alzheimer

Question 1

epidemiology and etiology?

Answer 1

most common cause of major NCD

1. accumulation of extraneuronal (CSF) beta amyloid plaques and intraneuronal tau protein tangles
2. autosomal dominant single gene mutation in amyloid precursor protein, presenilin 1, presenilin 2 causes early onset
3. having epsilon 4 variant of apolipoprotein gene is a risk for early onset

Question 2

clinical manifestation alzhiemer
four A’s ?

Answer 2

1. gradual and progressive decline in cognitive function including memory, learning, and language. in advanced stages, motor and sensory symptoms occur
2. personality changes, mood swings and paranoia are very common
3. death occurs within 10 years

amnesia, agnosia, apraxia, aphasia

Question 3

diagnosis of alzheimer

Answer 3

insidious onset and progressive worsening decline in at least one cognitive domain.
only confirmatory test is post-mortem pathological exam to see the plaques and tangles

Question 4

treatment of alzheimer

Answer 4

1. no cure
2. cholinesterase inhibitors (donepezil, rivastigmine, galantamine) can delay deterioration by one year. NMDA receptor antagonists can help too (memantine)
3. antipsychotics can be given in LOW DOSES to treat agitation (associated with high mortality in dementia patients)
4. supportive care and caregiver support. multidisciplinary approach

Question 5

vascular disease occurance? and risk factors?

Answer 5

second most common major NCD and comorbid with other causes of NCD (esp AD)

risks: HTN, DM, hyperlipidemia, obesity, smoking, AF, old age, coronary artery disease

Question 6

cognitive domains affected in vascular dementia?

Answer 6

complex attention and executive function

Question 7

diagnosis and tx for vascular?

Answer 7

neuroimaging and clinical correlation
tx: no cure. manage risk factors to prevent future strokes