Dementia Theraputics Flashcards
What are the 10 warning signs of AD?
- memory loss that disruts daily life
- challenges planning or solving problems
- difficulty completing familiar tasks
- confusion with time/place
- trouble with visual image or spatial relationships
- new problems with words when speaking/ writing
- misplacing things and losing ability to retrace steps
- decreased/ poor judgement
- withdrawal from work/socail activities
- change in mood/personality
What are risk factors for AD?
- aging
- 1st degree relative
- APDE-4 gene
- lower levels of education/ cognitive engagement
- African-American and Hispanics
- Women
- moderate-severe brain injury
- current smoking
- midlife obesity
- CV diseases (HTN, heart disease, stroke, diabetes)
How can lifestyle be modified to decrease risk of AD?
- mental/social activity
- mediterranean diet
- DASH/ heart healthy diet
- physical activity
How is AD diagnosed?
differential diagnosis must rule out all other types of dementia, cerebrovascular disease/brain injury
What are other causes of AD symptoms?
- depression
- hypothyroidism
- B12 / folate deficiences
- drug-induced cognitive impairment
- CNS infection
- substance use disorder
What are biomarkers of alzhimers disease?
PET scaning or CSF measured abnormal amount of beta-amyloid
What screening tools can help diagnose AD?
DSM 5- recognizes major and mild neurocognitive impairment
What screening tool can help record cognitive changes over time?
Mini-Mental State Exam (MMSE)
What are disadvantages to the MMSE?
- Biased against people with poor education (language and math)
- Biased against visually impaired
- poor sensitivity for mild/poor dementia
What is the MMSE scoring criteria?
0-17: severe cognitive impairment
18-23: mild cognitive impairment
24-30: no cognitive impairment
What are non pharm therapies for AD?
- group support
- education of pt, fam, and caregivers
- physical and mental activity (aerobic exercise, socialization. cognitive acitvietes)
- avoid inappropriate medications
What role do cholinesterase inhibitors have in AD?
recommended to start early to maximize benefits
What is a disadvntage to using cholinesterase inhibitors?
interuption of therapy for more than a few days requires registration from starting dose
Why are cholinesterase inhibitors a concern in pts with PUD or NSAID use?
increase gastric acid production
Why are cholinesterase inhibitors a concern in pts that take beta blocker?
Syncope, hypotension due to bradycardia from cholinergic effects
Donepezil
ARICEPT
Rivastigmine
EXELON
Galantamine
RAZADYNE
What is the MOA of NMDA blockers?
overstimulation of glutamate receptors causes excitatory neuronal cell death
When should NMDA blockers be used in therapy?
- added to cholinesterase inhibitors when symptoms progress
- Cannot tolerate cholinesterse inhibitors
- CI to cholinesterase inhibitors
What are cautions with MEMENTINE?
- seizure disorder
- hepatic impairment
- GU conditions that raise pH may decreas eclearance
- dose adjust if CrCl<30
Memantine
NAMENDA
Which medications are best for poor adherence due to the need to retitrate after 7 days of missed doses?
- Galantamine
- Donezipil
Which medications need to be retitrated after 3-4 days?
- Rivastigmine
- menamntine
Memantine/ Donezipil
NAMZARIC
