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OTC Test 2 > Dementia > Flashcards

Dementia Flashcards

1
Q

Define dementia

A

An acquired persistent (often slowly progredient)

– Loss of intellectual function due to a brain disorder

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2
Q

Define aging

A

An acquired, persistent, slowly progredient disorder

– Leads to loss of various organ functions over time

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3
Q

Define Alzheimer’s disease

A 
"senile dementia"
Gradual memory loss
Decline in ability to perform routine tasks
Disordientation
Difficulty in learning
Loss of language skills
Impairment of judgement
Personality changes
Age associated
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4
Q

What is the pathophysiology of Alzheimer’s?

A
  • Amyloid plaques formed by false processing of APP (Amyloid precursor protein) – genetically or environmental contributions
  • Neurofibrillary tangles in neurons due to hyper-phosphorylation of the tau-protein — changes signal transduction; loss of axonal transport
  • Neuronal cell death, primarily of cholinergic neurons (severe memory loss and loss of cognitive functioning)
  • –Accelerated aging
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5
Q

Treatment of Alzheimer’s?

A

Enhancement of cholinergic function to improve cognition (low does prevents activity but high causes toxicity)

  • Reduction of amyloid and NFT formation (inhibits abnormal enzymatic pathways by enzyme inhibitors, antioxidative strategies)
  • – Stem cell and gene therapies
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6
Q

What does it mean enhancement of cholinergic function?

A

Inhibition of AChE and muscarinic agonists

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7
Q

What is arecoline?

A

Brain-permeable muscarinic agonists of botanical origin

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8
Q

What is physostigma venenosum (Calabar bean)?

A

West African climbing herb
Source of “Ordeal bean of Calabar”
First anticholinesterase known

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9
Q

What are other acetycholinesterase inhibitors from plants?

A

Galanthamine

Huperzine A

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10
Q

What is Huperzine A?

A

Inhibits acetylcholine esterase reversibly
- Placebo-controlled double blind trail: 50% AD patients showed improvement after 8 weeks at 200 micro but 36% placebo did as well

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11
Q

What is ginkgo?

A

Fossil
150-300 mil yo
Resistant to insects and microbes

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12
Q

What is ginkgo biloba?

A

Resistant to environmental conditions (pH, salt, air, pollution)
Biloba: two lobes
Quality is not guaranteed –> but best selling herbal remedy

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13
Q

What is EGb761?

A 
Extract Ginkgo biloba
Flavone glycosides (rutin 25-30%)
Terpenoids: ginkgolides, bilobalide (3% each)
Organic acid, ascorbic acid
Bitter taste
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14
Q

What do extraction procedure eliminate?

A 
Ginkgolic acids 
Tannins
Steroids
Proteins
Minerals
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15
Q

Cardiovascular effects of EGb761

A 
Potent antioxidative properties
Reduction of blood viscosity
PAF- antagonistic properties
Inhibits platelet aggregation
Arterial occlusive disease and tinnitus
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16
Q

What are acute neuroprotective effects of EGb761?

A

Increase tolerance to brain hypoxia
Inhibition of edema formation
Inhibition of membrane breakdown during ischemia
Interactions with various neurotransmitters and receptors
Active in stroke, brain, trauma

17
Q

What are problems with anti-dementia drugs?

A

Dead neurons cannot be replaced by drug treatment–> therapy goal is prevention further degeneration
- Trials must be very long

18
Q

What are the criteria for improvement in dementia?

A

Level of daily activities (social interactions, care needs via social interactions, care needs)
Level of performance activities (psychometric tests via psychologists, staff)
Level of psychopathology (complaints and symptoms via physician)

19
Q

Placebo-controlled clinical trials?

A

Placebo-treated group gets worse

Ginkgo-treated group remains stable for 6-9 months

20
Q

Meta-analysis of clinical trials?

A

Small but significant improvement of AD with Ginkgo extract
Efficacy comparable to esterase inhibitor but overall efficacy rather limited
Not effect for benign age-associated memory impairment

21
Q

What shows oxidative stress in its brain in the mouse model?

A

Study used a Tg2576, which over express APP, acquires A-beta plaque deposits

22
Q

Indications for Ginkgo extracts WITHOUT clinical evidence of effectiveness?

A 
Hypercholesterolemia, hypertension
Asthma, bronchitis
Angina pectoris
Regulation of gastric acidity
Improvement of liver function 
Premenstrual syndrome
Improvement of sexual performance
Eye problems
Dysentery, filariasis
23
Q

What is the toxicity of Ginkgo extract EGb761?

A
  • Lethal dose could not be detmined in rats after oral administration
  • No organ damage during chronic application, no carcinogenicity, no teratogenicity
  • Clinical toxicity is very low
  • Rare cases of allergenicity, GI disturbances (with nausea and vomiting) and bleeding disorders
  • Do not use in patients with coagulopathies
24
Q

Define curcumin

A

Recently been reported to reduce amyloid formation in vitro

25
Q

Define ursolic acid

A

Antioxidative properties

May reduce amyloid plaque formation (speculative)

26
Q

Define withania

A

Commonly used in Ayurvedic medicine

Botanical orgin

27
Q

Define bupleurum

A

Botanical origin

28
Q

Define salvia and melissa

A

Botanical orgin

29
Q

What plants beneficial effects for aging or dementia have NOT been convincingly shown?

A 
Curcuma longa
Origanum marjorana
Withania somnifera
Bupleurum chinense 
Bupleurum chinense
Mellissa off and salvia off
30
Q

Define hawthorn

A
  • Dementia

Circulatory stimulant

31
Q

Define rosemary

A
  • Dementia

Stimulates circulation, improves digestion, relieves depression

32
Q

Define siberian ginseng or American Ginseng

A

Increase endurance and improve cerebral circulation

— Caution if you have blood pressure

33
Q

Define lemon balm

A

Reduces spasms and anxiety

34
Q

Define Ginger

A

Helps with general weakness

35
Q

Define St John’s wort

A

Helps relieve depression and anxiety

OTC Test 2 (9 decks)

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