Alzheimer's Flashcards
Epidemiology of Alzheimer’s
5.3 million people in the US
Prevalence changes based on age
6% of individuals aged 65-74
44% of individuals aged 75-84
46% of individuals age 85 and older
Disease impacts a greater percentage of Americans as our population ages. In 2050:
20% of population will be > 65 years
3 hallmark features of Alzheimer’s
Cognitive impairment
Often identified first
Noncognitive (behavioral) impairment
Typically seen later in disease progression
Functional impairment
Motor and sensory defects not common until more advanced stages
Genetic Risk Factors/Etiology of Alzheimer’s
Chromosome mutations Apolipoprotein E (APOE)
Environmental Risk Factor/Etiology of Alzheimer’s
Age
Reduced brain size
Low education and occupational attainment
Reduced mental and physical activity late in life
Down Syndrome
Depression
head injury
What is the definitive marker for Alzheimer’s Disease?
The only definitive marker of AD is NFTs – found postmortem
5 Clinical Presentations that occur with Alzheimer’s
Gradual onset and progressive deterioration Memory and cognitive impairments Visuospactial abnormalities language impairment behavioral and psych symptoms
4 memory and cognitive impairments associated with Alzheimer’s
Inability to learn new information at first
Procedural memory loss follows
Executive function impairments
Long-term memory impaired in late stages
2 Visuospatial abnormalities associated with Alzheimer’s
Difficulty recognizing faces
Disorientation in familiar surroundings
2 Language impairment associated with Alzheimer’s
Initially manifested as difficulty in word finding and impaired naming ability (anomia)
Comprehension and meaningful language decreases as AD progresses
What are some medications associated with memory loss
Anticholinergic agents Benzodiazepines and other sedative hypnotics Opioid analgesics Antipsychotics Anticonvulsants NSAIDs Histamine H2 receptor antagonists Digoxin Amiodarone Corticosteroids Antihypertensives
4 Stages of Alzheimers
Mild Cognitive Impairment (MCI): Mild AD (MMSE 26-18): Moderate AD (MMSE 17-10 Severe AD (9-0):
Severe stage of Alzheimer’s includes what symptoms
agitation, altered sleep patterns, assistance is required for dressing, feeding, bathing, established behavioral and psychological symptoms of dementia, become bedbound, no speech, incontinent, basic psychomotor skills lost
Mild stage of AD includes what symptoms
forgetfulness, short term memory loss, repetitive questions, hobbies and interests lost, impaired activities of daily living
Moderate AD includes what symptoms
progression of cognitive deficits, further impaired activities of daily living, transitions in care, emergence of behavioral and psychological symptoms of dementia
Mild Cognitive impairment stage of AD includes what symptoms?
Complaints of memory loss, intact activities of daily living, no evidence of AD
Therapy for Alzheimer’s is aimed at what 3 things?
Symptom control
Delay of progression
Improvement in quality of life
1st line Cholinesterase inhibitors are FDA approved for mild-to-moderate AD
What are the 3 medications?
Donepezil hydrochloride (Aricept®) Galantamine hydrobromide (Razadyne®) Rivastigmine tartrate and transdermal (Exelon®)
What do cholinesterase inhibitors do?
enhance cholinergic activity
Efficacy of the Cholinesterase inhibitor medications for AD
All have similar efficacy First 6 months MMSE: 1-1.5 point improvement ADAS-Cog: 2.8-4 point improvement After first 6 months Declined efficacy but still better than not treating
Average efficacy for a patient with AD not on medication
MMSE and AGAS
MMSE: 2-4 point decline
AGAS-Cog: 7 point decline
Consider therapy effective if decline less than above
DONEPEZIL – ARICEPT®
MOA, dose, adjustments, Side effects
Reversible CI mild to mod AD Dosed QD CYP interactions no renal/hepatic adjustments High specificity for acetylcholinesterase and not butyrylcholinesterase--> causing less ADR
GALANTAMINE – RAZADYNE® MOA
Dual MOA
Inhibits acetylcholinesterase
Modulates nicotinic receptors increased release and enhancement of cholinergic function
GALANTAMINE – RAZADYNE®
titrate, adjustment, when to take
Titrate every 4 wks
adjust for hepatic dysfunction
take at morning and evening meals
RIVASTIGMINE – EXELON® MOA
Reversible CI (but very slow dissociation from acetylcholinesterase) Substantially inhibits butyrylcholinesterase
