Alzheimer's Disease

Exam Cram

• Alzheimer's Disease is the commonest cause of dementia in the UK and represents significant morbidity and mortality

• Presentation: insidious onset memory decline over years with reduced ability to function at home

• Diagnosis: clinical @ psychiatry memory clinic, after ruling out reversible casues

• Management: lifestyle/ psyhchiatry MDT; anticholinesterase inhibitors, memantine

Outline

Background 

• Alzheimer's patients on biopsy reliably have beta amyloid deposits and tau proteins in neurofibillary tangles

• Early onset Alzheimer's disease has autosomal dominant genes that affect amyloid proteins. 

• No disease modifying medication is currently listed, however research is going into reducing the amyloid deposits

Assessment

Presentation

• Insidious onset memory loss, functional decline

• Family concerns around memory and coping

• Elderly

Examination

• Frail

• Confused

Investigations

• Normal baseline investigations- FBC, U&Es, CRP, LFTs; B12, folate, TFT, Calcium, Magnesium, blood sugar; CT-H

• Reduced cognitive questionnaires: MOCA < 23/30, ACEii < 70/100

Diagnosis

Diagnostic criteria: clinical @ psychiatry memory clinic

Differentials: 

• Mimics (reversible causes)

  • Infection- usually acuter onset

  • Medications- benzodiazepine, gabapentinoids, antipsychotics

  • B12, folate, hypercalcaemia, hyponatraemia, hypomagnesaemia; 

  • Normal Pressure Hydrocephalus, Space occupying lesion- e.g. CNS malignancy; 

  • Hypothyroidism, Diabetes

• Dementia Subtypes

  • Vascular Dementia (VD)

  • Lewy Body Dementia (LBD) 

  • Frontal Temporal Disease (FTD) 

  • Parkinson's Disease & Corticobasal syndrome (Parkinsons +)

Examination:

Ix

• Rule out reversible causes

  • • • CT-H

      • B12, folate, Fe studies, calcium, magnesium folate, BSL, TFTs

• Medication review

Differentials

• Dementia differentials: Lewy body, vascular, frontal temporal, parkinsons

• Depression

• Reversible causes: intracranial bleed, intracranial tumour, hypothyroidism, hypocalaemia, medication induced

Management

Severity assessment

MOCA

• Mild:

• Moderate:

• Severe:

0. Family Education, referral to memory clinic, rule out reversible causes

1. Anticholinergics (mild)

2. Addition of memantine in mod/severe

Donepezil side effects: bradycardia, 

References

Page written in 2024. 

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