Alzheimer's Disease

Question 1

What is MMSE and what score indicates a memory disorder?

Answer 1

Mini-Mental State Exam (MMSE)

Score <24 indicates disorder

Question 2

What medications can worsen dementia?

Answer 2

Antiemetics
Antihistamines (benadryl, doxylamine)
Antipsychotics (aripiprazole, chlorpromazine)
Barbiturates (phenobarb, butalbital)
Benzos
Central anticholinergics (benztropine)
Peripheral anticholinergics
Skeletal muscle relaxants
Other CNS depressants (opioids, sedatives)

Question 3

What supplements may have benefits for Alzheimer’s dementia

Answer 3

Vitamin E

Ginkgo biloba

Question 4

What is the mainstay treatment for Alzheimer’s?

Answer 4

Acetylcholinesterase inhibitors (donepezil) +/- memantine
Just slows progression of disease

Question 5

When to take donepezil

Answer 5

Nighttime (can reduce nausea)

Morning if insomnia is concern

Question 6

What is Namzaric? When to use?

Answer 6

Combo of donepezil 10mg and memantine 7mg

Can use if pt is stable on donepezil 10mg

Question 7

What medications are acetylcholinesterase inhibitors and what is their MOA?

Answer 7

Donepezil (Aricept)
Rivastigmine (Exelon)
MOA: inhibit acetylcholinesterase, increasing ACh

Question 8

Donepezil and rivastigmine warnings, SE and notes

Answer 8

Warnings: cardiac effects including bradycardia
SE: nausea, diarrhea
Notes: donepezil dosed QHS to decrease nausea; patch and ODT have less GI effects

Question 9

Memantine MOA, SE

Answer 9

MOA: blocks NMDA receptors inhibiting glutamate from binding and decreased abnormal neuron activation
SE: dizziness, confusion, HA

Question 10

What medications can decrease efficacy of AChE inhibitors?

Answer 10

anticholinergic medications

D/c incontinence drug if no benefit

Question 11

Where to apply Exelon (rivastigmine) patch

Answer 11

Upper or lower back (preferred if pt might remove) or upper arm fo chest