Alzheimers/Dementia

Question 1

Overview

Answer 1

Degeneration of neurons- cerebral cortex and subcortical regions
Reduced cholinergic transmission
Beta-amyloid and neuritic plaques
Neurofibrillary tangles and tau
Apolipoprotein E4 (ApoE)
Endoplasmic reticulum-associated binding protein (ERAB)
Elevated homocysteine
 ]

Question 2

Cholinesterase inhibitors

Answer 2

• donepezil
• rivastigmine
• galantamine
  MOA- prevent the breakdown of Ach by acetylcholinesterase, thereby increasing the availability of Ach at cholinergic synapses
  Use- mild to mod symptoms
  SE- n/v, dyspepsia, diarrhea, dizziness, HA, sypmtomatic bradycardia, syncopal episodes, falls

Question 3

NMDA antagonists

Answer 3

• memantine
• MOA- modulates the effects of glutamate at NMDA receptors, blocks further Ca++ entry, plays a critical role in memory and learning
  Clinical use: mod to severe AD
  SE: dizziness, HA confusion, constipation