Alzheimer's Flashcards
Alzheimer’s Disease
-progressive dementia that affects memory, higher learning, reasoning, behavior, emotion
Brain Characteristics in AD
- neurofibrillary tangles and plaques
- brain neuronal pathways destroyed (cholinergic, noradrenergic, serotonergic)
Name a few proposed mechanisms of AD pathogenesis.
- beta amyloid plaques
- neurofibrillary tangles
- cholinergic deficit
- CV risk factors are also risk factors for dementia: HTN, low HDL, high LDL, DM
Mild AD MMSE Score and Abilities
- score 26-18
- pt has difficulty remembering recent events or may withdraw from difficult activities
- can carry out regular household activities
Moderate AD MMSE Score and Abilities
- score 17-10
- pt requires assistance with ADLs
- frequently disoriented and may forget details of past life
- agitation, paranoia, delusions
Severe AD MMSE Score and Abilities
- score 10-0
- pt loses ability to speak, walk, feed self
- requires 24/7 care
What are some potential AD prevention measures?
- protect the cardiovascular system (many CV risk factors are same as dementia)
- physical activity and healthy eating
- maintain social connections and strong intellectual activity
- reduce head trauma
AD Treatment Goals
- symptomatic tx of cognitive sxs
- maintain patient function as long as possible
- treat psychiatric and behavioral sequelae as they occur
Nonpharm Therapy for AD
- educate pt and family/caregivers
- make plans while patient is able
- discuss illness course, tx decisions, legal and financial decisions
- resources for support and research
- distraction and redirection
- provide a safe enviro, avoid overstimulation
MOA of Cholinesterase Inhibitors
- cholinesterase breaks down ACh
- cholinesterase inhibitors prevent ACh breakdown –> more ACh in brain for good brain function
Efficacy of Cholinesterase Inhibitors
- may delay or slow worsening of sxs for 6-12 months
- may have positive effects on psychiatric and behavioral sxs
Cholinesterase Inhibitors Indication
mild to moderate AD
Which cholinesterase inhibitor is best tolerated?
donepezil/Aricept
Adverse Effects of Donepezil, Galantamine, Rivastigmine
- N/V/D
- anorexia, weight loss
- bradycardia (leading to syncope, dizziness, and pacemaker insertion)
- SLUD
What is unique about donepezil/Aricept?
1/2 life of 70 hours
Why is the cholinesterase inhibitor Tacrine/Cognex not used as frequently as others?
-hepatotoxicity risk
Memantine/Namenda Indication
moderate to severe AD (alone or with cholinesterase inhibitors)
Memantine/Namenda MOA
decreases effects of glutamate (excitatory NT), which can cause neurodegenerative disorders
Memantine/Namenda Adverse Effects
- generally well-tolerated
- constipation
- dizziness, HA, somnolence
Caprylidene/Axona
-medical food that can be used by neurons to generate more ATP and increase supply of ACh
Caprylidene/Axona Adverse Effects
-mild GI most common: N/D, flatulence, dyspepsia
How much benefit do AD/dementia medications provide? When should a benefit be seen?
- modest benefit on average
- not all patients benefit
- benefits should be seen in 3-6 months
When should dementia meds be discontinued?
- patients and caregivers need to decide if meds are worth potential side effects and cost
- consider stopping meds when impairment becomes severe (MMSE < 10)
Possible Targets for Future AD Therapies
- beta amyloid
- tau protein
- inflammation
- insulin resistance
