What is the pathophysiology in AD?

Answer 12

-Amyloid precursor protein [APP] = transmembrane protein
-Normal =  and γ secretase → normal degradation product
-AD = by  and γ secretase → abnormal product resistant to degradation → A
-A accumulates outside the cell to form amyloid plaques
-A accumulates outside the cell to form amyloid plaques
-Interferes with neuronal communication (+ inflammation) → dementia
-Tau tangles
Inside the neuron
-Tau = protein that supports microfilaments within the neuron

Question 13

What does Abeta do?

Answer 13

A triggers phosphorylation of tau, causing it to disassociate from the MF and accumulate into neurofibrillary tangles
Tangles + weakened microfilaments → ↓neuronal function and apoptosis → atrophy
↓ACh
Cortex
Pathological changes → degeneration of cholinergic nuclei → ↓ cortical ACh

Question 14

What are key phrases for AD pathophysiology?

Answer 14

• β Amyloid → extracellular plaques
• Hyperphosphorylated tau → neurofibrillary tangles
• Neuronal and synaptic loss

Question 15

Where does Memory retrieval/long-term memory in the brain?

Answer 15

posterior cingulate cortex

hippocampus

Question 16

Where is short term memory in brain?

Answer 16

Anterior thalamus

Question 17

Which two enzymes are amyloid plaques produced by?

Answer 17

Beta and gamma secretase

Question 18

Which neurotransmitter is deficient in Alzheimers?

Answer 18

acetylcholine

Question 19

What does the MCA say?

Answer 19

assume a person has the capacity to make a decision themselves, unless it’s proved otherwise
wherever possible, help people to make their own decisions
don’t treat a person as lacking the capacity to make a decision just because they make an unwise decision
if you make a decision for someone who doesn’t have capacity, it must be in their best interests
treatment and care provided to someone who lacks capacity should be the least restrictive of their basic rights and freedoms

Question 20

What is capacity?

Answer 20

-The person must be able to:
-understand the information relevant to the decision
-retain that information
-use or weigh up that information as part of the process of making the decision
-Capacity is decision and time-specific
E.g. may have capacity to choose tea or coffee but may not have capacity to decide whether or not they require help in ADLs.
E.g. may not have capacity today due to fever but may next week when recovered

Question 21

Who decides best interest?

Answer 21

Technically, you as the medical professional.

BUT must take into account
The patient
Those caring for the patient
/Family
Independent advocates/ Lasting power of attorneys/court-appointed guides.

Question 22

What was the patient?

Answer 22

Patient with memory problems
6-CIT
Diagnosed with probable Alzheimer’s
Clinical communication and ethical challenges

Question 23

What is dementia?

Answer 23

Umbrella term for cognitive decline
Insidious onset
Progressive
Interfering with activities of daily life

Not situational stress; clear consciousness​
Deficits: behaviour, attention, memory,language, visuospatial function

8 or above on the 6-CIT

Question 24

What is mild cognitive impairment?

Answer 24

Still cognitive decline
Worse than would normally be expected for a healthy person of their age
But NOT interfering with activities of daily life
10-15% progress to dementia per year
6-8 on the 6-CIT

Question 25

What is normal ageing?

Answer 25

Key differentiators:
Normal aging preserves temporal orientation, visuospatial skills and insight.

Dementia/MCI tend to lose these.

Both tend to lose verbal recall, mental flexibility and sustained attention