Alzheimer's disease resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: , Fahimeh Shojaei, M.D.

Synonyms and keywords:

Overview

Alzheimer's disease is the most common cause of dementia among older people. Dementia is a loss of thinking, remembering, and reasoning skills that interferes with a person's daily life and activities.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

• Alzheimer's disease is not a life threatening condition that may result in death or permanent disability within 24 hours if left untreated.

Common Causes

While there is no direct cause for the developement of Alzheimer's disease, there are several factors that may contribute in its acquisition:

• Chromosomal
  • Down syndrome
    • Trisomy 21
    • Over expression of amyloid precursor protein (APP) on chromosome 21
    • Develop the neuropathologic hallmarks of AD after age 40 years
• Familial
  • Late-onset familial (AD2)
    • APOE gene:
    • TREM2 gene:
    • PLD3 gene
    • UNC5C gene
    • AKAP9 gene (in African-Americans only)
  • Early-onset familial AD (AD1, AD3, AD4)
    • PSEN1 gene:
    • PSEN2 gene:
    • APP gene:

• Unknown (includes genetic/environment interactions)
  • Multifactorial
    • Aging
    • Genetic predisposition
    • Exposure to one or more environmental agents including head trauma, low education level, viruses, and/or toxins

Diagnosis

Shown below is an algorithm summarizing the diagnosis of amnesia according to the the American Academy of Neurology guidelines:

Patient with amnesia

Acute onset

Chronic onset

Measure vitamin B12, and folate, and TSH

Abnormal?

Yes

Vitamin deficiency, hypothyroidism

Fluctuating course, inattention, disorganized thinking, or altered level of consciousness?

Positive for SIGE CAPS questionary?

Yes

Depression

Yes

No

Severe disimpairment in social functioning?

No

Normal aging

Delirium

Dementia

Take history and perform physical examination

Take history and perform physical examination

History of head trauma?

Yes

No

Concussion, post-concussive amnesia

Measure urine toxicology, CBC, creatinine, electrolites, and glucose to reveal cause

Initial short term memory loss

Vascular risk factors, imaging evidence of cerebrovascular involvement

Young age, behavioral symptoms or language impairment

Bradikinesia or features of parkinsonism, fluctuating cognition, [[visual hallucinations]]

Dementia occuring 1 year after onset of Parkinson disease

Alzheimer disease

Vascular dementia

Frontotemporal dementia

Dementia with Lewy bodies

Parkinson's disease

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

Do's

• The content in this section is in bullet points.

Don'ts

• The content in this section is in bullet points.

References

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