Flashcards in Exam 3 -- Dementia and Alzheimer's Disease Deck (18):
What percentage of dementia are classified as Alzheimer's?
True or false: there is evidence linking closed-angle glaucoma and Alzheimer's Disease.
False; the evidence links primary open angle glaucoma and Alzheimer's.
The diagnosis of dementia requires an acquired decline in one or more of several areas (learning/memory, language, executive function, etc.). What additional signs might be found in a patient with Alzheimer's Disease?
Loss of insight, sleep disturbances, seizures, olfactory changes.
Which gender has a higher predilection for Alzheimer's?
Briefly outline the molecular cause of the plaques that occur in early onset Alzheimer's (age 30-60).
Amyloid precursor protein is improperly cut, releasing beta amyloid (beta amyloid 42 in particular), which clumps up creating the senile plaques. These tend to accumulate in the hippocampus and amygdala.
Early onset Alzheimer's is inherited in an autosomal dominant fashion. Defects may occur in the following chromosomes and genes:
Chromosome 1 (PSEN2)
Chromosome 21 (APP)
Chromosome 14 (PSEN1)
Which inheritance of these defective genes is most commonly the cause of early onset Alzheimer's?
PSEN1, on chromosome 14
The following are isoforms of the gene APOE on chromosome 19. Which of these isoforms is detrimental, and found in late onset Alzheimer's? What does it cause?
APOE-ε4. It increases beta-amyloid clumping, affects microtubule function, affects choline acetyltransferase activity in the hippocampus, and is associated with vascular disease.
What protein, encoded by a gene on chromosome 17, is involved in the production of neurofibrillary tangles? What is this protein's normal function?
Tau protein. It normally acts to stabilize microtubules, but in Alzheimer's becomes hyperphosphorylated and can no longer perform this function.
What 7-minute test is the most widely used cognitive test for dementia? What does the shorter version of this test involve?
The Mini-Mental State Examination (MMSE), which involves testing the patient's presence of mind and ability to follow instructions. The shorter version of the test involves having the patient repeat three words, draw a picture of a clock, and then repeat those same three words back to you from memory.
What might neuroimaging show in a patient with Alzheimer's?
Cortical/hippocampal atrophy, white matter lesions, enlarged ventricles.
Patients with Alzheimer's live an average of 10 years from the time of diagnosis. What is a common cause of death?
What two classes of drugs are available to treat Alzheimer's disease?
Acetylcholinesterase inhibitors (Donepezil in particular) and NMDA receptor antagonists (Memantidine)
Visual Variant Alzheimer's Dementia (VVAD), also called posterior cortical atrophy, involves hypometabolism of glucose in the occipital-parietal area. What symptoms might a patient with this condition experience?
Simultagnosia (inability to see more than one object at a time), prosopagnosia (inability/difficulty recognizing faces), visual agnosia (inability/difficulty recognizing objects), and difficulty with depth perception.
Fill in the blank:_________ dementia may be the second most common form of dementia.
Patients with vascular dementia may experience multiple strokes, CV risk factors, and white matter lesions on MRI. Get their CV risk factors under control, and use the same treatment as in Alzheimer's.
True or false: in Lewy Body dementia, memory is affected sooner than in Alzheimer's.
False; it is affected later.
What are the clinical features of Lewy Body dementia?
Fluctuations or "blanking out"
Recurrent, detailed visual hallucinations (67%)
REM sleep behavior disorder
Recurrent falls, fainting