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16 Cards in this Set
- Front
- Back
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Dementia and Alzheimer’s? |
• Dementia - Chronic progressive mental disorder that adversely affects higher cortical functions including memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgment. • Alzheimer's disease - Most common form of dementia. - Degenerative cerebral disease with characteristic neuropathological and neurochemical features Onset and development is slowly but steadily over several years - Progressive deterioration in cognition, function and behavior |
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Common symptoms? |
• Cognitive • Memory loss • Failing intellect (inability to learn new skills) • Poor concentration • Language impairment •Disorientation/confusion . Non-cognitive • Depression • Delusion • Anxiety • Aggression • Sleep disturbances • Dis-inhibition • Disability • Difficulties with activities of daily living •Self-neglect • Incontinence and other physical disabilities |
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Pathology? |
Amyloid plaques and neurofibrillary tangles. They are scattered throughout the entire cortex |
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Diagnosis? |
-Symptoms and Memory assessment (Clinical criteria) •MRI and PET Scans for biomarkers (Neuropathological hallmarks) • Outcomes: -Memory tests can show problems in particular areas -CT and MRI scans may show brain shrinkage (atrophy) -PET scans may show areas of • Loss of function (fluoro deoxyglucose [FDG]PET) • Presence of AD biomarkers (PET with amyloid-binding radiotracer or chemical marker of cerebrospinal fluid [CSF] amyloid and tau proteins) |
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Mini mental state exam? |
• Scored out of 30 • >27 = Normal • 19-24 = Mild cognitive impairment • 10-18 = Moderate impairment • <9 = Severe impairment |
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Clock drawing Test? |
15/15 = no dimentia 11/15 = Alzheimer’s 3/15= suspected dimentia |
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Genes for Alzheimer’s? |
1 APOE4 gene |
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Current pharmacological interventions? |
Anti-amyloid monoclonal antibody [aducanumab] Cholinergic signalling Glutamatergic signalling |
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Modulating neurotransmitters? |
•Acetylcholinesterase Inhibitors - Donepezil - Galantamine - Rivastigmine - Effects: •Enhance cholinergic transmission and improve cognitive functions *Therapeutic effectiveness decreases with increasing neuronal damage *Does not prevent progression of disease! Benefit assessed by repeating the cognitive assessment after 3 months treatment. Discontinue treatment if patient does not respond to therapy! - Only a subset of patients respond - High doses have side effects e.g., nausea, vomiting, diarrhoea |
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Anticholinergic Burden? |
• Medicines with anti-cholinergic effects are associated with increased risk of adverse reactions in the elderly. • The anticholinergic effect increases if a • stronger anticholinergic is used, or if different anticholinergics are used in combination. • Medicines with anticholinergic effects now categorised with an ACB score. 3+ is clinically relevant and alternative treatments should be sought. |
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Neurotransmittions? |
Neurotransmission • N-methyl D-aspartate antagonism - Memantine- non-competitive antagonist at NMDA receptors. - Effects: * Improves cognitive functions Effects evident at late stages of disease •Role in early stage of AD unclear... Not certain if it prevents progression of disease... • Possible drug interactions e.g., antipsychotic (see non-cognitive changes and treatments!), anticoagulant (warfarin), analgesic and muscle relaxant. |
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NICE guidelines? |
NICE guidelines • Donepezil, Galantamine and Rivastigmine recommended for managing: -mild -moderate Alzheimer's disease • Memantine is now recommended as an option for managing: -moderate Alzheimer's disease for people who cannot take AChE inhibitors -severe Alzheimer's disease -In combination? Not currently recommended |
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What are the Novel strategies for treating dementia? |
Modulating neurotransmission Amyloid based therapies Tau based therapies Mitochondrial targeted therapy Anti-inflammatory therapy Drug repurposing |
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What are the non- pharmacological interventions? |
Non pharmacological interventions: • neuroAD system (Neuronix) - combines repetitive transcranial magnetic stimulation with cognitive training. - Europe, Australia, and Israel (FDA did not approve) - approved in Europe €5000 for a 6 week 'therapy' session. |
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What are the problems with aducanumab? |
Aducanumab is a monoclonal antibody that removes amyloid plaques. The central controversy is whether the amyloid clearance protects patients from cognitive and functional decline The problem(s) with aducanumal •2021: aducanumab (Biogen) - Controversial approval process - One positive trial result and one negative trial result - Immunotherapy. -FDA approved with the need for more data via Phase (on-going) |
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Pharmacological interventions for behaviour that challenges & emotional disorders? |
Behaviour that challenges • Antipsychotics Patients with mild-to moderate non-cognitive symptoms should not be prescribed antipsychotic drugs • Sedatives For challenging behaviour: violence, aggression, severe agitation: i.m, Lorazepam, Haloperidol or Olanzapine Emotional disorders •Antidepressants People with dementia who also have major depressive disorder should be offered antidepressant medication Avoid certain TCA and MAOI as they have anticholinergic properties |
