Alzheimers/Dementia Flashcards
What is the pathologic process that results in the
neuronal degradation associated with Alzheimer’s
disease?
Deposition of amyloid beta peptides produces neuritic plaques
and neurofibrillatory tangles that result in disruption of
neurotransmitter function and the death of neurons.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 620.
What test is diagnostic of Alzheimer’s disease?
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.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 245.
What is the incidence of Alzhemier’s and what
population does it affect the most?
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.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 619.
What is the average life expectancy after a diagnosis
of Alzheimer’s disease?
8 years.
Jaffe RA, Samuels SI. Anesthesiologist’s Manual of Surgical
Procedures. 4th ed. Philadelphia, PA: Lippincott Williams and
Wilkins, 2009: 149.
What is the standard medical treatment for patients
with Alzheimer’s disease?
Cholinesterase inhibitors such as rivastigmine, donepazil, and
galantamine are the standard medical treatments for
Alzheimer’s disease.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 245.
What are the side effects of the most common drugs
used to treat Alzheimer’s?
Acetylcholinesterase inhibitors are the most common treatment
and may result in nausea, vomiting, bradycardia, syncope, and
fatigue.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 620.
How is the function of choline acetyltransferase
affected in patients with Alzheimer’s disease?
Patients with Alzheimer’s experience a significant decrease in
the activity of choline acetyltransferase.
Mccance KL, Huether SE, Brashers VL, & Rote NS.
Pathophysiology: The Biologic Basis of Disease. 6th ed.
Philadelphia, PA: Mosby, Inc.; 2010: 554.
What are the anesthetic management implications
for the patient with Alzheimer’s disease?
Preoperative sedation is usually avoided because it may
aggravate dementia and precipitate postoperative confusion.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 620.
How would you expect a patient with Alzheimer’s to
respond to succinylcholine?
Patients taking acetylcholinesterase inhibitors may have a
prolonged duration of action with succinylcholine.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 621.
How would you expect a patient with Alzheimer’s
disease to respond to muscle relaxants?
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.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 245.
If you need to administer an anticholinergic to a
patient with Alzheimer’s disease, which one is
preferred and why?
Glycopyrrolate is preferred because it doesn’t cross the bloodbrain
barrier. Atropine and scopolamine may result in increased
confusion.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 621.
