Alzheimer's Disease Flashcards
What’s Alzheimer’s Disease?
Alzheimer’s disease (AD) is a progressive dementia
affecting cognition, behavior, and functional status with
no known cause or cure.
Patients eventually lose cognitive, analytical, and
physical functioning, and the disease is ultimately fatal.
Pathophysiology- The signature findings are
Intracellular neurofibrillary tangles (NFTs), extracellular neuritic plaques, degeneration of neurons and synapses, and cortical atrophy.
Mechanisms proposed for these changes of Alzheimers
β-Amyloid protein aggregation, leading to formation of plaques.
Hyperphosphorylation of tau protein, leading to intracellular NFT development and collapse
of microtubules.
Inflammatory processes—levels of multiple cytokines and chemokines are elevated in AD
brains.
Neurovasculature dysfunction
Oxidative stress.
Mitochondrial dysfunction.
What correlates with Alzheimers’ Deficiency
Loss of cholinergic activity
and density of NFTs
Stages of Alzheimers
Mild (MMSE score of 26-18) Difficulty rememberin. cant do household chores, difficult remem bering, lost while driving.
Moderate (MMSE score 17-10) Requiries assisstance with activities- Disoriented. Can recall recent memories.
Severe (MMSE score of 9-0) Patient loses ability to speak, walk, feed self, and go to bathroom by self.
Requires care 24/7
Laboratory Tests Alzheimers:
Rule out Vitamin D and Folate Deficiency
Rule out Hypothyroidism with thyroid function tests
Blood cell counts, serum electrolytes, and liver tests
DESIRED OUTCOME
The primary goal of treatment in AD( Alzheimers)
is to maintain patient functioning as long as possible.
Secondary goals are to treat the psychiatric and behavioral sequelae.
NONPHARMACOLOGIC THERAPY:
s staying physically, mentally, and socially active,
adopting a low-fat/low-cholesterol diet rich in dark vegetables and fruit, and managing
body weight.
Managing blood pressure, cholesterol, and blood sugar may reduce the risk of
developing AD and may prevent the worsening of dementia in patients with AD.
TTT For Alzheimer
Donepezil, rivastigmine, and
galantamine are indicated in mild to moderate AD, while donepezil is also indicated in severe AD.
Whats Donepezil (Aricept) MOA
is a piperidine derivative with specificity for inhibition of acetylcholinesterase rather than butyrylcholinesterase.
Whats Rivastigmine MOA
has central activity at acetylcholinesterase and butyrylcholinesterase sites, but low activity at
these sites in the periphery.
Whats Galantamine MOA
is a cholinesterase inhibitor that also has activity as a nicotinic receptor agonist
Memantine (Namenda) - the other drug for Alzheimers Disease
Moa
USED AS
blocks glutamatergic neurotransmission by
antagonizing N -methyl- D -aspartate receptors, which may prevent excitotoxic
reactions.
It is used as monotherapy, and data suggest that when it is combined with a cholinesterase inhibitor, there is improvement in cognition and activities of daily living.
✓It is indicated for treatment of moderate to severe AD. ✓It is not metabolized by the liver, but is primarily excreted unchanged in the
urine (half-life of elimination = 60 to 80 hours).
✓It is usually well tolerated, and side effects include constipation, confusion,
dizziness, hallucinations, headache, cough, and hypertension. ✓
It is initiated at 5 mg/day and increased weekly by 5 mg/day to the effective
dose of 10 mg twice daily. Dosing must be adjusted in patients with renal
impairment.
Why isn’t NSAID recommended for Alzheimer Disease
Because of a significant incidence of side effects and a lack of compelling evidence,
Treatments that may be work
Lipid lowering agents : 3- hydroxy-3-
methylglutaryl coenzyme A–reductase inhibitors-Pravastatin and lovastatin
EGb 761 (an extract of ginkgo biloba)- s/e so caution huperzine A,
