Alzheimer's Disease Flashcards
Conditions causing dementia-like symptoms
- Depression
- Hypothyroidism
- B12 deficiency
- Alcohol
- Trauma
Alzheimer’s Disease Risk Factors
- Age
- Family History
- E4 allele of ApoE gene
- History of Psychiatric illness
- Other: Down syndrome, head injury, diabetes
Functional staging FAST Scale stage 7
a) Only 6 words
b) Only 1 word
c) Cannot walk
d) Cannot sit
e) Cannot smile
f) Cannot hold head up
Scoring for the clock drawing test
1 point for the following
- Closed circle
- Correct numbers
- Correct positions
- Hands in the correct position
Montreal Cognitive Assessment (MoCA) staging
- Mild: 18 to 26
- Moderate: 10 to 17
- Severe: <10
Definition of Dementia
-Cognitive impairment
PLUS
-Functional impairment
Goals of therapy for AD treatment
1) Maintain function for as long as possible
2) Treat psych and behavioral sequelae
How to treat mild to moderate cognitive symptoms
- MoCA 10 to 26
- Cholinesterase inhibitors
ex. Donepezil, galantamine, rivastigmine
How to treat moderate to sever cognitive symptoms
-MoCA <17
-Cholinesterase inhibitors
PLUS
-Memantine
-May consider either as monotherapy as well
Average expected decline in MoCA score
- Untreated = 2-4pts/yr
- Treated < 2pts/yr
ADAS-Cog expected decline
- 4pts/6mo
- 7pts/1yr
How to treat vascular dementia
- Manage: diabetes, hypertension, hyperlipidemia
- May use cholinesterase inhibitors or memantine too
Medications used to manage BPSD
- Atypical antipsychotics
ex. Quetiapine, risperidone, olanzapine - SSRIs second line
- AVOID TCAs
Mood stabilizers
- Valproic acid
- Lithium
Donepezil
- Cholinesterase inhibitor
- Frequent first line
