AD - Medical Management Flashcards
Anticholinesterase therapy used for and name the two types
to block the enzyme that normally degrades the neurotransmitter ACh
- Cognex (Tacrine)
- Aricept (Donepezil)
Memantine used for and it does this by working on
Regulates excess glutamate activity
Glutamate also involved in memory functions
Used for treatment of moderate to severe AD
Amphetamines use for
Given for abulia or inattention
Benzodiazepines (Ativan) treats
(AD) Given for behavior control related to agitation and confusion
Anti-Inflammatories (NSAIDS, glucocorticoids) treats
AD
Limit neurodegeneration
Neurotrophic factors
treats
Nerve Growth Factors (NGF)
Enhances survival of cholinergic neurons
Antioxidants
also neuroprotective
Given to pt with AD
Vitamins E & C
Co-enzyme Q10
Cognex (Tacrine) is a type of and treats
AChE inhibitor
Effectively improves cognitive function
(AD)
Aricept (Donepezil) is a type of and treats
AChE inhibitor
Effectively improves cognitive function
has fewer side-effects
Rehabilitation goals for AD
Goal: ↑ QOL & maintain maximal function
Intervention determined by stage of disease
Tips for PT with AD patients
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
Management of Sundowning
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
PT management for pts with AD
what would we work on in PT sessions
-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
(AD and) Declarative memory involves
Explicit information about facts
Often absent in AD due to damage to the hippocampal regions.
(AD and) Procedural memory involves
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
Exercise & AD
What is released
What are the benefits
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.
What does a ↓ BDNF in AD cause
Cripples the hippocampus in 2 ways:
Weakens the synaptic encoding capacity
Makes hippocampal neurons more vulnerable to insult and degeneration
What does and ↑ BDNF cause
Exercise has been shown to ↑ BDNF
Physical activity lowers risk of cognitive impairments
Also lowers risk of depression in moderate to severe AD
