Alzheimer's disease

Causes
1. Genetic
  1. APP
    1. Chr 21
    2. Neuronal repair
  2. PSN-1/2
    1. Chr 1/14
    2. y-secretase
  3. APOE
    1. Lipid metabolism
    2. Chr 12/19
  4. Tau
    1. Chr 17
    2. Microtubule associated
Signs and symptoms
1. Memory loss
  1. Limbic system
    1. Cortical structures
      1. Limbic lobe
        Subcallosal area
        Cingulate gyrus
        Isthmus of limbic lobe
        Parahippocampal gyrus
        Uncus
      2. Hippocampal formation
        Hippocampus proper
        Subiculum
        Dentate gyrus
        Entorhinal cortex
      3. Septa area
      4. Orbito-frontal cortex
    2. Subcortical structures
      1. Anterior nucleus of thalamus
      2. Hypothalamus
        Mammillary bodies
      3. Amygdala
    3. Connecting pathways
      1. Fornix
      2. Mammilothalamic tract
      3. Stria temrinalis
      4. Cingulum
      5. Longitudinal stria
      6. Medial forebrain bundle (MFB)
      7. Anterior commisure
  2. Types of memory
    1. Short term memory
    2. Intermediate memory
    3. Long term memory
    4. Sensory memory
  3. Physiology of memory
    1. Habituation
      1. Inhibition of pathways
      2. Inhibiton of presynaptic Ca2+ influx
      3. Less release of neurotransmitters
    2. Sensitization
      1. Facilitation of pathways
      2. Stimulation of presynaptic Ca2+ influx
      3. Increased release of neurotransmitters
Dementia
1. Vascular dementia
2. Lewy body dementia
3. Frontotemporal dementia
4. Mixed dementia
5. Al cohol related dementia
Pathophysiology
1. Formation of plaques
2. Formation of neurofibrillary tangles
3. Plaques and tangles
  1. Inflammation (neuronal injury)
  2. Neuronal death
  3. Disrupt neuronal signalling
Investigations
1. Mini-mental state examination (MMSE)
  1. Assess
    1. Orientation
    2. Registeration
    3. Attention and calculation
    4. Recall
    5. Language
    6. Copying
2. Blood tests
  1. CBC
  2. ESR
  3. Liver/kidney function tests
  4. Blood glucose
  5. Thyroid function tests
  6. Blood culture
  7. HIV test
3. Imaging
  1. PET
  2. CT/MRI
4. Genetic testing
Management
1. Drugs
  1. Selective cholinesterase inhibitors
    1. Rivastigmine, Galantamine, Donepezil
    2. Side effects
      1. DUMBELSS
        Diarrhea
        Urination
        Myosis
        Bronchospasm
        Emesis
        Lacrimation
        Salivation/sweating
  2. NMDA antagonist
    1. Memantine
    2. Side effects
      1. Dizziness
      2. Confusion
      3. Hallucinations
Risk factors
1. Non-Modifiable
  1. Age
  2. Family history
  3. Down syndrome
  4. Head injuries
2. Modifiable
  1. Cardiovascular disease
  2. Smoking/Alcohol
  3. Obesity
  4. Diabetes
  5. Hypertension
  6. Lack of sleep
  7. Sedentary lifestyle
  8. Lack of education
  9. Seizure
  10. Strokes

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Alzheimer's disease

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	Created by H S about 3 years ago