AD - Medical Management

Question 1

Anticholinesterase therapy used for and name the two types

Answer 1

to block the enzyme that normally degrades the neurotransmitter ACh

• Cognex (Tacrine)
• Aricept (Donepezil)

Question 2

Memantine used for and it does this by working on

Answer 2

Regulates excess glutamate activity

Glutamate also involved in memory functions

Used for treatment of moderate to severe AD

Question 3

Amphetamines use for

Answer 3

Given for abulia or inattention

Question 4

Benzodiazepines (Ativan) treats

Answer 4

(AD) Given for behavior control related to agitation and confusion

Question 5

Anti-Inflammatories (NSAIDS, glucocorticoids) treats

AD

Answer 5

Limit neurodegeneration

Question 6

Neurotrophic factors

treats

Answer 6

Nerve Growth Factors (NGF)

Enhances survival of cholinergic neurons

Question 7

Antioxidants

Answer 7

also neuroprotective
Given to pt with AD

Vitamins E & C
Co-enzyme Q10

Question 8

Cognex (Tacrine) is a type of and treats

Answer 8

AChE inhibitor
Effectively improves cognitive function
(AD)

Question 9

Aricept (Donepezil) is a type of and treats

Answer 9

AChE inhibitor
Effectively improves cognitive function

has fewer side-effects

Question 10

Rehabilitation goals for AD

Answer 10

Goal: ↑ QOL & maintain maximal function

Intervention determined by stage of disease

Question 11

Tips for PT with AD patients

Answer 11

Simple instructions – gentle, slow
Use of person’s first name
Manual cuing
Structured environment & well-lit, quiet room
Familiar surrounding –> sense of security
Maximize repetition & use of functional movement patterns
Planned activities & participation in daily routines

Question 12

Management of Sundowning

Answer 12

Manipulation of the environment is an effective alternative to physical or chemical restraints

• Keep lights on in a pts room at night time
• Create more “homey” feel, not sterile like hospital
• Wandering can be ↓ by using brick-wall design wall paper on exits – serve as “facades”
• Physical exercise during the day to reduce nighttime agitation and daytime drowsiness
• Sensory integration – hammocks are effective (prioprioceptive & kinesthetic input); use of different textures, temp, light touch, etc.

Effective redirection

Question 13

PT management for pts with AD

what would we work on in PT sessions

Answer 13

-Gait & balance training
-Strengthening: Encourage extension!
-Respiratory Training
(Can use Gegenhalten Tone to your advantage by applying pressure on diaphragm)
-Fall Prevention
-Adapting the environment (home modification)
-Patient & Caregiver -Education

Question 14

(AD and) Declarative memory involves

Answer 14

Explicit information about facts

Often absent in AD due to damage to the hippocampal regions.

Question 15

(AD and) Procedural memory involves

Answer 15

Knowledge of rules of action and procedures, which can become quite automatic with repetition

Often intact in persons with AD

Intact procedural memory in AD can be utilized as a means by which AD patients can learn new tasks.

Structured, repetitive practice of procedures, with little changing of routine, may be helpful

Question 16

Exercise & AD
What is released
What are the benefits

Answer 16

Brain-Derived Neurotrophic Factor (BDNF) – a protein produced especially by neurons in the hippocampus and the cortex

Neuroprotective in nature
promotes neuronal survival & resilience to injury

Also has a powerful role in facilitating activity-dependent plasticity, which underlies the capacity for learning and memory.

Question 17

What does a ↓ BDNF in AD cause

Answer 17

Cripples the hippocampus in 2 ways:
Weakens the synaptic encoding capacity
Makes hippocampal neurons more vulnerable to insult and degeneration

Question 18

What does and ↑ BDNF cause

Answer 18

Exercise has been shown to ↑ BDNF

Physical activity lowers risk of cognitive impairments

Also lowers risk of depression in moderate to severe AD