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Test1_Chapter 12C

Alzheimers-Chapter 12

Dementia MOA Insidious decline over time, can still have conversation, but lack short term initially
Cortical-Frontal dementia More dis-inhibition or inappropriate behavior. Cognitive deficites in calculation and word finding.
Subcortical-midbrain Dementia Can be Parkinsons, Huntingtins, or Normal pressure hydrocephalus (REVERSIBLE)
Delirium Acute situation patient is not conversation and can be reversed
Risks for Alzeheimers Age, FHx, Chromosomes (21,14,1)
Pathology Alzeheimers Senile B-amyloid plaques, Apo E4, decrease in choline acetyltransferase
Senile B-amyloid plaque Aggregation of B-pleated sheets potential nerve damage
Apo E4 Lack function of the nutrient transporter tau-higher risk
Choline acetyltransferase Memory impairment (also seen with anticholinergics)
Mental State evaluation based on Orientation, Calculation, Recall total of 30 possible
Alzeheimers MSE score of > 24 Normal
MSE score <24 Likely cognitive impairment
MSE 17-23 Mild impairment
MSE 10-16 Moderate impairment
MSE < 10 severe
Alzeheimers rule out Vitamin deficiency, TSH, drugs (BZD, anticholinergics,methyldopa, reserpine, narcotics)
Diagnosis of alzeheimers Based on exculsion, insidious- 6-8 months, decline in greater than 1 area of cognition (have conversation)
Alzeheimers 1st line Choline esterase inhibitors
Choline esterase inhibitors Donepezil (Aircept), Rivastigmine, Galantamine
Treat severe Alzeheimers Choline esterase inhibitor and NMDA receptor antagonist
NMDA receptor antagonist Memantine
Donepezil use Immediately therapeutic, AVOID ALL CHOLINERGICS, TCA
Cholinesterase inhibitors caution COPD, asthma, PUD,sick-sinus syndrome
Rivastigamine use Therapeutic in a month, buteryl choline esterase inhibitor, metabolized VIA BLOOD
Ginko Biloba effects Mixed results some sugest cognitive enhancing effects eimular to AcHEi
Menantine use Only drug approved to treat severe dementia, requires renal adjustment, has not produced psychosis in humans
Vitamine E and Selegiline Delayed endpoints of death,instutionalization, loss of ADL, but there has been reports that high dose VIT E causes increased mortality
Alzeheimers and antipsychotics Postive with risperidone and olanzipine- increased risk of stroke
Antidepression in Alzeheimers Use SSRI, Not TCA
Estrogen in Alzeheimers Ok for aggressive/sexually aggressive behavior
Created by: jhrobins99