Alzheimer's Flashcards by erica kaczmarczyk

name two pathologic hallmarks of AD in the brain

neurofibrillary tangles

neuritic plaques

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disruption of pathways by plaques and tangles leads to a shortage of what

acetylcholine

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what leads to neuronal death and a higher rate of plaque formation

overactivation of glutamate

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cognitive symptoms of AD

memory loss
problems with language
disorientation to time and place
poor or decreased judgement
problems with learning and abstract thinking
misplacing things

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Noncognitive symptoms of AD

changes in mood or behavior
changes in personality
loss of initiative

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functional symptoms of AD

difficulty performing familiar tasks

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What tests should be done to exclude other causes of dementia

depression screen, vitamin b 12 deficiency, thyroid function tests, CBC, and chemistry panel

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which medication classes are associated with cognitive impairment

anticholinergics
anticonvulsants
antipsychotics
benzodiazepines
hypnotics
opioids

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onset of probable AD

insidious

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onset of possible AD

sudden

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history of probable AD is

clear

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history or possible AD is

unclear

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possible AD when presence of what

concomitant cerebrovascular disease
features of dementia with Lewy bodies other than demetia itself
Another neurologic disease or nonneurological medical comorbidity
use of medication that could have substantial effect of cognition

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MMSE tests what areas

orientation
short term memory 
language
attention
praxis (performance of an action)

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Mild AD MMSE score

18-26

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Moderate AD MMSE score

10-17

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Severe AD MMSE score

0-9

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Mild AD definition

difficulty remembering recent events; decreased ability to manage finances, prepare food; may get lost while driving; begins to withdraw from difficult tasks and gives up hobbies

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Moderate AD definition

requires assistance with ADL; disoriented with regards to time; recall of recent events is severely impaired; forgets details of past life and names of family/friends; function fluctuates from day-to-day; loses ability to drive safely; agitation, paranoia, and delusions are common

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Severe AD defintion

loses ability to speak, walk, and feed self; incontinent bowel and bladder, requires 24/7 care

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primary goal of therapy for AD

treat cognitive symptoms and maintain function

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secondary goal of therapy for AD

treat psychiatric and behavioral symptoms that occur as a result of AD

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cholinesterase inhibitors used in AD

donepezil
rivastigmine
galantamine

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NMDA receptor antagonist

memantine

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donepezil brand name

aricept

rivastigamine brand name

exelon

galantamine brand name

razadyne

memantine brand name

namenda

Treat mild-moderate AD with what medication/s

cholinesterase inhibitor

treat moderate to severe AD with what medication/s

memantine +/- cholinesterase inhibitor

when to monitor AD for safety of medications

2-4 weeks

When to monitor AD for effectiveness

3-6 months then Q6months

When is a cholinesterase inhibitor not working

greater than 2-4 point decline in MMSE per year

Initial dose of donepezil

5 mg QD

maintenance dose of donepezil

5-23 mg QD

Time between dose adjustment for donepezil

5-10 mg = 4-6 weeks | 10-23 mg = 12 weeks

therapeutic effect of cholinesterase inhibitors

slows cognitive decline by enhancing cholinergic activity

common AEs of cholinesterase inhibitors

nausea, vomiting, diarrhea

dose related AEs of cholinesterase inhibitors

``` urinary incontinence dizziness headache syncope bradycardia muscle weakness salivation sweating ```

cholinesterase inhibitors are for what stages of AD

mild-moderate | donepezil also severe

what medications should be avoided with cholinesterase inhibitors

anticholinergics

memantine initial dose

5 mg QD or 7 mg QD (ER capsule)

memantine maintenance dose

10 mg BID or 28 mg QD (ER capsule)

time between memantine dose adjustments

1 week

dose adjustments for renal impairment for memantine

CrCl < 30 - 10 mg or 14 mg QD

therapeutic effects of NMDA antagonist

inhibits overstimulation of glutamate

AEs of NMDA antagonists

``` constipation confusion dizziness headache hallucinations coughing hypertension ```

NMDA antagonists used for what stages of AD

moderate-severe

Rivastigamine initial dose

1.5 mg BID or 4.6mg/24 hour patch

Rivastigamine maintenance dose

3-6 mg BID or 9.5 mg/24 hour patch

time between dose adjustments for rivastigamine patch

4 weeks

time between dose adjustments for rivastigamine oral

2 weeks

galantamine initial dose

4 mg BID or 8 mg QD ER

galantamine maintenance dose

8-12 mg BID or 16-24 mg QD ER

time between dose adjustments for galantamine

4 weeks

dose adjustments for galantamine

Max 16 mg for moderate hepatic or renal funciton. DO not use in severe hepatic or renal dysfunction

possible underlying causes of behavioral symptoms in AD

``` pain constipation hunger/dehydration depression fear anxiety loss of sleep UTI AEs of meds ```

What antipsychotics used in AD and doses

olanzapine 5-10 mg Quetiapine 100-300 mg risperidone 0.75-2 mg

Antipsychotics treat what behavioral AD syptoms

``` hallucinations delusions suspiciousness disruptive behaviors aggitation aggression ```

antidepressants treat what behavioral AD symptoms

``` poor appetite insomnia hopelessness withdrawal suicidal thoughts agitation anxiety ```

Which antidepressants are used in AD and doses

citalopram 10-20 mg escitalopram 20-40 mg sertraline 75-100 mg

AEs of donepezil

``` insomnia nausea diarrhea accident infection ```

AEs of rivastigmine

``` dizziness weight loss headache agitation falling N/V anorexia abdominal pain tremor local reaction to patch ```

AEs of galantamine

Nausea vomitting diarrhea