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Stuff not in the slides

  • Delirium - can be caused by UTI or bad influenza
  • MRI - atrophy (not reaching the skull), contraction of the lateral ventricle (due to atrophy), hippocampus is particularly shrunk is alzheimer's disease
  • Ischaemic changes - white stuff showing vascular damage
  • PET scan with PiB, which adheres to amyloid plaques. The more red = worse Alzheimers. In the middle = mild cognitive impairment. On the right = AD
  • Need to distinguish between age-related memory decline and Alzheimer's.
  • Basically all the brain NT chemicals are decreased in the brain in AD - particularly ACh (which is important for memory).
  • Linear structures = tangles.
  • Nerve cells in AD are bald - fewer connections.
  • Amyloid beta protein plaque with a halo of degenerating neurons and inflammatory cells surrounding it.
  • Amyloid precursor protein in the cell membrane is normally split by the alpha secretase for recycling.
  • In AD, both beta and gamma secretases, and produce protein breakdown products that clump together, and the body puts them together into plaques as a waste dump.
  • The axon of a nerve cell contains microtubules that are maintained by a tau protein. In AD, tau becomes phosphorylated and the microtubules get twisted, and the nerve cell dies.
  • Aetiology
    • <1% have autosomal dominant (get it in 40s-50s). Most is sporadic (although family history increases risk).
    • Apoliprotein E is associated with AD.
    • Major cause is age
    • Down syndrome
  • Goal = delay Alzheimer's onset.
  • Diet - antioxidant
  • Body - regular exercise
  • Brain - cognitive exercise
  • Health checks - hypertension, head injury, smoking
  • etc, etc
  • Sarcopenia = low muscle mass, results in high
  • AD = high levels of A protein and low levels of beta protein (being shoved into plaque). With exercise, these levels are normalised.
  • Cholinesterase inhibitors, cause increased levels of ACh.
  • NMDA antagonist is more for moderate-severe dementia.
  • A lot of drugs aimed at reducing the violent outbursts associated (memory loss is not as much of a disturbing factor for families as these violent outbursts are).