Alzheimer's Disease Flashcards
What can cause AD?
- genetics
- vascular dementia
- Huntington’s disease
- Pick’s disease
- normal pressure hydrocephalus
- PD
What is actually happening that causes AD?
- B amyloid plaques (sticky proteins bw nerve cells)
- neurofibrillary tangles (intracellular & twisted fibers = tau proteins); can happen in elderly w/o AD
=> neuronal degeneration & brain atrophy
LOSS OF NTs
What may incr. incidence of AD?
- obesity
- insulin resistance
- T2DM
Would sequestering b-amyloid work?
studied, but found to be unsuccessful
What do we use to diagnose AD?
National institute of neurologic and communicative disorders and Stroke AD & Related disorders
Can we use imaging to diagnose AD?
- not likely to alter management based on findings
- maybe if focal signs or suspected to have reversible cause (subdural hematoma, treatable malignancy, etc)
- amyloid PET if etiology is unclear
What screening tools do we use to diagnose AD?
Folstein MMSE (30 pt test)
- memory
- language
- calculations
- judgement
- orientation
(limitations: pt education level, copyright protection)
Mini-cog (5 pt test)
- clock-draw test; 3 unrelated word recall
(memory/visualspatial, executive funct.)
*NOT affected by level of education/language
Montreal cognitive (30 pt test)
- memory
- language
- attention
- executive func
AD8 (Our favorite) (8 y/n ?s) - memory - thinking - functioning (answered by patient OR INFORMANT) 2+ yes = (+) screen
Define dementia:
loss of memory + 1+:
- aphasia (language)
- apraxia (coordinate movements)
- agnosia (recognize the familiar)
- disturbance in executive funct
- gradual/insidious process
AND
- substantial impairment in social/occupational funct.
Clinical manifestations of AD:
- confusion with time & location
- difficulty completing familiar tasks
- difficulty solving problems
- misplacing items
- memory loss
- poor judgement
- unfounded emotions (laughing/crying w/o reason)
- trouble with images/ spaces (clock draw test!)
- difficulty with words
- withdrawal from social activities
Delirium definition:
disturbance of consciousness + change in cognition
Mild Cognitive impairment (MCI) definition:
decline from baseline of func in cognitive domain, but DOES NOT interfere with activities of daily living (ADL)
Mild AD
MMSE (21 - 26)
- problems with more complex tasks (cooking, complicated med schedule)
- memory loss
- language impairment
- social withdrawal
- self-care/ daily activities unimpaired
Moderate AD
MMSE (10 - 20)
- trouble c simple food prep, routine tasks
- need assistance c personal care
- more dependent
- LT memory inaccuracy
- confusion of identities
Severe AD
MMSE (<10)
- considerable to TOTAL assistance needed
- verbal skills & comprehension impaired
- lose personality
- urinary & fecal incontinence
- motor complications
- wt loss
What CNS acting-meds that affect worsen cognition?
- opioids
- BZDs
- sedative/hypnotics
- muscle relaxants
- anticholinergics
AChI SE
- anorexia
- N/V/D
- bradycardia
- incontinence
- WT LOSS
PO donepezil best tolerated (no benefits > 10 mg/d)
- rivastigmine patch tolerated ~ same, but $$$
- -> PO Rivastigmine has higher incidence of GI AE
*memantine used to decr. these
(can be used if failed/CI AChI)
AChI tx strategy:
- initiate in mild-mod AD @ diagnosis
- slow titrate to decr. GI SE (4-6 wks bw dose titrations)
- assess efficacy @ 6 mo (d/c if no benefit)
- partial response, continue & reeval @ 1 yr
- mod AD…add memantine to AChI once tolerated
What if the pt has depression/anx sx + AD?
SSRI/SNRI, AChI, memantine
What if delusions/psychosis/hallucinations + AD?
risperidone, olanzapine
What if physical aggression/agitation?
risperidone, olanzapine
What if pseudobulbar affect?
(unattached to mood/emotions)
dextromethorphan 20/quinidine 10
What if bladder anticholinergics + AChI?
greater rate of functional decline!!!
want bladder selective –> solifenacin
*may experience worsen incontinence c/ AChI
