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.
- <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).