NR 547 Week 6
1. Alzheimer's disease: Reisberg scale: -stage 1: no impairment
-stage 2: mild cognitive decline
-stage 3: mild cognitive impairment, signs of early confusion
-stage 4: mild alzheimer's disease, lasts about 2 years
-stage 5: early dementis to moderate alzheimer's diease, cognitive decline moredrastic, lasts
1.5 years
-stage 6: moderatly severe alzheimer's disease, help with basic daily tasks, lasts 2.5years
-stage 7: final stage, speech severely limited, decline in basic abilities, movementabilities
affected
2. Diagnosis of dementia and Alzheimer's disease: -Patient History
-Physical Exam
-neurological eval
-neuropsychological test
• MMSE: scores 20-24 mild dementia, 13-20 moderate, <13 severe dementia
• mini-cog test
-Psychiatric evaluation
-Brain scans
• CT scans
• MRI
• reason for brain scans: ID larger masses, differential diagnosis, monitor diseaseprogression,
research purposes
3. Other conditions that can cause dementia like symptoms: anemiadepression
infection diabetes kidney diseaseetc.
4. Treatment of dementia and Alzheimer's disease: No Cure
-Medications lesson symptoms
-meds target neurotransmitters:
• acetylcholine
• glutamate
-Cholinesterase Inhibitors
,-Memantine
5. Cholinesterase Inhibitors: acetylcholine neurotransmitter
-helps neurons communicateAcetylcholinesterase
-breaks down acetylcholine CHOLINESTERACE INHIBITORS
-stop acetylcholinesterase from breaking down acetylcholine
• allowing more acetylcholine to build up, helping neurons communicate
-delay worsening dementia symptoms for 6-12 months
• for about 1/2 of patients
-side effects: N/V, loss of appetite
Medication:
-Donepezil (Aricept)
-Rivastigmine (Exelon)
-Galantamine (Razadyne, Razadyne ER)
6. Memantine: Glutamate
-excitatory neurotransmitter
-normal levels: learning & memory
-too high: toxic (excitotoxicity)
• cell too stimulated, may die
-Memantine blocks NMDA receptor for glutamate, keeping channel closed so toomany ions
do not get in so cell doesn't get excitotoxicity
-used to tx moderate to severe alzheimer's disease
-often taken with cholinesterase inhibitors
-side effects: headache, confusion, dizziness
Medication:
-Memantine (Namenda)
7. heritability of AD: late-onset AD showing heritability of 58-79% and early-onsetAD
showing over 90%
8. Donepezil (Aricept): -inhibits centrally active acetylcholinesterase
-Side effects:
• GI symptoms, headache, dizziness, muscle weakness
, -Precautions:
• sick sinus syndrome
• seizure disorder
-Pearls:
• Taper to avoid withdrawal effects
• approved to treat moderate to severe AD at 23 mg/day dose, minimal improvementin cognitive
functioning when compared to a 10 mg/day dose
• added to CYP2D6 or CYP3A4, there is a possibility of peripheral side effects, andinducers
of CYP2D6 and CYP3A4 may increase the rate of elimination
9. Rivastigmine (Exelon): -acts centrally for both acetylcholinesterase and bu-
tyrylcholinesterase
• potentially increasing its efficacy
-side effects:
• GI symptoms, weakness, dizziness, tremor
-Precautions
• asthma or COPD
• sick sinus syndrome
• GI Bleeding
• weight < 50 kg
-Pearls:
• orally or topically (transdermal patch)
• transdermal patch is used for dementia associated with Parkinson's disease
10. Galantamine (Razadyne, Razadyne ER): -elevating acetylcholine (Ach) in the cerebral
cortex, modulating the nicotinic Ach receptors to increase Ach release from existing presynaptic
nerve terminals, increases glutamate and serotonin levels
-Side effects: GI symptoms, headache, dizziness, fatigue
-Precautions:
• NSAID use
• GI bleed
• asthma or COPD
• concurrent use with medications that slow or decrease heart rate
-Contraindications
1. Alzheimer's disease: Reisberg scale: -stage 1: no impairment
-stage 2: mild cognitive decline
-stage 3: mild cognitive impairment, signs of early confusion
-stage 4: mild alzheimer's disease, lasts about 2 years
-stage 5: early dementis to moderate alzheimer's diease, cognitive decline moredrastic, lasts
1.5 years
-stage 6: moderatly severe alzheimer's disease, help with basic daily tasks, lasts 2.5years
-stage 7: final stage, speech severely limited, decline in basic abilities, movementabilities
affected
2. Diagnosis of dementia and Alzheimer's disease: -Patient History
-Physical Exam
-neurological eval
-neuropsychological test
• MMSE: scores 20-24 mild dementia, 13-20 moderate, <13 severe dementia
• mini-cog test
-Psychiatric evaluation
-Brain scans
• CT scans
• MRI
• reason for brain scans: ID larger masses, differential diagnosis, monitor diseaseprogression,
research purposes
3. Other conditions that can cause dementia like symptoms: anemiadepression
infection diabetes kidney diseaseetc.
4. Treatment of dementia and Alzheimer's disease: No Cure
-Medications lesson symptoms
-meds target neurotransmitters:
• acetylcholine
• glutamate
-Cholinesterase Inhibitors
,-Memantine
5. Cholinesterase Inhibitors: acetylcholine neurotransmitter
-helps neurons communicateAcetylcholinesterase
-breaks down acetylcholine CHOLINESTERACE INHIBITORS
-stop acetylcholinesterase from breaking down acetylcholine
• allowing more acetylcholine to build up, helping neurons communicate
-delay worsening dementia symptoms for 6-12 months
• for about 1/2 of patients
-side effects: N/V, loss of appetite
Medication:
-Donepezil (Aricept)
-Rivastigmine (Exelon)
-Galantamine (Razadyne, Razadyne ER)
6. Memantine: Glutamate
-excitatory neurotransmitter
-normal levels: learning & memory
-too high: toxic (excitotoxicity)
• cell too stimulated, may die
-Memantine blocks NMDA receptor for glutamate, keeping channel closed so toomany ions
do not get in so cell doesn't get excitotoxicity
-used to tx moderate to severe alzheimer's disease
-often taken with cholinesterase inhibitors
-side effects: headache, confusion, dizziness
Medication:
-Memantine (Namenda)
7. heritability of AD: late-onset AD showing heritability of 58-79% and early-onsetAD
showing over 90%
8. Donepezil (Aricept): -inhibits centrally active acetylcholinesterase
-Side effects:
• GI symptoms, headache, dizziness, muscle weakness
, -Precautions:
• sick sinus syndrome
• seizure disorder
-Pearls:
• Taper to avoid withdrawal effects
• approved to treat moderate to severe AD at 23 mg/day dose, minimal improvementin cognitive
functioning when compared to a 10 mg/day dose
• added to CYP2D6 or CYP3A4, there is a possibility of peripheral side effects, andinducers
of CYP2D6 and CYP3A4 may increase the rate of elimination
9. Rivastigmine (Exelon): -acts centrally for both acetylcholinesterase and bu-
tyrylcholinesterase
• potentially increasing its efficacy
-side effects:
• GI symptoms, weakness, dizziness, tremor
-Precautions
• asthma or COPD
• sick sinus syndrome
• GI Bleeding
• weight < 50 kg
-Pearls:
• orally or topically (transdermal patch)
• transdermal patch is used for dementia associated with Parkinson's disease
10. Galantamine (Razadyne, Razadyne ER): -elevating acetylcholine (Ach) in the cerebral
cortex, modulating the nicotinic Ach receptors to increase Ach release from existing presynaptic
nerve terminals, increases glutamate and serotonin levels
-Side effects: GI symptoms, headache, dizziness, fatigue
-Precautions:
• NSAID use
• GI bleed
• asthma or COPD
• concurrent use with medications that slow or decrease heart rate
-Contraindications
