Clinical Neuroscience - Alzheimers

Wichtige Krankheitsbilder der Neurowissenschaften - Alzheimers

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T. F.

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T. F.

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This flashcard set covers the advanced study of dementia and Alzheimer's disease at the university level, focusing on key aspects like dementia types, diagnostic tools, risk factors, and pathology. It delves into the differences between Alzheimer's and other forms of dementia, such as vascular dementia and dementia with Lewy bodies, and explores the clinical criteria and diagnostic methods used to identify these conditions. The set also examines the risk factors associated with Alzheimer's, including age, genetic predisposition, and lifestyle factors, as well as the pathological changes in the brain that characterize the disease. This flashcard set is invaluable for medical students and professionals seeking a comprehensive understanding of clinical neuroscience related to dementia and Alzheimer's disease.

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Alzheimers is not the the same as Dementia. Dementia is a serious loss of global cognitive ability in a previously unimpaired person. (NON SPECIFIC SYNDROME). What are the common forms of Dementia?

Alzheimers disease/dementia (AD)

Vascular dementia (VAD) resp. mixed dementia AD/VAD

Frontotemporal lobar degeneration (FTLD)

Dementia with Lewy Bodies (DLB)

AD is most frequent but less common <50 years

Name the risk factors for Alzheimers?

AGING: incidence doubles every 6 years after age of 60

Cereborvascular diseases

Blood pressure (high or low blood pressure tributes to vascular damage)

Type II Diabetes: increase with Apo(epsilon)4

overweight: contributes to cardiovascular risk

Name the risk factors for Alzheimers?

Smoking: contributes to vascular damage

Traumatic brain injury: pathology risk

Depression

Activity: decreases likelihood of other risk factors

Mental activity, education and IQ: higher tolerance to pathological damage but faster decline with onset

Depression and Alzheimers: what is true?

increases risk for dementia

severity of depression increases risk for dementia

depression causes dementia

depression is the first sign of dementia

it is unclear if depression is the first sign of the cause for dementia

What is prevalence?

"Verbreitung"

"Vorkommnis"

number of invalids/sick persons @ beginning of an evaluation period (already sick)

number of newly invalids/sick persons over a period of time (becoming sick)

What is incidence?

"Vorkommnis"

"Verbreitung"

number of invalids/sick persons @ beginning of an evaluation period (already sick)

number of newly invalids/sick persons for a period of time (becoming sick)

What is true about pathology and pathophysiology of dementia?

Depostion of toxic protein species (common for neurodegenrative diseases)

pathology accumulates slowly before onset of cognitive impairment

familial forms are rare

sporadic AD dominates over hereditary forms (Apo-epsilon4 risk factor)

spotted by autopsy only (no diagnostic tool)

The striking pathologic aspects in AD are?

accumulation of amyloid-beta and intracellular-tau deposits

loss of synapses, neurons and brain volume (tau-associated)

signs of infection: activated microglia, proinflammatory cytokines and astrogliosis

associated lesions: lewy bodies, vascular changes and sclerosis

accumulation of alpha-synuclein deposits

What is true about the familial forms of AD?

autosomal dominant in APP-gene and Presenilin 1/2 gene (5% of fAD)

APP = amyloid precusor protein

mutation in subunit of secretases cleaving APP

100% penetrance usually before the age of 60

Apo-epsilon4 risk factor functions as a risk factor in fAD

The mild cognitive impairment (MIC) is involved in a later development of AD.
Persons having a MIC have a 30% risk for a progression towards AD (or relative risk x4.7-9.5).
What is true about the transitional stage between normal aging and AD?

decline of cognitive performance

decline verified by objective measurement

underlying conditions are numerous

preserved activities of daily living

duration @least 6 months

Which are the clinical criteria of the Dementia Syndrome?

McKhann 2011: cognitive or behavioral impairmaint involves a minimum of 2 domains

ICD-10: memory impairment as "must-have" criteria

ICD-10: @least one additional impairment: language, apraxia executive functions, orientation or attention

= impaired activities of daily living caused by cognitive dysfunction

screening tool: Mini-Mental Status (MMSE)

Primary versus Secondary dementia?

primary dementia: dementia is the major sign (organic brain disease)

primary dementia: dementia is not related to another disease

secondary dementia: occur in context of diseases

secondary dementia: dementia is not the main disease manifestation

primary dementia: occur in context of diseases

What is a red flag symptom/sign?

refer to signs and symptoms which indicate urgent need for treatment/condition

Besides infections other potential causes of secondyra dementia are?

tumors of nervous system

hypoxic/traumatic brain injury

drugs

psychatric disorders

autoimmune disease (e.g. multiple sclerosis)

Which typical diagnostic tools are mainly used in dementia?

medical history

MMSE

psycho/neuro/somatostatus

MRI

blood diagnostics

Which are more specialized diagnostic tools in dementia?

CSF investiagtion

PET

other specialists

SPECT

fMRI

What are the causes of Vascular Dementia (VD)

reduced substrate delivery (O2 and glucos) = stroke-like conditions

manifold patterns of cerebral damage = infarction (regional lack in O2)

prototypic vascular dementia = sudden onset of impairment (lesion related to clinical syndrome)

typical mixed pathology

overactive glucose metabolism

FTLD is one commone form of dementia - Frontotemporal lobar degeneration.
Which are the features pointing towards a diagnosis of FTLD?

early onset (age 40 is possible)

behavioral symptoms and language problems

pathology: focal atrophy in frontal/temporal lobe

reduced glucose metabolism in frontal lobe (FDG-PET)

neuropsychology: impaired semantic varints

Dementia with lewy bodies (DBL) has not to be confused with PDD. In DLB cognitive impairment is present shortly before or within one year after EPS (extra-pyramidal symptoms). Which features point toward a diagnosis of DBL?

EPS, hallucinations and fluctuations (core criteria)

REM-sleep behavioral disorder: acting out dreams during REM-phase

Neurospychology: impairment of visuoconstriction

Intolerance of antidopaminergic medication

DAT-SPECT: dopamine transporter in brain unvisible

In which type of dementia are the amyloid-beta deposits visible (biomarker amyloid-PET)?

DLB

FTDL

VAD

What are the early warnings in AD?

loosing recently acquired information

misplacing of objects

difficulties in handling complex tasks

mood disorders, anxiety

aphasia

What is the main characteristic in AD?

Impaired cued delayed recall (no memory even with benefit from cues)

By with method are amyloid-beta deposits indentified

PIB-PET

Biomarkers in CSF for diagnosis of AD?

exclusion: no increased cell count

exclusion: no OBCs (missing immune response)

BBB-dysfunction

lowered A-beta42 protein

increase in total-tau and phospho-tau (AD-specific)

What is true about the pharmacotherapy in treatment of dementia?

AD is treated with cholinesterase-inhibitors

Memantin is nit used as a drug in AD

DLB is treated with cholinesterase-inhibitors

FTLD is treated symptomatic

today no cure is available in dementia

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Clinical Neuroscience - Alzheimers

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