Alzheimer's pathophysiology
Which protein structures accumulate in Alzheimer's?
Beta-amyloid and tau-tangles
What are the textbook presenting sxs of Alzheimer's?
Loss of recent memory first.
Shortly followed by loss of executive function and nominal dysphasia.
What are the typical presenting sxs of vascular dementia?
Memory loss, inattention, and personality changes with stepwise increase in severity
How common is vascular dementia?
Give 3 egs of acetylcholinesterase inhibitors
Rivastigmine, donepezil, galantamine
Which neurotransmitter is classically reduced in Alzheimer's?
What are some of the other sxs of Alzheimer's?
Lots eg - executive dysfunction, coordination problems, emotional lability, disorientation, insomnia, agnosia
What are some of the other sxs of vascular dementia?
Lots eg - executive dysfunction, coordination problems, emotional lability, disorientation, insomnia, gait instability, focal neurological signs
Describe the pathophysiology of vascular dementia
Ischaemic and/or hemorrhagic cerebrovascular disease, which leads to damage to brain parenchyma
What is the mechanism of action of memantine?
Glutamine (NMDAR) receptor antagonist. Prevents neurotoxicity induced by excessive glutamine activation in Alzheimer's
Which areas of the brain atrophy in Alzheimer's?
Widespread atrophy, particularly affects hippocampus
Describe the pathophysiology of Alzheimer's to a lay person
...
Describe the key differences between vascular dementia and Alzheimer's presentation
In vascular, there is less impairment in episodic memory and more in visuospatial ability, semantic memory and executive function when compared to Alzheimer's
What are some risk factors for vascular dementia?
How do we treat vascular dementia?
No specific treatment - focus on 2ndary prevention of CVD
Can prescribe acetylcholinesterase inhibitors or memantine but only if suspecting co-morbid Alzheimer's, PD dementia or Lewy
Which immune cells are likely to be activated in Alzheimer's?
Microglia and astrocytes
What tools could you use to investigate for Alzheimer's?
10-point cognitive screener, Mini-MMSE, MoCa, mini-cog
List 4 differential diagnoses when suspecting vascular dementia
Alzheimer's, Lewy body, frontotemporal dementia, normal pressure hydrocephalus
What are some non-pharmacological dementia treatments?
Cognitive stimulation therapy
Group reminiscence therapy
Cognitive rehab or occupational therapy
What specialist investigations are available?
MRI, SPECT scan, CSF fluid analysis (total tau, phosphorylated tau, free amyloid)
Which areas of the MoCa will be most affected by Alzheimer's?
Memory, delayed recall, naming animals, list words starting with a letter, draw a clock
Which areas of the Moca will be most affected by vascular dementia?
Connecting dots, attention, and abstraction sections
What Alzheimer's therapies are being researched currently?
Monoclonal antibodies to clear amyloid plaques
Gene therapy to slow down cholinergic neurodegeneration