Alzheimers-Chapter 12
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| Dementia MOA | Insidious decline over time, can still have conversation, but lack short term initially
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| Cortical-Frontal dementia | More dis-inhibition or inappropriate behavior. Cognitive deficites in calculation and word finding.
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| Subcortical-midbrain Dementia | Can be Parkinsons, Huntingtins, or Normal pressure hydrocephalus (REVERSIBLE)
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| Delirium | Acute situation patient is not conversation and can be reversed
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| Risks for Alzeheimers | Age, FHx, Chromosomes (21,14,1)
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| Pathology Alzeheimers | Senile B-amyloid plaques, Apo E4, decrease in choline acetyltransferase
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| Senile B-amyloid plaque | Aggregation of B-pleated sheets potential nerve damage
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| Apo E4 | Lack function of the nutrient transporter tau-higher risk
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| Choline acetyltransferase | Memory impairment (also seen with anticholinergics)
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| Mental State evaluation based on | Orientation, Calculation, Recall total of 30 possible
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| Alzeheimers MSE score of > 24 | Normal
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| MSE score <24 | Likely cognitive impairment
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| MSE 17-23 | Mild impairment
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| MSE 10-16 | Moderate impairment
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| MSE < 10 | severe
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| Alzeheimers rule out | Vitamin deficiency, TSH, drugs (BZD, anticholinergics,methyldopa, reserpine, narcotics)
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| Diagnosis of alzeheimers | Based on exculsion, insidious- 6-8 months, decline in greater than 1 area of cognition (have conversation)
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| Alzeheimers 1st line | Choline esterase inhibitors
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| Choline esterase inhibitors | Donepezil (Aircept), Rivastigmine, Galantamine
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| Treat severe Alzeheimers | Choline esterase inhibitor and NMDA receptor antagonist
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| NMDA receptor antagonist | Memantine
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| Donepezil use | Immediately therapeutic, AVOID ALL CHOLINERGICS, TCA
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| Cholinesterase inhibitors caution | COPD, asthma, PUD,sick-sinus syndrome
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| Rivastigamine use | Therapeutic in a month, buteryl choline esterase inhibitor, metabolized VIA BLOOD
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| Ginko Biloba effects | Mixed results some sugest cognitive enhancing effects eimular to AcHEi
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| Menantine use | Only drug approved to treat severe dementia, requires renal adjustment, has not produced psychosis in humans
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| 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
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| Alzeheimers and antipsychotics | Postive with risperidone and olanzipine- increased risk of stroke
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| Antidepression in Alzeheimers | Use SSRI, Not TCA
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| Estrogen in Alzeheimers | Ok for aggressive/sexually aggressive behavior
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