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Y3 Exam 2 > Alzheimer's/ dementia > Flashcards

Alzheimer's/ dementia Flashcards

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1
Q

Name the different types of dementia

A

Alzheimer’s
Vascular
Lewy Body Frontotemporal

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2
Q

Outline clinical features of early onset Alzheimer’s

A

Language difficulties
depression
slight memory impairment
misplace items

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3
Q

Outline clinical features of severe Alzheimer’s

A

Seizures
Short and long term memory loss
Incontinent
Lack of speech –> may become mute

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3
Q

Outline clinical features of Mid stage Alzheimer’s

A

Aphasia –> struggle to listen and speak
May be able to speak but the words don’t make sense
Amnesia –> new memory loss
Need living assistance
BPSD starts
disturbed sleep

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4
Q

Outline clinical features of vascular dementia

A

Change in personality
Apraxia –> struggle performing movements
Agnosia –> cant recognise objects or faces
Dysarthria –> Struggle speaking due to muscle weakness
Dizziness

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5
Q

What are some clinical symptoms to differentiate Alzheimer’s and vascular

A

Gait –> vascular = shuffling, preserved arm swing
Pseudobulbar palsy –> Cant control facial movements
Extensor plantar response –> big toe bends backwards

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6
Q

What are the risk factors for vascular dementia

A

Smoking
diabetes
HTN
Hyperlipidaemia
obesity
history of stroke
AF

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7
Q

Outline clinical features for lewy body dementia

A

Visual hallucinations
Gait disturbances
Lack of attention
Increased risk of falls due to gait disturbances
depression

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8
Q

How does lewy body dementia form

A

Alpha-synuclein aggregates
causes neuronal damage
brain activity decreases

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9
Q

Outline clinical features of Frontotemporal dementia

A

Insidious onset
slow progression
impulsive and obsessive behaviours
depression
decrease in speech

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10
Q

What are the 2 mental state examination criteria for diagnosis

A

ICD-11 –> International classification of disease
DSM-5

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11
Q

What class of medications do we use for alzheimers

A

Acetylcholinesterase inhibitors
non-competitive NMDA antagonist

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12
Q

Give examples of the acetylcholinesterase inhibitors used

A

Donepezil
Astigmine
Galantamine

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13
Q

Give examples of NMDA antagonist used

A

Memantine

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14
Q

What are the side effects of Alzheimer’s medication

A

Cholinergic effects –> think parasympathetic

GI
sleep disturbance
headache
fatigue
bradycardia

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15
Q

What medications increase anticholinergic burden?

A

Antihistamines
tricyclic antidepressants
Antipsychotics
urinary incontinence
Hyoscine
Pain killers

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16
Q

Give an example of tricyclic antidepressants

A

Amitriptyline
Nortriptyline

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17
Q

What drugs are used in urinary incontinence

A

Solfenacin
Micrabegron

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18
Q

What should be prescribed alongside rivastigmine patches

A

Emollient due to rash caused.
Encourage rotation of application sites

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19
Q

When is memantine used

A

Severe Alzheimer’s
When someone cant have AchE inhibitors

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20
Q

What are the side effects of memantine

A

Headache
dizziness
hypertension

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21
Q

What part of the brain is affected during alzhemers

A

Hippocampus
cerebral cortex
Undergo atrophy and destruction
Spinal fluid ventricles expand

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22
Q

What is the hippocampus responsible for

A

Short term memory and learning

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23
Q

What are the risk factors for alzheimers

Study These Flashcards
A

Age –> >60
Down syndrome –> extra chromosome 21
Decreased IQ
Diabetes
Depression

24
How is beta amyloid produced
Cleaving of amyloid precursor protein (APP) by Alpha and beta secretase produced amyloid beta monomers
25
What is the role of alpha and gamma secretase?
Cleaves APP into smaller fragments that can be eliminated
26
How big are the APP monomers
36-43 AA long
27
What is usually involved in the breakdown of amyloid beta monomers?
Microglia cells --> immune cells Astrocytes --> internalise them
28
How do amyloid beta monomers cause neuronal cell dysfunction
Aggregate to form oligomers Oligomers aggregate to form plaques plaques are found in the synapse where they block acetylcholine neurotransmitters from their receptor Decreased LTP
29
What is long term potentiation
NMDA receptors activated and Ca2+ Releases more glutamate which increases this process increased synapse strength Increases memory and recall
30
What are the 2 ways neuronal damage can occur in Alzheimer's
amyloid beta formation through APP cleaving --> plaques Neurofibrillary tangles --> Phosphorylated Tau
31
What are microtubules used for
Cellular transport
32
What is the role of tau in microtubules
Stabalisation
33
How does Tau become phosphorylated
Beta amyloid has a kinase that phosphorylates tau
34
What happens when tau becomes dephosphylated
Detaches from microtutubles microtubules become unstable Tau aggregates and forms neurofibrillary tangles and remain in neuron Cellular transport disrupted Neuronal cell death
35
What is the imact in neuronal cell death
Decreased cholinergic production
36
How and where it acetylcholine produced
Hippocampus and cerebral cortex = Produce ChAT enzyme produced acetylcholine in synapse
37
Outline the genetic factors that can contribute to Alzheimer's
Down syndrome APO E4 Presenilin 1, 2 gene
38
How does down syndrome increase the risk
Extra chromosome 21 contains APP more APP to be cleaved into amyloid beta
39
How does APO E4 increase the risk
APO E4 = lipid binding protein Has lower clearance rate of Amyloid beta
40
How does Presenilin 1, 2 gene increase the risk
increases gamma secretase production Increased beta amyloid production Amyloid B42
41
What does AchE break Ach down to
Acetate and choline
42
Why do we want to inhibit AchE
Inhibits breakdown of Ach increases amount of time acetylcholine is in synapse greater chance to exert effect
43
Why is Ach important?
Excitatory neurotransmitter responsible for learning and memory
44
Summarise the MOA of memantine
Decreases excitotoxity of neurons NMDA Antagonist Reduction in Ca2+ intracellular
45
Summarise what causes neuronal cell death in excitotoxicity
Increase in Ca2+ Mitochondrial overload --> ROS and oxidative stress Generates more glutamate release which goes back into the receptor and stimulates more Ca2+ entry Proteases stimulated --> destroy membrane Inflammatory cytokines released in response to destruction
46
What does BPSD stand for
Behavioural psychological symptoms dementia
47
What are the behavioural symptoms observed in dementia
Physical aggression screaming wandering sexual disinhibition
48
What are some psychological symptoms observed in dementia
Anxiety depression hallucinations delusions
49
What are the non-dementia reasons people can display Behavioural and psychological symptoms
Stress being in a strange environment --> hospital, care home Hearing impairment disability hunger / thirst physical discomfort embarrassment disliking others
50
What is the ABC method in BPSD
Antecedents Behaviour itself consequences
51
What pain scale is used in BPSD
Abbey pain scale
52
What does the Abbey pain scale include
Vocalisation Facial expression changes in body language behavioural psychological
53
How often do we have to reveiew antpsychotics in dementia
6 weeks
54
How often do we have to review psychotropics in dementia
3 months
55
Give examples of psychotropics
Antidepressants mood stabilisers anti-anxiety
56
What are the symptoms of delusions
People stealing things close relatives are imposters Abandonment misidentification infidelity
57
What are the risk factors of antipsychotics
Oversedation dehydration Infection increased risk of stroke x3 increased risk of falls and fractures
58
When would you give Risperidone
Persistent aggression 6 week treatment

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