Alzheimers/Dementia

Question 1

What is the pathologic process that results in the
neuronal degradation associated with Alzheimer’s
disease?

Answer 1

Deposition of amyloid beta peptides produces neuritic plaques and neurofibrillatory tangles that result in disruption of neurotransmitter function and the death of neurons

Question 2

What test is diagnostic of Alzheimer’s disease?

Answer 2

Although computed tomography may demonstrate ventricular dilation and cortical atrophy and positive emission tomography may exhibit areas of decreased cerebral blood flow, only postmortem examination of the brain tissue is definitively
diagnostic of Alzheimer’s.

Question 3

What is the incidence of Alzhemier’s and what

population does it affect the most?

Answer 3

Alzheimer’s is the most common form of neurodegenerative disease and is responsible for 40-80% of all cases of dementia. It affects approximately 20% of of patients over 80 years of age.

Question 4

What is the average life expectancy after a diagnosis of Alzheimer’s disease?

Answer 4

8 years.

Question 5

What is the standard medical treatment for patients

with Alzheimer’s disease?

Answer 5

Cholinesterase inhibitors such as rivastigmine, donepazil, and galantamine are the standard medical treatments for Alzheimer’s disease.

Question 6

What are the side effects of the most common drugs used to treat Alzheimer’s?

Answer 6

Acetylcholinesterase inhibitors are the most common treatment and may result in nausea, vomiting, bradycardia, syncope, and fatigue.

Question 7

How is the function of choline acetyltransferase

affected in patients with Alzheimer’s disease?

Answer 7

Patients with Alzheimer’s experience a significant decrease in the activity of choline acetyltransferase.

Question 8

What are the anesthetic management implications

for the patient with Alzheimer’s disease?

Answer 8

Preoperative sedation is usually avoided because it may aggravate dementia and precipitate postoperative confusion.

Question 9

How would you expect a patient with Alzheimer’s to

respond to succinylcholine?

Answer 9

Patients taking acetylcholinesterase inhibitors may have a prolonged duration of action with succinylcholine.

Question 10

How would you expect a patient with Alzheimer’s

disease to respond to muscle relaxants?

Answer 10

They will exhibit a resistance to nondepolarizing muscle relaxants due to the use of acetylcholinesterase inhibiting drugs as part of their medical management. They will also exhibit a
longer duration of action with succinylcholine.

Question 11

If you need to administer an anticholinergic to a
patient with Alzheimer’s disease, which one is
preferred and why?

Answer 11

Glycopyrrolate is preferred because it doesn’t cross the bloodbrain barrier. Atropine and scopolamine may result in increased confusion