Alzheimer's Disease

Question 1

Risk factors in Alzheimers Disease

Answer 1

Birth order
Age of birth?
Family hx of Down’s

Question 2

MAJOR SYMPTOM in AD

Answer 2

gradual dev’t of forgetfulness

Question 3

Law that applies to AD

Answer 3

The Ribot law of memory

Question 4

CF of AD

Answer 4

Insidous course

Unusual degree of CONFUSION in relation to febrile illness, operation, head injury, institution of medicine

Question 5

CF (speech) of AD

Answer 5

halting speech, restricted vocab
cant carry out complicated request
cant speak in full sentence
echolalia

Question 6

CF (detoriation in arithmetic)

Answer 6

dyscalculia/acalculia

Question 7

Apraxia in AD

Answer 7

ideational ans ideomotor

Question 8

Alterations in AD

Answer 8

Alterations in social graces, restlessness and agitation

Question 9

Neglect in AD

Answer 9

Neglect in self care

Question 10

Disturbed in?

Answer 10

Sleep pattern

Question 11

Affect in AD

Answer 11

Coarsening if affect

Question 12

Sex in AD

Answer 12

Sexual indiscretions

Question 13

Later stage in AD, these 2 reflexes are affected. What lobe releases these signs?

Answer 13

Grasp and sucking reflex

Frontal lobe

Question 14

in AD, there is difficulty in locomotion which will lead to unsteadiness and finally

Answer 14

persistenr vegitative state

Question 15

Symptomatic course in AD spans over how many years

Answer 15

5 years

Question 16

Pathologic changes occur how many years

Answer 16

15 years

Question 17

This is one of the early manifestations of AD which is describe as failure of short and long term memory

Answer 17

Amnesia

Question 18

This is one of the early manifestations of AD which is describe as forgetting of words

Answer 18

Dysnomia

Question 19

This is one of the early manifestations of AD which is caused by posterior cortical atrophy

Answer 19

Visuospatial disorientation

Question 20

This is one of the early manifestations of AD (psychiatry)

Answer 20

Paranoia and personality changes

Question 21

This is one of the early manifestations of AD which affects the coordinating and planning tasks

Answer 21

Executive function

Question 22

NINCDS CRITERIA
Probable AD (5)

Answer 22

1) Deficits in 2 or more domains of cognition
2) Progressive decline of memory and other cognitove functions
3) Preserved consciousness
4) Onset between ages 40 and 90
5) Absence of systemic or other brain disease that could account for symptoms

Question 23

NINDCS CRITERIA

Possible AD

Answer 23

1) Atypical onset, presentation, or clinical course of dimentia
2) Presence of another illness capable of producing dementia

Question 24

NINCDS

Definite AD

Answer 24

1) Clinical criteria for probable AD

2) Tissue dx by autopsy or biopsy

Question 25

Seen in advanced state of AD

Answer 25

Diffuse cortical atrophy in frontal, temporal and parietal lobes

Question 26

Most prominent pathology in AD

Answer 26

Hippocampal atrophy

Question 27

Microscopically, there is widespread loss of nerve cells in AD. In what 6 areas of the brain it is found?

Answer 27

``` 1 Hippocampus 2 Medial temporal cortex 3 Ant nuclei of thalamus 4 Septal nuclei 5 Diagonal band of Broca 6 Amygdala ```

Question 28

In AD, cerebral cortex cells are also loss. What neurons in the cerebral cortex is predominantly affected?

Answer 28

Large pyramidal neurons

Question 29

3 hallmark microscopic changes

Answer 29

1) Neurofibrillary tangles (NFTs) - silver staining material w/in cell cytoplasm (made of TAU protein) 2) Protein amyloid surrounded by neuritic plaques 3) Granulovacuolar degeneration of neurons - pyramidal layer of hippocampus

Question 30

NFT correlate best with what?

Answer 30

NFT correlate best with severity of dimentia the HIGHER The number of NFT, the severe the disease is

Question 31

4 regions disproportionately affected in AD

Answer 31

1) Hippocampus (CA1 and CA2 zones) 2) Entorrhinal cortex 3) Subiculum 4) Amygdala

Question 32

Amyloid precursor protein (APP) contains what protein

Answer 32

Aβ protein

Question 33

Aβ cleaved from APP by what enzymes

Answer 33

alpha, beta, gamma secretase

Question 34

APP cleaved NORMALLY by what enzyme?

Answer 34

alpha or beta secretase

Question 35

Abnormal cleavage of APP of what enzyme will result to toxin causing AD

Answer 35

beta and gamma secretase

Question 36

APP ---- beta and gamma secretase--->

Answer 36

Aβ40 and Aβ42 (toxic)

Question 37

In AD, there are also neurotransmitter abnormalities. What 2 neurotransmitters in the hippocampus and neocortex are reduced?

Answer 37

Choline acetyltransferase and acetylcholine

Question 38

What cells are reduced AD?

Answer 38

Cells in nucleus basalis of Meynert

Question 39

4 neurotransmitters that are low in AD

Answer 39

Glutamate Substance P Somatostatin Cholecystokinin

Question 40

[GENETICS] | This modifies risk for acquiring AD (tripling of risk)

Answer 40

Apo E4

Question 41

Defective genes code this protein at chromosome 21

Answer 41

errant APP

Question 42

Component of gamma secretase (enzyme that produce AB42)

Answer 42

Presenillin 1 and 2

Question 43

3 results of MRI in AD

Answer 43

1. Atrophy of hippocampi with enlargement of temporal horns of lateral ventricles 2. Lateral and 3rd ventricles enlarged twice normal size 3. Cerebral sulci widened

Question 44

MRI

Answer 44

Posterior predominant cortical atrophy, medial temporal lobe atrophy

Question 45

Mild early? form of AD; 50% of this case develops AD

Answer 45

Mild congnitive impairement.

Question 46

Tx of AD which has modest effects

Answer 46

Cholinergic precursors and agonists

Question 47

Tx for late stage of AD

Answer 47

NMDA glutaminergic antagonists

Question 48

NMDA gluteminergic antagonists for late stage of Alzheimer

Answer 48

Memantine 20 mg daily

Question 49

Acetylcholinesterase inhibitors

Answer 49

Donezepil 10 mg OD Rivastigmine 6 mg BID or 9.5 mg OD patch Galantamine 24 mg OD

Question 50

NMDA glutamate antagonist

Answer 50

Memantine 10 mg BID

Question 51

Tx of AD

Answer 51

Cholinergic precursors and agonists Acetylcholinesterase inhibitors NMDA glutaminergic antagonists NMDA glutamate antagonists

Question 52

Other tx of AD

Answer 52

Gingko Biloba Statins Role of Insulin Vaccine against Aβ

Question 53

Other Tx of AD most benefit by 1 controlled trial

Answer 53

Gingko biloba

Question 54

Bedside screening testfor cognitive deficits

Answer 54

MMSE and MoCA

Question 55

What's included in MoCA

Answer 55

Clockdrawing test and trail test

Question 56

More sensitive screening test in detection of MILD impairment

Answer 56

MoCA

Question 57

Maximum score in MoCA

Answer 57

30

Question 58

Normal score of MoCA

Answer 58

26 - 30