Stahl ADHD and Dementia Flashcards
(29 cards)
What is ADHD?
ADHD is a disorder of the prefrontal cortex linked to specific brain parts.
What are the core symptoms of ADHD? (include the 4 core areas)
Core symptoms are linked to selective attention (ACC), sustained attention (DLPFC), hyperactivity (prefrontal motor cortex), and impulsivity (orbitofrontal cortex).
What is the firing pattern in ADHD?
In ADHD, there is decreased tonic and phasic firing of NE and DA.
What is the mechanism of NE in ADHD?
NE binds to alpha 2A receptor, closing the channel and strengthening the signal.
What is the mechanism of DA in ADHD?
DA binds to D1 receptor, opening the channel and weakening the signal while increasing noise.
How does ADHD change with age?
Impulsivity and hyperactivity decrease with age, but inattention remains steady in adulthood.
What is the order of treatment for adults with comorbidities?
Substance use → Mood disorder → Anxiety → ADHD → Nicotine dependence.
What is the action of Methylphenidate?
Methylphenidate blocks DAT and NET, leading to the release of DA and NE.
How does Amphetamine differ from Methylphenidate?
Amphetamine blocks DAT, NET, and VMAT, and is transported into neurons, kicking DA out.
What is the risk associated with pulsatile stimulants?
Pulsatile stimulants amplify tonic and phasic NE and DA signals, increasing the risk of abuse.
What is Atomoxetine?
Atomoxetine is a non-stimulant NRI that blocks the NE pump in the PFC, increasing NE.
What is the role of Guanfacine in ADHD treatment?
Guanfacine is an alpha 2A agonist with no DA action.
What is the definition of all-cause dementia?
All-cause dementia refers to cognitive and/or neuropsych symptoms that interfere with function, with a decline that cannot be attributed to another etiology.
What is mild cognitive impairment?
Mild cognitive impairment is benign forgetfulness that allows for functioning.
How is dementia diagnosed?
Most diagnoses are made post-mortem, and most dementias are mixed.
What does Alzheimer’s disease show in terms of pathology?
Alzheimer’s shows tangles and plaques.
What is the amyloid cascade hypothesis?
The hypothesis states that amyloid precursor protein is cleaved, leading to beta amyloid peptides that aggregate into plaques.
What are the three stages of Alzheimer’s disease?
- Presymptomatic: decreased CSF alpha-beta. 2. Mild Cognitive Impairment: episodic memory problems with increased CSF tau. 3. Dementia: loss of function.
What is the cholinergic hypothesis of Alzheimer’s?
The hypothesis suggests that loss of cholinergic neurons leads to cognitive decline.
What are the types of acetylcholine receptors?
There are muscarinic and nicotinic receptors.
What is the action of Donepezil?
Donepezil blocks acetylcholinesterase in central and peripheral systems, affecting the gut.
What is Memantine’s role in Alzheimer’s treatment?
Memantine acts as a substitute for magnesium on the NMDA receptor, lowering calcium and stopping cytotoxicity.
What is the role of Pimavanserin in dementia?
Pimavanserin blocks excitatory serotonin 5HT2A receptors, balancing glutamate release and reducing hallucinations.
What is the multimodal approach for agitation in dementia?
Brexpiprazole and dextromethorphan-bupropion are used to control agitation.
