Alzheimer's Disease

Question 1

What is the relationship b/w anticholinergic drugs and Alzheimer’s disease?

Answer 1

Anticholinergic drugs can cause memory impairments

Question 2

What is sundowning?

Answer 2

It is when a patient with Alzieimer’s Disease or dementia symptoms get worse during late afternoon or evening. AKA Late-day confusion.

Question 3

What are some differential diagnosis which should be considered in the diagnosis of Alzheimer’s disease?

Answer 3

Vitamin B12 deficiency
Depression
Infection

Note: Vitamin B12 deficiency can also cause neuropathy

Question 4

What are the 3 different types of dementia?

Answer 4

Alzheimer’s disease (most common)
Vascular dementia
Lewy body dementia

Question 5

Can Memantine ER be crushed or chewed?

Answer 5

No but it can be sprinkled on apple sauce

Question 6

Aceylcholinesterase inhibitors ADE

Answer 6

Insomnia
Nausea

Warning:
Bradycardia

Question 7

What is the brand name of Donepezil + Memantine?

Answer 7

Namzaric

Question 8

What are the symptoms of Alzheimer’s disease?

Answer 8

Memory loss, getting lost
Difficulty communicating, repeating words and info
Inability to learn or remember new info 
poor coordination and motor function 
Personality changes
Inappropriate behavior
Paranoia
Agitation 
Hallucination

Question 9

Pathophysiology of Alzheimer’s dementia disease

Answer 9

Neuritic plaques and tangles in brain tissue which interrupt neuron signaling and/or alteration of neurotransmitters (e.g. decrease in acetylcholine)

Question 10

What are some natural products used for memory improvements?

Answer 10

Vitamin E

Ginkgo

Question 11

What are some drug treatments of Alzheimer’s disease?

Answer 11

Aceylcholinesterase inhibitors:

• Donepezil (Aricept)
• Rivastigmine (Exelon) (patch)
• Galantamine (Razadyne)

NMDA blockers:
- Mematine (Namenda)

Question 12

What time of the day is Donepezil given and why?

Answer 12

At bedtime

to minimize nausea ADE

Question 13

What are some screening tools for Alzheimer’s disease?

Answer 13

Mini-Mental State Exam (MMSE, a score < 24 indicated memory disorder)

Montreal Cognitive Assessment (MoCA)
DSM-5

Question 14

At what point in the disease progression of Alzheimer’s disease is Memantine used?

Answer 14

Moderate - Severe

with or without Acetylcholinesterase inhibitor

Question 15

What are some drugs which can worsen dementia?

Answer 15

Antihistamines 
Antiemetics 
Antipsychotics 
Barbiturates 
Benzodiazepines 
Central anticholinergics 
Peripheral anticholinergics (including incontinence and IBS drugs) 
Skeletal muscle relaxants 
other CNS depressants