Cognitive Enhancing Agents Flashcards
According to the 2011 AD criteria-phases, when does MCI and Dementia begin?
MCI
- Cognitive impairment presents on neuropsychological testing
- ~1/3 decline from baseline
Dementia
- Evidence of clinically significant impairment
- ~2/3 decline from baseline
What are the biomarkers of Aß accumulation?
Abnormal tracer retention on amyloid PET
Low CSF Aß42
What are the biomarkers of neuronal degeneration or injury?
Elevated CSF tau
Decreased fluorodeoxyglucose uptake on PET
Atrophy on structural MRI
What chromosome increases the risk of AD by 10 to 30 times?
Chromosome 19
- APOE e4
What is the primary effect of pharmacotherapy in treating dementia?
Slowing the rate of decline
What drugs are included in acetylcholinesterase inhibitors?
Tacrine- DC in US because of liver failure
Donepezil
Rivastigmine
Galantamine
What is the dominant drug used for dementia?
Donepezil
- Only FDA approval for AD
Why is Donepezil given in the AM?
To avoid nightmares
What other adverse effects are associated with Donepezil?
Nausea/Diarrhea/Lacrimation/Salvation- Cholinergic effects
Syncope
What are contraindications to Donepezil use?
Severe heart disease Severe cardiac conduction disturbances Bradycardia Pacemaker placement Hip fracature
What common symptom associated with dementai does Donepezil help reduce?
Agitation
What type of cholinesterase inhibitor is Rivastigmine?
Central vs Peripheral
Central
- AChE and BuChE inhibitor
What can patients do to help reduce side effects of Rivastigmine?
Take it with a large meal
Titrate slowly
*Side effect profile similar to Donepezil
What is a benefit of Rivastigmine?
No significant DDI or hepatic metabolism
What kind of cholinesterase inhibitor is Galantamine?
What other receptors does it act on?
Central
Nicotinergic receptors