Geriatrics - Alzheimer's Disease

Question 1

What are the risk factors for Alzheimer’s disease?

Answer 1

• Age
• Family history
• Apoprotein E allele
• White
• Down’s syndrome

Question 2

What are the pathological changes in the brain in Alzheimer’s disease?

Answer 2

Macroscopic
- Cerebral atrophy of cortex and hippocampus

Microscopic
- Cortical plaques

Biochemical
- ACh deficit from damage to ascending forebrain projections

Question 3

How is Alzheimer’s disease managed non-pharmacologically?

Answer 3

• Activities to promote wellbeing
• Group cognitive stimulation therapy
• Reminiscence therapy

Question 4

What pharmacological management is used for Alzheimer’s disease?

Answer 4

AChEis:
- Donepezil (do not give in patients with bradycardia), can cause insomnia
- Rivastigmine

Memantine (NMDA receptor antagonist) - second-line treatment

Question 5

When is memantine used?

Answer 5

• Moderate Alzheimer’s who have contraindication to AChEis
• Add-on to AChEis
• Monotherapy in severe Alzheimer’s

Question 6

How are non-cognitive symptoms managed?

Answer 6

• NICE does not recommend antidepressants for mild to moderate depression
• Antipsychotics only used for patients at risk of delirium

Question 7

How do cortical plaques form?

Answer 7

Hyperphosphorylation of tau proteins leads to abnormal aggregation

This causes formation and deposition of type A-Beta-amyloid proteins and intraneuronal neurofibrillary tangles