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57 Cards in this Set
- Front
- Back
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Most common form of dementia:
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Alzheimer's disease
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How many US people are
-currently affected by AD -Will have AD in 2015 -Will have AD in 2030 |
Current - 4.5 million
2015 - 8 million 2030 - 15 million |
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What % of 65 yo's and 85 yo's have AD?
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65 - 6%
85 - 47.5% |
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What is the present day cost of AD?
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100 billion/yr
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What % of ALL dementia cases are caused by alzheimers?
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65-70%
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What is the "transitional stage" through which patients with AD go before actually becoming demented called?
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Mild cognitive impairment
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What is the conversion rate of MCI to AD per year?
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12-15%
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What % of MCI patients convert to AD within 6 years?
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80%
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What is mild cognitive impairment?
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The intermediate stage of cognitive impairment - beyond whats normal with aging, but not severe enough to be called dementia or alzheimer's yet.
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What % of dementia is alzheimer's dementia?
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65-70%
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What is the 2nd leading cause of dementia?
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Vascular dementia
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What is another name for multi-infarct dementia?
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Binswanger's disease
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What is the main complaint of patients with MCI? (mild cogn impairment)
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Memory loss
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How do you confirm MCI?
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Talk to the family or PCP
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How do patients with MCI DIFFER from those with alzheimer's?
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-NORMAL adl's
-NORMAL general cognitive function |
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How do you establish the diagnosis of MCI?
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Neuropsych testing - shows abnormal memory for that age - score 1.5 SD below the norm
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So what are the 3 diagnostic criteria for diagnosis of dementia?
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-Memory loss
-Impairment in AT LEAST ONE OTHER COGNITIVE FUNCTION -Severe - affects social or occupation |
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How do you test for cognitive impairment?
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MMSE
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What is the most powerful risk factor for alzheimers dementia?
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Age - prevalence doubles with every 5 yrs after age 65
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What gender is at higher risk of AD?
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Females
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What genetic risk factors are associated with AD?
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Mutations on chromosomes
1 14 21 |
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What is seen in patients with ch' 14 mutations and AD?
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EARLY onset - before age 60
Autosomal dominant inheritance 100% penetrance |
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In what condition is there high prevalence of Alzheimers?
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Down syndrome
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By what age do most patients with Downs develop signs of AD?
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35
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Why do patients with Downs have higher rates of alzheimers?
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The gene for Amyloid precursor protein is on Ch' 21
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What gene product of Ch' 19 is a metabolic risk factor for alzheimers dementia?
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Apolipoprotein E4
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What 'type' of gene is Apo E4?
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SUGGESTIVE; not predictive!
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What are 2 'structural' risk factors for AD?
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-Head trauma
-Vascular disease |
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What other pathology does Alzheimer's disease have significant overlap with?
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Vascular dementia
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What are 4 features that would make you lean towards diagnosing VASCULAR dementia instead of alzheimer's?
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-SUDDEN onset
-FOCAL neurologic signs -SEIZURES -Gait disturbances EARLY |
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What should the complete history demonstrate when evaluating a patient for AD?
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Progressive cognitive function decline
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What 2 screens should you do?
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-MMSE
-Depression screen |
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What should you order if you suspect syphilis?
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VDRL
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What should you order if you suspect creutzfeldt jakob?
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CSF 14-3-3
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What should you order for neuroimaging at the initial evaluation?
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Noncontrast CT or MRI
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Should you do special imaging or genetic tests?
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No not recommended
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What are the 2 hallmark pathologic features of AD?
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-Neurofibrillary tangles
-B-amyloid plaques |
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What neurotransmitters are seen in excess in AD?
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-Acetylcholine
-Glutamate |
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What is the main site of excitotoxicity leading to ACh deficit in AD?
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Nucleus Basalis of Maynert
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So what areas are known to be degenerated in Alzheimer's disease?
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Enterorhinal cortex
Hippocampus |
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So what what NT is in excess, and what is in deficit in AD?
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Excess - Glutamate
Deficit - ACh |
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Where are neurofibrillary tangles found in alzheimer's?
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INTRAcellular in brain regions of learning, memory, and language
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What are neurofibrillary tangles?
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Paired helical filaments of Microtubule-associated protein TAU
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Where are B-Amyloid plaques found in AD?
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EXTRACellular
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What are B-amyloid plaques made up of?
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Aggregates of A-Beta 1-42 fragments
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What are the AB 1-42 fragments derived from?
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Processed APP amyloid precursor protein
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Why are the B-amyloid plaques bad?
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They are neurotoxic and lead to neurodegeneration
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What happens to ACh in alzheimer's disease?
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It is deficient
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What is ACh important for?
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Memory
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So loss of ACh in AD correlates with impaired
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Memory
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What can enhance Cholinergic function in AD?
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Cholinesterase inhibitors!
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For what nature of AD are cholinesterase inhibitors indicated?
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Mild to moderate AD
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What are 4 cholinesterase inhibitors?
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DRG T
Donepezil Rivastigmine Galantamine Tacrine |
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Is Tacrine still used much? Why?
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No - HEPATOTOXIC and requires dosing 4x daily
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What is Memantine?
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Another drug approved for mild-mod Alzheimers that works on the GLUTAMATE pathway
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How does Memantine work?
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NMDA-ANTAGONIST so it inhibits the excitotoxicity of glutamate
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What is the general efficacy of medication treatment of AD?
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Slows progression by 6 months
Delays institutionalization by 1.5 yrs |
