Alzheimer's Disease

Question 1

What needs to be done to confirm the definite diagnosis of AD?

Answer 1

Autopsy - looking for plaques and tangles in the brain

Question 2

What is Alzheimer’s Disease?

Answer 2

It is a progressive neurodegenerative disease.

Question 3

How much does AD contribute to dementia?

Answer 3

60-70%

Question 4

What are the risk factors for developing AD?

Answer 4

1. AD is poorly understood
2. 70% - genetic
3. Head injuries
4. Depression
5. Hypertension

Question 5

What is the treatment of AD?

Answer 5

1. There is no current treatment for reversing progression.

2. Some medication are used to improve symptoms.

Question 6

What is the pathophysiology of AD?

Answer 6

Currently there is very limited knowledge however hypotheses have been developed to explain the condition.

Question 7

What are the 3 main hypotheses?

Answer 7

1. Cholinergic hypothesis
2. Amyloid hypothesis
3. Tau hypothesis

Question 8

What is the cholinergic hypothesis?

Answer 8

• oldest hypothesis
• based on current drug treatment
• reduced synthesis of acetylcholine neurotransmitter
• not much support for hypothesis

Question 9

What is the amyloid hypothesis?

Answer 9

1, Mutation in the chromosome 21 causes deposits of misfolded amyloid in the brain.

2. These destroy neuronal connections. resulting in decline in cognitive funciton

Question 10

Who are at most risk of developing AD and why?

Answer 10

Down Syndrome as the extra chromosome may cause extra deposits in of amyloid (trisomy 21) in the brain, causing dementia as soon as the age of 40.

Question 11

What is the tau hypothesis?

Answer 11

1. Abnormalities in th tau protiens trigger a cascade
2. they become hyperphosphorylated
3. This causes them to aggregate with other tau causing the formation of neurofibrillary tangles
4. this cuases the microtubules to degenerate
5. That causes the cell to collapse as the cytoskeleton is broken.
6. This results into cell death.

Question 12

What is a tau protein?

Answer 12

Are used to stabilise microtubules in the neurons in the CNS.

Question 13

What is the NEUROpathophysiology?

Answer 13

1. AD characterised by loss of neurons and synapses in the cerebral cortex
2, This causes gross atrophy of regions
3. Such as 
-temporal lobe
-frontal cortex
-cingulate gyrus
-parietal lobe

Question 14

What is the cerebral cortex?

Answer 14

Most developed part of the human brain, known as the grey matter it is the outside layer of the brain.

Question 15

What is the function of the cerebral cortex

Answer 15

Memory
Attention
Cognition
Perception 
Language 
Conciousness

Question 16

How do we diagnose AD?

Answer 16

Work Up 
1. Metabolic bloods
2. Medical history
3. Collateral history
4. Neuroimaging - exclude other pathologies
5. Assessment of intellectual function
MMSE

Question 17

What is involved in management?

Answer 17

1. Management in palliative in nature
2. Acetylcholine esterase inhibitors
   - tarcine
   - rivastigmine
   - galantine
   - donepezil
3. Efficacy is mild
4. Psychological intervention

Question 18

What are the signs and symptoms divided into?

Answer 18

1. Pre-dementia
2. Early stage
3. Middle stage
4. Late stage

Question 19

What are the late stages of AD

Answer 19

1. Complete dependence
2. Single word phrases
3. apathy
4. deterioration in mobility
5. cause of death such as pneumonia or pressure ulcers (due to lack of mobility)

Question 20

What are the middle stages of AD?

Answer 20

1. Unable to carry out most common activities
2. Inability to recall vocab
3. Reading and writing lose
4. Less coordination
5. Long term memory impairment
6. Behavioural changes
   - labile
   - irritable
   - delusional
   - Sundowning
   - Urinary incontinence

Question 21

What are the early stages of AD?

Answer 21

Agnosia
Apraxia
Older memories are affected