Alzheimer's disease

• What is Alzheimer's disease?

  Chronic, neurodegenerative disorder

  Characterised by progressive accumulation of abnormal protein deposits (amyloid plaques & tau tangles) in the brain -> deterioration of cognitive function, memory loss & various behavioural and psychological symptoms
• What are the RFs for Alzheimer's disease?

  Genetics (APOE, EOFAD)

  Age

  Female

  HTN

  Diabetes

  Obesity

  Smoking

  Head injury

  Low education levels
• Pathophys - Alzheimer's disease

  Accumulation of beta-amyloid protein fragments outside nerve cells -> abnormal protein deposits -> disrupts neuronal communication, inflam & cell death

  Abnormal tau protein accumulates inside nerve cells -> neurofibrillary tangles -> interfere with transport of essential nutrients within neurons -> dysfunction & eventual demise

  Progression -> signif neuronal loss (esp in hippocampus & cerebral cortex) -> brain atrophy, reduced ACh levels & chronic neuroinflammation
• What are the signs & symptoms of Alzheimer's disease?

  Memory impairment (affects recent events, difficulty learning new info)

  Language impairment (difficulty finding words, struggling to express self, aphasia (later stages))

  Executive dysfunction (inability to plan, organise & carry out tasks)

  Behavioural changes (agitation, aggression, apathy, sometimes with mood swings)

  Psychological symptoms (hallucinations, delusions & paranoia)

  Disorientation

  Loss of motor skills

  Disinhibition
• What are the Inx for Alzheimer's disease?

  Full Hx (inc. functional history & collateral history)

  Assess cognitive decline (e.g. MMSE)

  Examination (full neuro)

  Bloods (confusion screen (FBC, U&Es, LFTs, CRP/ESR, TFTs, B12, folate, syphilis, HIV))

  CT/MRI

  Possible cerebrospinal fluid analysis
• What are the DDx of Alzheimer's disease?

  Vascular dementia

  Lewy body dementia

  Frontotemporal dementia

  Mild cognitive impairment
• What is the management of Alzheimer's disease?

  Cognitive stimulation therapy

  Occupational therapy

  Education & support for family & caregivers

  Meds

  • cholinesterase inhibitors (donepezil) -> used for mild to moderate dementia
  • NMDA receptor antagonists (memantine) -> for severe dementia
  • if evidence of behavioural & psychological symptoms of dementia (BPSD) -> can start low dose risperidone
• Who is donepezil contraindicated in?

  Pts with bradycardia
• What is a common adverse effect of donepezil?

  Insomnia