Alzheimer Disease

1. Treatment

1.1. CHOLINESTERASE INHIBITORS: (donepezil, rivastigmine, galantamine)

1.2. Memantine , anN-methyl-D-aspartate (NMDA) receptor antagonist

1.3. Vitamin E (randomized trials show mixed results)

2. Genetics

2.1. 3 gene mutations for early onset...

2.2. Presenilin1( PSEN1) on chrom.14q

2.3. Presenilin 2 (PSEN2) on chrom.1q

2.4. Amyloid Precursor Protein (APP) on 21q

2.5. 1gene mutation for Late Onset AD (LOAD) = Apolipoprotein E (APOE) on chromosome 19

2.6. Autosomal dominant inheritance pattern

3. Common Findings

3.1. affects 1 in 5 women; 1 in 10 men

3.2. Age of onset usually after 60

3.3. early onset = 35 to 60 years

3.4. cardinal sign = memory impairment

3.5. Executive dysfunction, visuospatial impairment, language deficits, and behavioral symptoms appear later.

3.6. Most common cause of demntia

4. Diagnostics

4.1. Mini-Mental State Examination (MMSE)

4.2. The Montreal Cognitive Assessment (MoCA)

4.3. Magnetic Resonance Imaging (MRI)

4.4. Fluorodeoxyglucose Positron Emission Tomography (FDG-PET)

4.5. Single-Photon Emission Computed Tomography (SPECT)

5. Etiology

5.1. amyloid plaques

5.2. neurofibrillary tangles

5.3. neuronal loss

5.4. in cerebral cortex & hippocampus

6. Risk Factors

6.1. Vascular risk factors (smoking, diabetes, hypertension, hypercholesterolemia)

6.2. Risk doubles with one affected first degree relative

7. References

7.1. UpToDate, Alzheimer's Genetics. 2017. Retrieved from: https://www-uptodate-com.lb-proxy2.touro.edu/contents/genetics-of-alzheimer-disease?search=alzheimers%20genetics&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

7.2. UpToDate, Alzheimer Diagnosis, 2017. Retrieved from: atehttps://www-uptodate-com.lb-proxy2.touro.edu/contents/clinical-features-and-diagnosis-of-alzheimer-disease?search=alzheimers%20diagnosis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

7.3. UpToDate,Alzheimer Treaments,2017. Retrieved from: https://www-uptodate-com.lb-proxy2.touro.edu/contents/treatment-of-dementia?search=alzheimers%20treatment&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

7.4. McCance & Huether, 2015, Pathophysiology: The biologic basis for disease in adults and children, seventh edition. St. Louis, MO: Mosby Elsevier.